Table 4.

Example refinement rules based on human interpretation and guidance

Initial Topic Name(s)	Initial Topic Keyword(s)	Rule Type	Refinement Outcome
10. Electrocautery Technique	“buzz”, “sweep”, “that”, “it”	Split	“buzz” from “sweep”
9. Sweeping Technique and Nerve Preservation	“sweep”, “gentle”, “off”, “do”	Split	“coag” from “sweep”
19. Surgical Plane Identification and Management	“plane”, “this”, “travel”, “easy”	Split	“travel” from “plane” and “easy”
18. Instrument Handling and Needle Control	“needle”, “your”, “instrument”, “driver”	Split	“needle” from “instrument” and “driver”
14. Bleeding Management and Hemostasis	“bleed”, “stop”, “there”, “gone”	Split	“bleed” from “stop”
27. Positive Feedback on Surgical Technique	“work”, “job”, “good”, “nice”	Merge	Combine into a new topic: “0. Affirmative Feedback and Inquiry”
23. Positive Reinforcement on Maneuver Execution	“nice”, “move”, “beautiful”, “very”
1. Positive Reinforcement and Guidance	“good”, “okay”, “great”, “that”
17. Surgical Guidance and Directional Feedback	“keep”, “go”, “let;, “okay”	Merge	Combine into a new topic: “2. Encouraging Continuation and Progress”
16. Acknowledgment and Affirmation of Actions	“mhm”,“mmhm,“mhmm”,“lucky”
4. Affirmative and Corrective Guidance Feedback	“yup”, “yeah”, “uh”, “huh”

The topic refinement rules were categorized into three types: splitting, merging, and approval. Where approval required no adjustment to the originally discovered topic cluster.