From andragogy to heutagogy: a scaffolded pathway for self-directed neurosurgical learning

Neurosurgical practice demands continual adaptation to complex pathologies, novel technologies, and evolving service models. Traditional teacher-centred training may be insufficient to cultivate the autonomous, reflective, and adaptive experts required for modern neurosurgical care.

We conducted a targeted narrative review of literature on pedagogy, andragogy, heutagogy, self-directed learning, and the Master Adaptive Learner (MAL) framework, and mapped key principles onto the UK Intercollegiate Surgical Curriculum Programme (ISCP) for neurosurgery and the European neurosurgical curriculum. Through iterative discussions with neurosurgical educators and trainees, we developed a theoretical three-stage conceptual framework that aligns increasing learner autonomy with training milestones and continuing professional development (CPD).

Stage 1, Foundations, applies an andragogical approach to early neurosurgical training, emphasising competency-based curricula, high-fidelity simulation, structured deliberate practice, and frequent formative feedback to establish core technical and decision-making skills. Stage 2, Transition, supports guided self-directed learning through personalised learning plans, mentor-coaching, curated digital resources, and explicit metacognitive training, operationalising the MAL framework to foster adaptive expertise. Stage 3, Heutagogical practice, promotes self-determined CPD, with trainees and consultants leading quality-improvement or research projects, engaging in peer teaching, pursuing bespoke micro-credentials, and building personal learning networks that demonstrate transfer of learning to novel clinical contexts. Key enablers include protected learning time, faculty development in coaching and feedback, robust workplace-based assessments, and institutional recognition of learner-driven outputs; anticipated barriers include variable learner motivation, assessment burden, workforce shortages, and cultural resistance to devolved autonomy.

Embedding a staged andragogy-to-heutagogy pathway within neurosurgical training and CPD can offer a pragmatic strategy to develop master adaptive neurosurgeons who are capable, reflective, and resilient. Prospective evaluation is required to link this theoretical framework to educational, clinical, and patient-centred outcomes.