Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis?

Halsted’s impact on formal surgical education remains foundational and enduring. His historic tenet of, “see one, do one, teach one,” established during his tenure at Johns Hopkins in the 1890s defined the apprenticeship model centered on experiential learning and structured repetition. While this framework has historically served as the backbone of surgical training, contemporary medical education and practice have evolved substantially in response to exponential growth of medical knowledge, technical advancement, and increasing complexity healthcare systems. This dynamically evolving field necessitates more efficient and deliberate educational strategies, beyond that of the historic apprenticeship model. This need is amplified by implementation of the 80-hour work week that reduced overall clinical exposure, and further emphasizes the importance of maximizing educational efficiency and effectiveness. Subsequently, there has been great effort in revolutionizing surgical education using adult learning theory as a foundation to develop more structured, efficient, and intentional education. Modern adult learning theories offer promising and robust frameworks to address these challenges and were central in the curriculum development described herein. Cognitive apprenticeship, described by Collins, emphasizes explicit demonstration of expert reasoning to facilitate acquisition of technical skills and development of clinical judgement. With articulation of expert thinking and making cognitive processes, “visible,” learners are better able to acquire knowledge more efficiently and translate that theoretical knowledge to real-world applications. Within surgical education, it is imperative that not only technical proficiency, but the cognitive skills and critical thinking behind the scalpel, be imparted throughout training. The concept of the zone of proximal development (ZPD), originally described by Vygotsky, further informed curriculum design by defining the range in which learners can progress within a supportive framework. Through scaffolding, educators can deliberately adjust and reduce assistance to promote autonomy as competence gradually increases. This approach is particularly applicable to intraoperative teaching, where surgical trainees advance incrementally from performing discrete components of a procedure to performing its entirety with decreasing levels of assistance over time. Finally, situated learning and collaborative learning environments are critical components of modern adult learning and were emphasizes in design of the curriculum. In contrast to passive lecture-based formats, active engagement within authentic clinical contexts has shown to enhance knowledge retention, trainee engagement, and application of knowledge to real-world scenarios.