Early engagement: The value of MRIT student externs in supporting recruitment, retention, and the future of the medical imaging professions.

The healthcare system faces critical challenges in recruitment and retention due to increased patient volumes, post-pandemic recovery needs, and a departing experienced workforce. The concept of an 'extern' role, increasingly explored in professions such as nursing, allows healthcare students to take on paid employment in assistive roles in settings relevant to their future profession. The cornerstone of such an initiative is to bridge academic learning with practical clinical support, engaging the future of the workforce in a safe and meaningful way. METHODS: An extern program was piloted at a major urban multi-site medical imaging department beginning in 2022. Over three cohort years, it has explored two types of extern roles (junior and clinical) across three entry-to-practice MRIT disciplines - radiological technology, nuclear medicine and molecular imaging, and ultrasound. In developing roles, compliance with legislative regulations, considerations in defining roles and eligibility criteria, and aligning work commitment with student learning schedules were paramount in informing the program's structure and success. Seventy-three candidates applied to related roles and 34 externs were hired. BENEFITS/CHALLENGES: Benefits to the program include engagement in clinical and administrative tasks, facilitation of departmental efficiency, and support for the existing workforce. Specific tasks for clinical externs included supporting staff in patient transfers and positioning, cleaning and restocking rooms, triaging patients and demands, calling inpatients and coordinating porters, and monitoring patients and schedules. For junior externs, tasks involved record-keeping, curating teaching cases, and supporting billing code reviews and quality control exercises like lead apron testing. IMPACTS/OUTCOMES: The program's value in shaping the future of healthcare professions has been recognized, particularly in enhancing student transition into practice and increasing recruitment opportunities for the host site. Staff overtime hours were reduced, and new graduates who had worked as externs were more quickly able to work autonomously following hire. The program was mutually beneficial to existing staff and future professionals, reinforcing the workforce without sacrificing the higher level learning achieved through university-based preparation for practice.

Experimentally induced and real-world anxiety have no demonstrable effect on goal-directed behaviour.

BACKGROUND: Goal-directed control guides optimal decision-making and it is an important cognitive faculty that protects against developing habits. Previous studies have found some evidence of goal-directed deficits when healthy individuals are stressed, and in psychiatric conditions characterised by compulsive behaviours and anxiety. Here, we tested if goal-directed control is affected by state anxiety, which might explain the former results. METHODS: We carried out a causal test of this hypothesis in two experiments (between-subject N = 88; within-subject N = 50) that used the inhalation of hypercapnic gas (7.5% CO2) to induce an acute state of anxiety in healthy volunteers. In a third experiment (N = 1413), we used a correlational design to test if real-life anxiety-provoking events (panic attacks, stressful events) are associated with impaired goal-directed control. RESULTS: In the former two causal experiments, we induced a profoundly anxious state, both physiologically and psychologically, but this did not affect goal-directed performance. In the third, correlational, study, we found no evidence for an association between goal-directed control, panic attacks or stressful life eventsover and above variance accounted for by trait differences in compulsivity. CONCLUSIONS: In sum, three complementary experiments found no evidence that anxiety impairs goal-directed control in human subjects.

A dimensional investigation of error-related negativity (ERN) and self-reported psychiatric symptoms.

Alterations in error processing are implicated in a range of DSM-defined psychiatric disorders. For instance, obsessive-compulsive disorder (OCD) and generalised anxiety disorder show enhanced electrophysiological responses to errors-i.e. error-related negativity (ERN)-while others like schizophrenia have an attenuated ERN. However, as diagnostic categories in psychiatry are heterogeneous and also highly intercorrelated, the precise mapping of ERN enhancements/impairments is unclear. To address this, we recorded electroencephalograms (EEG) from 196 participants who performed the Flanker task and collected scores on 9 questionnaires assessing psychiatric symptoms to test if a dimensional framework could reveal specific transdiagnostic clinical manifestations of error processing dysfunctions. Contrary to our hypothesis, we found non-significant associations between ERN amplitude and symptom severity of OCD, trait anxiety, depression, social anxiety, impulsivity, eating disorders, alcohol addiction, schizotypy and apathy. A transdiagnostic approach did nothing to improve signal; there were non-significant associations between all three transdiagnostic dimensions (anxious-depression, compulsive behaviour and intrusive thought, and social withdrawal) and ERN magnitude. In these same individuals, we replicated a previously published transdiagnostic association between goal-directed learning and compulsive behaviour and intrusive thought. Possible explanations discussed are (i) that associations between the ERN and psychopathology might be smaller than previously assumed, (ii) that these associations might depend on a greater level of symptom severity than other transdiagnostic cognitive biomarkers, or (iii) that task parameters, such as the ratio of compatible to incompatible trials, might be crucial for ensuring the sensitivity of the ERN to clinical phenomena.

Impact of high-fidelity e-learning on knowledge acquisition and satisfaction in radiation oncology trainees.

Background: e-Learning is an underutilized tool in education for the health professions, and radiation medicine, given its reliance on technology for clinical practice, is well-suited to training simulation in online environments. The purpose of the present study was to evaluate the knowledge impact and user interface satisfaction of high-(hf) compared with low-fidelity (lf) e-learning modules (e-modules) in radiation oncology training. Methods: Two versions of an e-module on lung radiotherapy (lf and hf) were developed. Radiation oncology residents and fellows were invited to be randomized to complete either the lf or the hf module through individual online accounts over a 2-week period. A 25-item multiple-choice knowledge assessment was administered before and after module completion, and user interface satisfaction was measured using the Questionnaire for User Interaction Satisfaction (quis) tool. Results: Of 18 trainees, 8 were randomized to the lf module, and 10, to the hf module. Overall, knowledge assessment performance increased (11%, p < 0.05), with hf-group participants reporting a 13% improvement (p = 0.02), and senior participants reporting an almost 15% improvement (p < 0.01). Scores on the quis indicated that participants were satisfied with various aspects of the user interface. Conclusions: The hf e-module had a greater impact on knowledge acquisition, and users expressed satisfaction with the interface in both the hf and lf situations. The use of e-learning in a competency-based curriculum could have educational advantages; participants expressed benefits and drawbacks. Preferences for e-learning integration in education for the health professions should be explored further.

A trans-diagnostic perspective on obsessive-compulsive disorder.

Progress in understanding the underlying neurobiology of obsessive-compulsive disorder (OCD) has stalled in part because of the considerable problem of heterogeneity within this diagnostic category, and homogeneity across other putatively discrete, diagnostic categories. As psychiatry begins to recognize the shortcomings of a purely symptom-based psychiatric nosology, new data-driven approaches have begun to be utilized with the goal of solving these problems: specifically, identifying trans-diagnostic aspects of clinical phenomenology based on their association with neurobiological processes. In this review, we describe key methodological approaches to understanding OCD from this perspective and highlight the candidate traits that have already been identified as a result of these early endeavours. We discuss how important inferences can be made from pre-existing case-control studies as well as showcasing newer methods that rely on large general population datasets to refine and validate psychiatric phenotypes. As exemplars, we take 'compulsivity' and 'anxiety', putatively trans-diagnostic symptom dimensions that are linked to well-defined neurobiological mechanisms, goal-directed learning and error-related negativity, respectively. We argue that the identification of biologically valid, more homogeneous, dimensions such as these provides renewed optimism for identifying reliable genetic contributions to OCD and other disorders, improving animal models and critically, provides a path towards a future of more targeted psychiatric treatments.

Disorders of compulsivity: a common bias towards learning habits.

Why do we repeat choices that we know are bad for us? Decision making is characterized by the parallel engagement of two distinct systems, goal-directed and habitual, thought to arise from two computational learning mechanisms, model-based and model-free. The habitual system is a candidate source of pathological fixedness. Using a decision task that measures the contribution to learning of either mechanism, we show a bias towards model-free (habit) acquisition in disorders involving both natural (binge eating) and artificial (methamphetamine) rewards, and obsessive-compulsive disorder. This favoring of model-free learning may underlie the repetitive behaviors that ultimately dominate in these disorders. Further, we show that the habit formation bias is associated with lower gray matter volumes in caudate and medial orbitofrontal cortex. Our findings suggest that the dysfunction in a common neurocomputational mechanism may underlie diverse disorders involving compulsion.

Punishment promotes response control deficits in obsessive-compulsive disorder: evidence from a motivational go/no-go task.

BACKGROUND: Obsessive-compulsive disorder (OCD) has been associated with response inhibition deficits under motivationally neutral contingencies. We examined response inhibition performance in the presence of reward and punishment. We further investigated whether the hypothesized difficulties in flexibly updating behaviour based on external feedback in OCD would also lead to a reduced ability to adjust to changes in the reward and punishment contingencies. METHOD: Participants completed a go/no-go task that used punishments or rewards to promote response activation or suppression. The task was administered to OCD patients free of current Axis-I co-morbidities including major depression (n = 20) and a group of healthy controls (n = 32). RESULTS: Compared with controls, patients with OCD had increased commission errors in punishment conditions, and failed to slow down immediately after receiving punishment. The punishment-induced increase in commission errors correlated with self-report measures of OCD symptom severity. Additionally, patients did not differ from controls in adapting their overall response style to the changes in task contingencies. CONCLUSIONS: Individuals with OCD showed reduced response control selectively under punishment conditions, manifesting in an impulsive response style that was related to their current symptom severity. This stresses failures of cognitive control in OCD, particularly under negative motivational contingencies.

Tumour regulation of fibroblast hyaluronan expression: a mechanism to facilitate tumour growth and invasion.

Hyaluronan, a high molecular weight glycosaminoglycan is associated with cellular proliferation and migration. In a number of different tumour types, there is a close correlation between tumour progression and hyaluronan production, either by the tumour cells or the surrounding stromal cells. We have examined the ability of an aggressive melanoma cell line (C8161) to stimulate the synthesis of fibroblast hyaluronan, and the association of cell-surface CD44 receptors and hyaluronan with invasion. Melanoma cell-conditioned medium (CM) prepared in low glucose medium (1 mg/ml) stimulated the synthesis of fibroblast glycosaminoglycan as measured by [3H] glucosamine incorporation, and the synthesis of hyaluronan as measured using a specific hyaluronan-binding plate assay, while tumour cell-CM prepared in high glucose medium (4.5 mg/ml) inhibited the synthesis of fibroblast glycosaminoglycan. High glucose tumour cell-CM contained large amounts of lactate that appeared to inhibit the tumour-derived factor stimulation of fibroblast glycosaminoglycan synthesis, as removal of the lactate restored the stimulating activity. Melanoma cells seeded on contracted collagen lattices and incubated at the air/liquid interface rapidly formed a multilayered cell mass on the surface, with significant invasion of the gel. Hyaluronan staining was apparent within the collagen gel, and strong staining was seen around the invading tumour cells, but not around those cell layers near the surface. CD44 expression on the tumour cells was confined to those invading cells and corresponded to cellular hyaluronan staining. Hyaluronan staining was also apparent around and between tumour cells invading fibroblast-free collagen lattices. Monolayer cultures of C8161 cells stained strongly for CD44, but few cells stained for hyaluronan, while no detectable hyaluronan was released into the medium. In summary, the C8161 melanoma cells stimulated the synthesis of fibroblast hyaluronan, and in collagen lattices, only the invasive tumour cells expressed CD44 and hyaluronan, either in the presence or absence of fibroblasts.