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Imposter syndrome is a psychological phenomenon in which individuals experience persistent self-doubt and feelings of inadequacy despite achieving objective measures of success. This phenomenon is associated with lower job satisfaction, increased rates of burnout, and reduced productivity.

Harsh Wadhwa et al conducted a study to determine the prevalence of imposter syndrome among orthopaedic surgery residents and determine whether specific individual or residency characteristics predict higher rates of imposter syndrome.

The study was performed at the Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California.

An anonymous survey was distributed to residents at 7 ACGME-accredited orthopaedic surgery residencies by the authors. Respondents provided deidentified demographic data and completed the Clance Imposter Phenomenon Scale (CIPS) assessment. CIPS scores were used to categorize imposter syndrome severity as none to mild, moderate, significant, or intense. Differences were calculated and compared using t-test and x2 analyses. Multivariable regression analysis was used to identify predictors of increased symptom severity.

The key findings of the study were:

• One hundred orthopaedic surgery residents completed the survey.

• Forty percent of respondents were female, and the mean age was 30.6 ± 2.8 years.

• The prevalence of significant or intense imposter syndrome was 73%.

• CIPS scores and significant or intense imposter syndrome did not vary by age, gender, sexual orientation, race/ethnicity, level of training, program region, research year, non-MD degrees, and Step 1, Step 2, or Orthopaedic In-Training Examination (OITE) scores on univariable analyses.

• On multivariable analysis, female residents were 5.64 (OR = 5.64 [1.04-30.63]) times more likely to have significant or intense imposter syndrome (p = 0.045).

• Residents at western programs were 0.13 (OR = 0.13 [0.02-0.90]) times as likely to experience significant or intense imposter syndrome (p = 0.039).

• Women (estimate = 8.72 [1.41-16.04]; p = 0.0201) and those with OITE scores in the 0 to 25th (estimate = 11.92 [0.29- 23.54]; p = 0.0446) and 51st-75th (estimate = 12.73 [2.79-22.67]; p = 0.0128) percentiles had higher CIPS scores.

The authors concluded that – “Imposter syndrome is highly prevalent among orthopaedic surgery residents, with significant or intense symptoms affecting 73% of those surveyed. Female gender and lower OITE scores were associated with increased imposter syndrome severity, while training at an orthopaedic surgery residency program in the West was associated with decreased imposter syndrome. Additional research is needed to identify effective interventions to address imposter syndrome and minimize its effects on individuals’ careers. Implementing focused initiatives to address imposter syndrome may help alleviate burnout and promote both career fulfillment and professional growth.”

Further reading:

Imposter Syndrome Among Orthopaedic Surgery Residents is Extremely Common and Disproportionately Affects Female Residents

Harsh Wadhwa et al

JBJS Open Access 2025:e24.00132.

http://dx.doi.org/10.2106/JBJS.OA.24.00132

During the tightly regulated gastrulation, embryonic cells differentiate into the three germ layers – endoderm, mesoderm, and ectoderm – which eventually give rise to all tissues and organs. The late, renowned developmental biologist Lewis Wolpert once stated: “It is not birth, marriage, or death, but gastrulation which is truly the most important time in your life.” Gastrulation occurs during the fifth week of pregnancy, a time when many women are not yet aware that they are pregnant.

According to estimates by the Finnish Association on Intellectual and Developmental Disabilities, 600–3,000 children are born in Finland each year with permanent damage caused by alcohol, but due to the challenges of diagnosis, the true number is unknown.

Researchers at the University of Helsinki, in collaboration with the University of Eastern Finland, have now examined the effects of alcohol on this difficult-to-study stage of human development.

In the study, pluripotent embryonic stem cells were differentiated into the three germ layers in culture dishes. The cells were exposed to two different concentrations of alcohol: the lower exposure corresponded to less than one per mille, while the higher exceeded three per mille. The researchers then investigated the effects of alcohol on gene expression, epigenetic markers regulating gene activity, and cellular metabolism.

Stronger alcohol exposure caused more changes than the lower dose, and a dose-response relationship was observed in both gene activity and metabolism. The most significant metabolic changes were detected in the methionine cycle of the cells.

“The methionine cycle produces vital methyl groups in our cells, which attach to DNA strand and influence gene regulation. The observed changes confirm the importance of this epigenetic regulation in the disturbances caused by alcohol exposure,” the doctoral researcher Essi Wallén explains.

The First Neural Cells Are Most Sensitive to Alcohol

The most pronounced changes caused by alcohol exposure were seen in ectodermal cells, which give rise to the nervous system and the brain during development. It is well-known that prenatal alcohol exposure is one of the most significant causes of neurodevelopmental disorders.

“Many of the developmentally important genes altered in this study have previously been linked to prenatal alcohol exposure and its associated features, such as defects in heart and corpus callosum development, as well as holoprosencephaly, a failure of the forebrain to divide properly,” says Adjunct Professor Nina Kaminen-Ahola, who led the study.

According to the study, some of the developmental disorders caused by alcohol may arise during the very first weeks of pregnancy, when even minor changes in gene function may influence the course of development. However, further research is needed to clarify how well the cell model and alcohol concentrations correspond to actual exposure in humans.

This research is part of a broader project investigating the mechanisms by which alcohol affects early development and later health. Prenatal alcohol exposure causes a range of developmental disorders collectively referred to as fetal alcohol spectrum disorders (FASD).

Reference:

E. Wallén, Effects of alcohol on the transcriptome, methylome and metabolome of in vitro gastrulating human embryonic cells, Disease Models & Mechanisms, https://doi.org/10.1242/dmm.052150

Optical coherence tomography (OCT), a tool routinely used to diagnose and plan treatment for eye diseases, has now been modified to collect images of the inner ear. A proof-of-concept study led by researchers at the Keck School of Medicine of USC found that OCT imaging can measure fluid levels in the inner ear, which correlate with a patient’s degree of hearing loss. The findings were just published in Science Translational Medicine.

“These findings are exciting because hearing loss can happen very suddenly, and we often don’t know why. OCT offers a way to explore the underlying cause and potentially guide treatment,” said senior author John Oghalai, MD, professor and chair in the Caruso Department of Otolaryngology – Head and Neck Surgery and the Leon J. Tiber and David S. Alpert Chair in Medicine at the Keck School of Medicine.

A sudden loss of hearing, sometimes accompanied by vertigo, happens in Ménière’s disease, cochlear hydrops and other ear conditions. One hallmark of these diseases is an imbalance of fluids in the inner ear, but measuring fluid balance is a challenge. The best available technology, magnetic resonance imaging (MRI), lacks the resolution needed to reliably diagnose or guide treatment.

OCT offers a quicker, more accurate and less expensive way to see inner ear fluids, hair cells and other structures relevant to diagnosing and treating hearing loss. With funding from USC and the National Institutes of Health, Oghalai, Brian Applegate, PhD, professor of otolaryngology – head and neck surgery, and ophthalmology at the medical school and of biomedical engineering and electrical and computer engineering at USC Viterbi School of Engineering, and their team tested the new tool in 19 patients undergoing ear surgery for various conditions. They found that OCT could reliably detect fluid imbalance in the inner ear, which was correlated with the severity of a patient’s hearing loss. Although the tool is currently limited to use during surgery, the researchers are working to adapt it for application in the clinic.

The latest findings build on the team’s earlier work, where they used OCT to collect images of the cochlea in awake animals for the first time. With improvements, the tool could help clinicians more quickly find the cause of hearing loss, determine how to treat it, and even support efforts to develop new therapies to restore hearing, Oghalai said.

Measuring fluid balance

OCT uses light waves to scan tissue and create 3D images, similar to the way ultrasound produces images using sound waves.

The Keck School of Medicine team used the tool to scan the inner ears of 19 patients undergoing ear surgery. Six patients had normal inner ear function, four had Ménière’s disease, and nine had vestibular schwannoma (a benign tumor on a nerve that connects the inner ear to the brain). During surgery, a thick outer bone known as the mastoid was temporarily removed, allowing researchers to use OCT to collect images of the fluid compartments in the inner ear.

OCT images showed that patients with Ménière’s disease or vestibular schwannoma had higher levels of a fluid called endolymph, compared to those with normal inner ear function. Increased endolymph levels were linked to greater hearing loss, indicating that measuring these fluid levels could help predict the severity of symptoms.

“We’ve known for a long time that endolymph is related to hearing loss, but until now, measuring it in a living patient has been a major challenge,” Oghalai said.

A faster way to help

OCT can assist surgeons, including by helping to avoid damage to delicate ear structures and distinguishing brain tumors from healthy tissue. To this end, the researchers are working to develop a smaller, more affordable version of the tool that they plan to distribute and test with surgeons.

But OCT can benefit many more people if it can be used to collect images of the inner ear while patients are awake in the clinic. To achieve this goal, Oghalai, Applegate and their team have received federal funding and a Nemirovsky Engineering and Medicine Opportunity (NEMO) Prize from USC. They are now working to improve the software and image-processing techniques to obtain clear images from patients without removing the mastoid bone.

OCT could offer major benefits over MRI because it is less expensive, faster and can be done back-to-back to test treatment effectiveness. For example, a provider could collect an image, give medication treatment for a fluid imbalance, then take another image 30 minutes later.

“Patient symptoms—sensations of hearing loss, pressure in the ear, or vertigo-can be affected by many unrelated factors such as mood, stress, nasal congestion and allergies. However, inner ear fluid levels reliably assess what is going on inside the inner ear,” Oghalai said. “We have lots of treatment options available, but it often takes many weeks to figure out what works for a given patient. This could be a faster way to help.”

If OCT can be used outside the operating room, it can also support the development of new treatments for hearing loss. Several gene therapies, which aim to regenerate lost hair cells in the inner ear, are currently in clinical trials. OCT may provide a fast and precise way to test the effectiveness of such therapies by collecting images of hair cells as they grow.

“OCT helped researchers develop treatments for retinal diseases, including macular degeneration, so we’re hoping it can have a similar impact for hearing loss,” Oghalai said.

Reference:

Kim W, Pan DW, Kim BJ, Yang Z, Moran Mojica M, Doherty JK, Shibata SB, Applegate BE, Oghalai JS. Human inner ear fluid imbalance detected by optical coherence tomography correlates with hearing loss. Sci Transl Med. 2025 Jul 23;17(808):eadv3783. doi: 10.1126/scitranslmed.adv3783. 

Taiwan: Patients who experience severe cutaneous adverse reactions (SCARs) could face a markedly higher risk of developing autoimmune diseases (ADs), according to a large population-based cohort study published in Clinical and Experimental Dermatology. The study was conducted by Tzu-Min Lin and colleagues from the Division of Rheumatology, Immunology, and Allergy at Taipei Medical University Hospital in Taiwan.