Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents.

OBJECTIVE: To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. METHODS: Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. RESULTS: At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. CONCLUSIONS: A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.

SMARTer Goalsetting: A Pilot Innovation for Coaches During the Transition to Residency.

PROBLEM: Ability to set goals and work with coaches can support individualized, self-directed learning. Understanding the focus and quality of graduating medical student and first-year resident goals and the influence of coaching on goal-setting can inform efforts to support learners through the transition from medical school to residency. APPROACH: This observational study examined goal-setting among graduating medical students and first-year residents from April 2021 to March 2022. The medical students set goals while participating in a Transition to Residency elective. The residents in internal medicine, obstetrics and gynecology, emergency medicine, orthopedics, and pathology set goals through meeting 1:1 with coaches. Raters assessed goals using a 3-point rubric on domains of specific, measurable, attainable, relevant, and timely (i.e., SMART goal framework) and analyzed descriptive statistics, Mann-Whitney U tests, and linear regressions. OUTCOMES: Among 48 medical students, 30 (62.5%) set 108 goals for early residency. Among 134 residents, 62 (46.3%) entered goals. Residents met with coaches 2.8 times on average (range 0-8 meetings, median = 3). Goal quality was higher in residents than medical students (average score for S: 2.71 vs 2.06, P < .001; M: 2.38 vs 1.66, P < .001; A: 2.92 vs 2.64, P < .001; R: 2.94 vs 2.86, P = .002; T: 1.71 vs 1.31, P < .001). The number of coaching meetings was associated with more specific, measurable goals (specific: F [1, 1.02] = 6.56, P = .01, R2 = .10; measurable: F [1, 1.49] = 4.74, P = .03, R2 = .07). NEXT STEPS: Learners set realistic, attainable goals through the transition to residency, but the goals could be more specific, measurable, and timely. The residents set SMARTer goals, with coaching improving goal quality. Understanding how best to scaffold coaching and support goal-setting through this transition may improve trainees' self-directed learning and well-being.

The Transition From Medical Student to Resident: A Qualitative Study of New Residents' Perspectives.

PURPOSE: To understand the learner's perspective on the transition from medical school to residency and to develop a conceptual model for how learners experience the transition from student to resident. METHOD: This prospective qualitative study explored the experience of first-year residents using semistructured, one-on-one telephone interviews. Ten first-year residents who participated in the Transition to Residency elective as fourth-year students at the New York University Grossman School of Medicine in April 2018 participated from December 2018 to April 2019. Using a 3-phase coding process and grounded theory methodology, the authors identified categories, which they organized into broader themes across interview transcripts and used to develop a conceptual model. RESULTS: From the perspective of new residents, developing professional identity is the core construct of the transition experience. The residents focused on individual aspects of the experience-professional identity, self-awareness, professional growth, approach to learning, and personal balance-and external aspects-context of learning, professional relationships, and challenges in the context of their new role. Across these 8 categories, 5 broader themes emerged to describe an abrupt change in educational environment, an immersive experience of learning as a resident, ambivalence and tensions around the new role, navigation of professional relationships, and balance and integration of working in medicine with personal lives and goals. A conceptual model illustrates this phenomenon as a cell where professional identity and growth (the nucleus) is surrounded by interactions with patients and other members of the medical team (in the cytoplasm) that create a substrate for learning and development. CONCLUSIONS: This study suggests that being immersed in the residency experience is how medical students transition to resident physicians. Educational interventions that allow learners to acclimate to the experience of being a doctor through gradual exposure to authentic interactions have the potential to bridge the abrupt transition.

Perception of Child Weight and Feeding Styles in Parents of Chinese-American Preschoolers.

Parent perception of weight and feeding styles are associated with obesity in other racial groups but have not been explored in-depth in Chinese-American preschoolers. Cross-sectional survey of 253 Chinese-American parents with preschoolers was performed in a community clinic. Regression analysis was used to assess relationships between parental perception of weight and feeding styles. Parent under-perception of weight was common but more likely in boys than girls (χ2 = 4.91, p = 0.03). Pressuring was also greater in boys [adjusted mean difference (95% CI) 0.24 (0.004, 0.49)]. In girls, pressuring was lower for children perceived as overweight [adjusted mean difference in CFQ scores -0.75 (-1.27, -0.23)]; in boys, pressuring was high regardless of perceived child weight. Weight perceptions and feeding styles related to childhood obesity in other groups were identified in Chinese-American families. Parent under-perception of child weight and pressure to eat were more common in boys. These factors should be addressed in Chinese-American preschooler obesity prevention programs.