Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study.

OBJECTIVE: Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and the American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates. METHODS: In July to November 2020, we conducted an Institutional Review Board-approved qualitative study with semistructured interviews of residency graduates from 2 pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness. RESULTS: We interviewed 34 residency graduates from 2 institutions and identified 4 themes on how coaches influenced residency graduates' PIF by 1) the presence of a trusting relationship; 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback; 3) integrating clinical skill, career interests, and work-life integration; and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency. CONCLUSIONS: Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.

Where are youth active? Roles of proximity, active transport, and built environment.

PURPOSE: This study examined factors related to two sources of physical activity for youth: active use of recreation sites and active transport to recreation sites. METHODS: Parents of children (n = 87) and matched pairs of parents and adolescents (n = 124 pairs) in three US cities reported on youths' active use of, proximity to, and walking/biking to 12 recreation sites and on neighborhood walkability and safety. Multivariate regression models evaluated factors associated with youths' frequent site use and active transport to sites. RESULTS: Proximity to the site was associated with frequent use of large parks and public open space. Walking/biking to the site was associated with frequent use of most sites (indoor recreation sites, small and large parks, basketball courts, walking/running tracks, school recreation sites, playgrounds, and public open space). After controlling for proximity and demographic factors, active transport to sites remained significantly associated (P < 0.05) with frequent use of four sites for children (indoor recreation, walking/running tracks, school recreation facilities, and public open space) and all but three sites for adolescents (indoor recreation, playfields/courts, and beach/lake/rivers). Adolescents' active transport to more sites was most positively related to higher perceived traffic safety and to better pedestrian infrastructure and was negatively related to crime threat. Adolescents with driver's licenses walked/biked to recreation sites less often. CONCLUSIONS: Active transport was strongly associated with the use of multiple recreation sites by children and adolescents, even when accounting for proximity and demographic factors. Adolescents living in neighborhoods with better traffic safety walked/biked to more recreation sites for physical activity. Findings support the need for built environments and transportation policies that facilitate safe, active transport to recreation sites for youth physical activity.