Reply to “Family Medicine Research ‘Bright Spots’ in Low-Resource Settings”

We thank the authors for their insightful comments and wholeheartedly agree that studying residency programs is an important next step in this line of inquiry. Throughout our interviews with bright spots, residents, residency faculty, and residency programs played prominent roles. First, because they practice on the front lines, residents and residency faculty generate a lot of questions that have high relevance to family medicine. Second, researchers within bright spots were often identified during residency. Bright spot leaders described residencies as pipelines for faculty generally and researchers specifically. One leader looks for residents that can “think like…researcher[s],” or have “curiosity and passion that suggests they’re likely to ask and answer important questions.”1

While residencies are important to bright spots, we believe that they are, by themselves, essential to the success of the family medicine research enterprise. Bright spots represent a concentration of resources and expertise, but important research questions (like the authors’ project to improve maternal and fetal outcomes) are being asked and answered across the entire family medicine network. As the authors suggested, the themes we identified can be used by individuals working in low-resource settings to stimulate research. Engaged and committed program directors can value research and allocate the resources needed to support it. Residencies can acquire needed skills and resources by partnering with other departments, residencies in other specialties, training programs for other health professionals, and community organizations. Residencies often already have retreats to build trust among trainees going through a shared experience. Researchers can be included in these activities so that residents develop trust with them as well. Finally, residents already generate important questions that are critical to their identities as family physicians and the discipline as a whole. Faculty with research or quality improvement skills can work with residents to enhance the clarity and feasibility of these questions.

When conducting this study, we were concerned that our colleagues would view bright spots as beyond their reach, and therefore would never start the journey toward continuous learning. We hoped that these lessons would encourage others to consider the assets that are, at present, in their clinics, systems, and communities. These authors remind us that important, impactful work is already taking place at residencies nationwide and that there are new lessons to learn from them.