District Residency Program – Students’ Perception

The National Medical Commission (NMC) with the objective of serving and learning started a district residency program (DRP) for postgraduate residents. As per "Post-Graduate Medical Education Regulations of 2023," every postgraduate student has to work in a district hospital for three months. Though the DRP was announced by the National Medical Council (NMC) in 2020 but could not become operational due to the COVID-19 pandemic.[1] This is one of the mandatory programs before being eligible for their respective postgraduate qualification.[2] Though the program is ambitious and is one of the efforts to strengthen the public health system but lacks clarity in respect to implementation. Hence faced many challenges in implementation in the beginning. The survey was conducted among the students and faculty of institution in Maharashtra by sending a Google form. The positive impact of DRP was the student's involvement in national programs like Immunization, RBSK, Mission Indradhanush, ORS Week celebration, Breastfeeding Week celebration, Vector Control, Immunization, Baby Friendly Hospital Initiative, Birth Control, National TB day. The positive points shared by them included limited working hours, learning to work with minimal resources, friendly seniors and staff, freedom of expression, exploring government settings, being stress-free, having the chance to work in a limited facility, and spending some time at home. They learned about teamwork and enjoyed managing cases of poisoning, myocardial infarction, and accident cases. They opined that being able to be the first decision maker and to give orders without any fear of judgment by senior authorities. They also had plenty of opportunities for basic procedures. They appreciated the friendly working environment and limited working hours. The compliance by all the staff to doctors' orders was good. They understood the government set up, general medical (adult) problems and management, public awareness, and more hands-on practice. They could get more experience in the management of emergencies, caseloads, and procedures. They learned to work with limited resources, and manage busy OPD so got more confidence, mental peace, and happiness. The beauty of diagnosis with only with clinical findings with limited investigations. Some students also learned about managing other specialties, IV line access neonate resuscitation, to manage sick cases. They also developed bonds with other department doctors and understood how to face common public issues and educate the public. This improved their communication with patients. The student expressed that after the DRP posting increased confidence in handling cases on their own, mental peace, counseling and they became more independent, strong, and confident in clinical management. The students learned more about normal deliveries. They improved in efficiency and basic clinical skills including surgical skills. DRP also gave them more exposure to new cases and great scope for learning. They also came to know about disability certification. The resource-limited environment can be challenging which has some benefits and may even lead to innovative solutions for community problems. DRP may sensitize postgraduate students to the unmet needs of healthcare in the community. This may help to develop an empathic and holistic attitude. Some students also found managing a huge number of OP cases with a lack of knowledge in adult medicine difficult. They felt lack of teaching and less academic activities made them insecure. The majority faced problems with travel, accommodation, and difficult line access with no help. They were made to treat all cases with available government drugs and to treat them without lab investigations. They came across the abusive patients and felt place not comfortable. The challenges were security, food, and cleanliness, particularly for girls and some faced language barriers. There are many gaps in the implementation of DRP. The DRP program was implemented with no prior involvement of stakeholders. There was a communication gap between the state government and medical colleges. The coordination of all stakeholders like medical teachers and students with public health officials is equally important. The solutions proposed to overcome the challenges faced during DRP posting include better coordination of all stakeholders regarding accommodation, security, and food. Considering the strengths, weaknesses, threats, and opportunities of DRP, experiences from different states will guide in implementation of DRP. The majority of the students requested traveling facilities, food, and basic facilities like a clean washroom, security, proper doctor's room for staying during the night duties. It was difficult mainly for female residents and few wanted to cancel the program. The solutions suggested were day duties and clarity in the work schedule. The faculty interaction about DRP brought out the important areas of concern like less time for thesis work and absenteeism in academic activities. The interaction with medical college faculty brought out gaps in DRP. The main concern was inadequate training time. They felt that 3 years of postgraduate medical education itself is not enough to learn even basic skills that NMC advocates in the true sense. In this regard, many would consider it biting out important months away.[3] Some felt there would be teething troubles in any new program but appropriate corrective action may help in facing the challenges.[4] A similar experience is shared by the educator from Delhi. The program can create a balance between individual and community but it should be properly streamlined. It requires good monitoring with proper regulations to maintain quality. Based on the feedback of the students and faculty, NMC has issued a clarification which helps to resolve some problems.[5] There are bright chances of some changes in DRP so the program will evolve in the coming days to make it student-friendly without altering its objectives. The District Residency Programme Coordinator (DRPC) is the important person for the successful implementation of DRP. He must be a connecting link between the district residents and the state government authorities who can solve many problems. The residents must be sensitized before DRP posts about its objectives. This can help in the successful implementation of the DRP.[6] Medical colleges linked to district hospitals or public health facilities as per NMC norms will make the program more active and efficient. The uniform guidelines for DRP will improve the quality of training. Assessment drives learning so DRP should be monitored by log books, supportive supervision, and continuous assessment of performance.[7] The main objective of the DRP is to involve postgraduate students in public health care which may be in district hospitals or rural hospitals with 59–100 beds. The idea is to understand the National Health Programs implementation at the district level. The young postgraduate students get oriented to curative, promotive, preventive, and rehabilitative services of the National Health Mission. To make DRP successful, multistakeholder consultation with faculty at medical colleges, policymakers and very important postgraduate students is the need of the hour. Let us hope for the best solution for DRP. Data availability Available with authors. Author contribution AM, PM contributed to idea, write up,SM & JB reviewed and approved. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.