A Questionnaire-based Evaluation of the Impact of District Residency Program on Dermatology Training: Challenges, Experiences, and Need for Reform

Background: The District Residency Program (DRP), introduced by the National Medical Commission (NMC), envisages a three-month mandatory posting of all Indian postgraduate (PG) residents in district hospitals. It is aimed at strengthening the district health system; however, its impact on specialty training in dermatology remains unclear. Materials and Methods: After obtaining institutional ethical clearance, we conducted an anonymized online survey among dermatology PG residents across India, who had completed their DRP posting. It was based on a pre-designed and validated questionnaire, circulated via social media resident networks. The objective and subjective responses were collated and statistically analyzed. Results: Responses from 292 dermatology residents from government (156, 53.4%), private (91, 31.2%), deemed university (35, 12.1%), and government-aided (10, 3.4%) institutions were analyzed. Majority belonged to the PG-2022 batch (185, 63.4%). A significant hindrance to academics was reported by 96 (39.2%) residents, while it remained unaffected for 46 (15.8%). Thesis work was adversely impacted for 190 (65%) residents, with 133 (45.5%)reporting significant disruption. Dermatology procedural skill training during DRP was limited with no procedural dermatology exposure being reported by 159 (54.5%) respondents, while 42 (14.4%)performed procedures supervised, and 68 (23.3%) performed unsupervised. Accommodation was not provided for 229 (78.4%), while transport was not provided for 259 (88.7%) respondents. Lack of access to hygienic meals (206, 70.5%) and safety concerns (103, 35.3%) were significant issues reported. Regarding training outcomes, communication skills reportedly improved for 133 (45.6%). Exposure to the district health system was rated adequate by only 97 (33.2%), while only 59 (20.2%)felt that DRP strengthened district services. Only 93 (31.9%) agreed with the need for DRP posting during post-graduation, while 98 (33.6%) felt that it hampered their training. Limitations: Lack of formal psychometric validation of the questionnaire, a relatively small sample size, and the use of a voluntary online Google Form survey, which may have introduced selection and response bias. Conclusion: Targeted reforms are essential to align the program with dermatology specialty education, while upholding public health objectives at the same time.