District Residency Programme in India

Abstract

The recently launched District Residency Programme (DRP) has been an ambitious and disruptive change in Indian postgraduate medical education. National Medical Commission (NMC) advocates community-centric objectives in the 3-month mandatory training of postgraduate medical students within their residency tenure. The understanding of problems at the community level and “working while serving” model, despite initial hiccups, is supposed to bring impactful changes in the future. A brief strength, weakness, opportunities, and threat (SWOT) analysis of this grand initiative is author’s personal perspective in this context. The initiative, although disturbing to the smooth flow of residency, may offer certain benefits. Looking it differently, from an undesirable assignment to an important learning module, is the way forward for an enriching experience.

The DRP was announced by the National Medical Council (NMC) in 2020.^[1] The batches passing out from 2022 to 2023 onward are supposed to undergo this mandatory program before being eligible for their respective postgraduate qualification. The residents shall be called “District Residents” for that period.^[2] The move is a disruptive one in a long time as far as medical education is concerned. The 3-month rotational residential work in some district hospitals out of the total 3 years of postgraduate tenure does not seem a big fuss but in contrast to postgraduates in fields other than medicine, the 3 years of postgraduate medical education itself is much less a period to learn even basic skills that NMC advocates in the true sense. In this regard, many would consider it biting out important months away. Given the complexity of knowledge that is always updating itself and the focus shifting to competency-based learning, postgraduate medical education has undergone a sea change in recent years. There are various reasons for this program to be an idea whose time has come.^[3] DRP is poised to shake the time-tested rigmarole of higher medical education. Let’s try to perform a SWOT analysis of this big move in brief.

STRENGTH

The strength of the initiative lies in its objective itself and that is an ambitious one. Learning from places closest to the community and a learning target for the community needs is the principle objective of the initiative. It hopes to cater to a perennial requirement of human resource shortage at district hospitals that serves as the catchment areas for nearby villages, Taluk, and hinterlands. The patients there get basic medical advice or referrals as per the availability of doctors and ancillary staff. Usually, district hospitals are in better shape and staffed than primary care centers so working in these hospitals allows residents to watch, examine, and treat while learning about locally prevalent conditions (“learning while serving”). Apart from these, the local functioning of health-care machinery at the ground level shall enable them to learn leadership lessons. Acknowledging and excelling in a resource-limited environment has its own benefits as it offers different perspectives and may spark ingenious or innovative solutions to the problems affecting society. The unmet needs of the health-care mechanism at the grassroots level helps sensitization toward an empathic and holistic attitude during patient care. Understanding various health-care programs and social outreach can be better understood while actively being part of it. Social service in the field of health care can be understood better and may turn few of them into social entrepreneurs in later life. Many of them may play key roles in bringing impactful changes for society in the future. The benefit of learning from colleagues working in the district hospitals, who are there for many years and are seasoned through the process is an add-on benefit. Pearls and nuggets of wisdom and hacks or tricks of the trade can be learned from every health-care worker.

WEAKNESS

The work culture in most, if not all, district hospitals is not academic, and continuous professional development is not a norm there across the hierarchy. The completion of the task is the priority and academic learning from cases is usually passive or at times nonexistent. There are, however, few outliers. Usually prevalent systemicinertia takes over the need for knowledge updation and daily drill of managing cases in difficult working scenario dampens professional curiosity for many. The infrastructure also at times may not be suitable for providing optimal patient care and patient profile may differ significantly there. Despite scant facilities and workforce, the system runs smoothly due to dedicated staff and health-care workers. Many district hospitals will be having doctors with no postgraduate diploma or degree and learning of postgraduate in those centres will be a distant dream till situation improve. The lodging and food facilities that are to be provided may be another challenge in many hospitals. Many of the district hospitals even in good cities have dilapidated staff quarters and no separate canteen facility. The continuous electricity, water supply, and in today’s time, a decent Internet speed are important for living and learning. The district residents are also required to stay in contact remotely with the parent department for scheduled case discussions, journal club, and thesis assistance from the guide/coguide. As not all places in the country are similar, some minor issues in remote connection may be noted as occasional hurdles.

OPPORTUNITIES

The opportunity in this program for the postgraduates, although limited, exists for their personal growth. As compared to the medical college, where the patient load is more and the duty schedule leaves little time for a good study, the district hospitals may be less chaotic and provide quality reading time. Apart from these, the patients can be examined in detail and the clinical examination can be practiced over and over to serve useful in their practical examination. The cross-discipline discussion with other colleagues may have far more possibility to occur in a smaller district hospital. The parts of the thesis, like literature review can be done and completed here with the help of skillful time management. Journals and articles can be read in detail as many are available online during the tenure. There are plethora of massive open online courses on various topics and can be accessed for knowledge conveniently through the Internet.^[4] In nutshell, with a smart approach, these postings can be an experience worth cherishing through a positive attitude.

THREATS

With no significant threat except missing out on some exciting clinical work in the medical college, the District Residency Programme can be smooth sailing despite initial hiccups. In coming years, everything shall fall into the place for an efficient posting and rejoining. Postgraduates would certainly be missing out on many important cases during their absence in the medical college, some of which may be rare disorders or surgery which are only managed in the tertiary level center. Nothing, however, can replace that missed opportunity. Other threats and advantages both shall be known to us in coming years and shall serve to improve on the variables that positively impact the program.

In nutshell, due to the initial teething troubles and deep-rooted systemic inertia, the challenges of adapting to any novel tradition are hard in the beginning but medical science is all but escaping from the challenges.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.