District Residency Programme- A major Transform in Medical Education

District Residency Programme : NMC makes District Residency Programme mandatory for Post Graduate Programme

Key Summary :

The District Residency Programme (DRP) is also required for students accepted into private medical colleges and deemed universities.

As per rules District Residency program has been made mandatory for 3 months in District Hospitals and NMC has said that there should be student rotation during 3rd, 4th or 5th semester of postgraduate programme.

According to the Postgraduate Medical Education Regulations, 2000, each medical college or institution should mandatorily enroll their postgraduate students for the newly implemented District Residence Program (DRP). According to DRP, all postgraduate students pursuing MD/MS in various specialties should undergo a rotation of three months in the 3rd, 4th, or 5th semester of their course curriculum. Students undergoing DRP will be termed as a ‘District Residents’

Clarification on District Resident Program by NMC

S.NO	Point of Doubt	Clarification
1	From which batch DRP is to be implemented?	DRP is mandatory for all the students admitted in 2021 batch onwards.
2	Is DRP mandatory for students of private medical colleges and deemed universities?	DRP is also mandatory for students admitted in private medical colleges and deemed universities.
3	If the number of District Hospitals are less to accommodate the number of PG students available, can they be posted in Community Health Centres having 100 or more than 50 beds?	For the purpose of this programme, a District Hospital shall be a functional public sector/government-funded hospital of not less than 100 beds with facilities/staff for the designated specialities at that level/ facility. For the purpose of this programme, the District Health System shall also include all public sector/government-funded hospitals and facilities (including community health centres, primary health centres, sub health centres, urban health centres etc.), as well as community outreach system in a district. This would also include district system engaged in running respective public health services including the implementation of national and state public health programmes.
4	How to accommodate students when the District Hospitals are quite far away?	The State Government shall provide appropriate amenities to the District Residents, including, amongst others, suitable accommodation, transportation to workplace (if living quarters are faraway), security, especially for lady residents. Accommodation could be by means of government premises or that rented by concerned State Govt. and should conform to prescribe norms.
5	Whether the PG students can be posted in the District Hospital in those specialty where that specialty department exists but specialized Doctors are not available in the District Hospitals.	During this rotation, the District Resident will be posted with the concerned/aligned specialty team/unit at the District Hospital, and will be trained under the overall guidance of the District Specialists. The District Resident will work under the overall directions and supervision of the District Residency Programme Coordinator If yes, in such situation who will guide the PG students (DRPC). The clinical responsibilities assigned to the Residents would during their district residency under DRP? include serving in outpatient, inpatient, casualty and other areas, and encompass night duties.
6	Can students of other medical colleges be deputed in the District Hospitals where medical colleges are already linked to these District Hospitals?	Yes, provided that training is periodically monitored and is comparable to the PG training in a medical college hospital.
7	Can the PG students be posted for DRP in those District Hospitals which have been recently converted to the medical colleges for imparting only MBBS Courses?	Yes, provided that training is periodically monitored and is comparable to the PG training in a medical college hospital.

Principles of District Residence Programme

According to the Gazette of India titled “Board of Governors in supersession of Medical Council of India notification,” the DRP will be exercised based on the following two principles:

1. Learning experiences have to be derived from and targeted to the needs of the community.
2. Doctors have to be trained in diverse settings including those which are close to the community.

Objectives of District Residence Programme

1. To expose postgraduate students to the district health system and involve them in health care services being provided at the district hospitals for learning while serving.
2. To acquaint them with the planning, implementation, monitoring, and assessment of the outcomes of national health programs at the district level.
3. To orient them towards promotive, preventive, curative, and rehabilitative services being provided by various categories of healthcare professionals under the National Health Mission.

Implementation of District Residence Programme

The implementation of DRP will be jointly coordinated by:

• The Department / Directorate of Medical Education
• The Department/ Directorate of Health Services
• A State/ UT District Residency Program Nodal officer

• To coordinate, monitor, and implement the DRP, medical colleges have been asked to set up a committee under their respective academic cells.
• The respective state government will provide amenities such as suitable accommodation, transportation to the workplace, and security to the district hospitals in their jurisdiction.
• An electronic platform will be developed by the Board of Governors in the supersession of the Medical Council of India to ensure the smooth functioning of DRP across hospitals and institutions.
• The State DRP Nodal Officer will allot students to training facilities through the electronic platform.
• The Board of Governors in  supersession of the Medical Council of India will develop requisite norms, tools (logbook, feedback form, learning resources, etc.), guidelines for implementation, and maintain a dashboard on the program. They will also continuously monitor the quality of the training program.
• Additionally, the National Steering Committee will establish a National Coordination Cell (NCC) under the Board of Governors which will be responsible for the smooth and efficient implementation of the DRP and grievance redressal at the national level.
• A district resident will work under the overall directions and supervision of the District Residency Program Coordinator (DRPC).
• Jointly with the medical college, the DRPC will monitor and assess the quality of training through logbooks, supportive supervision, and continuous assessment of performance of residents. These will be tracked by an electronic system.

Responsibilities of a district resident

• Under DRP, a district resident from a core medicine discipline will be responsible for serving in outpatient, inpatient, casualty, and other departments, and encompass night duties.
• The district residents of pre/para clinical disciplines, such as anatomy, biochemistry, community medicine, forensic medicine, microbiology, pathology, physiology, and pharmacology will be responsible for:
• Contribution to the diagnostic/laboratory, pharmacy, and forensic services
• General clinical duties
• Managerial roles and public health programs
• Contribution to research facilities, laboratories, and field sites of the Indian Council of Medical Research and other national research organizations.
• Apart from serving the above-mentioned duties, a district resident will also have to remain in contact with their designated postgraduate faculty and departments at their parent medical college. They will also have to participate remotely in scheduled case discussions, seminars, journal clubs, and thesis discussions with their teacher(s).
• District residents will be entitled to benefits such as stipend and leave, as per the rules of the parent college.

A postgraduate student will be allowed to appear in the final examination of the respective postgraduate course only after satisfactory completion of the district residency.

Source – The Gazette of India, NMC website

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