District Residency Programme: A Boon or A Bane

Post Graduate Medical Education Regulation-2000 (PGMER-2000) provides 3 months of District Residency Programme (DRP) in the district health system for post-graduate (PG) students of broad specialty. These provisions were made in 2020 but were delayed due to the coronavirus disease-2019 (COVID-19) pandemic. So, from the 2021 batch onwards it will be mandatory for all the PGs of govt, private, and deemed universities to expose themselves to the district health system and involve them in health care services at the District hospitals (DH) for serving while learning on a rotation basis in 3rd /4th /5th semesters of the PG program. District health system shall include Community Health Centres (CHCs), Primary Health Centers (PHCs), and sub-health centers as well as a community outreach system. The additional manpower got through DRP should be used for promotive, preventive, curative, and rehabilitative services effectively. Thereby we can improve SDGs further.

For a large state like Karnataka with 31 districts and 65 medical colleges divided unequally into the districts with no medical college in Ramanagara, Haveri, and Vijayanagara and only private medical colleges in Davangere, Chithradurga, Dakshin Kannada, Kolar, Bagalkote, and Udupi with no PG seats in the districts like Chikkaballapur, Chikmagaluru, and Yadgiri. The total number of PG intake in Karnataka is 4,913. The number of PG seats is also improperly distributed in each district and each specialty like Bangalore has the highest number of PG seats of 1717 which is almost equal to 1/3^rd of the total PG seats followed by Dakshin Kannada with 794 seats and Bijapur has the lowest number of PG seats with only 10 seats.

When the program implements now after COVID-19, a lot of uncertainties remain unaddressed.

To make the program more active and efficient all the medical colleges should be mapped to DHS. Uniform guidance and nodal officers at the college level and in the district hospitals should coordinate the activities of district residents. Quality of training shall be monitored by log books, supportive supervision, and continuous assessment of performance.

Clinical PGs can be used for OPD services but the role of some special branches like radiotherapy, aviation medicine, immune hematology, palliative medicine, physical medicine, and rehabilitation transfusion medicine is not clear since these specialties will not be available in DHS, so the subject-oriented training won’t be possible. Pre- and para-clinical subjects like Pathology and Microbiology can be used in integrated public health laboratories, but such laboratories are not available in all the districts so in such districts no clarity about what they should do. The roles of pre- and paraclinical PGs like Anatomy, Physiology, Pharmacology, Forensic medicine, and Biochemistry are also unclear regarding the work they should do or how can we make use of them. Hence a mechanism needs to be framed where these doctors can be used for supplementing activities for the National Health Program and can also be used for providing training to paramedical students available in the district hospital. Since new medical colleges are attached to a few district hospitals, in such cases, these doctors may be doing DRP at CHP/ Taluk hospital level to expose them to the existing health system and understand the healthcare delivery system.

Nodal officers from each district hospital and taluk hospital should sit and coordinate the deputation of PGs, effective training, utilization of their services in the National Health Program, monitoring, addressing their grievance, and issuing completion. All efforts need to be done by all departments involved concerted, and combined for DRP to ensure the services of the PGs are effectively utilized and PGs should appreciate the importance of DRP and consider it to be a good learning initiative. Care should be taken so that they have a pleasant experience and their genuine problems or grievance are immediately addressed. Otherwise, the vii Editorial, RNJPH 2023;8(1): program will end up with a lot of complaints and will not fulfill the objective with which it was envisaged.

The regulations regarding the stay, food, and transportation to the facilities should be provided by the college itself for all the district residents, but the guidelines for the same are unclear since female PGs will also be a part of the program, so their safety should be taken care of. Additionally, the rotation of PGs, every 3 months should be taken care of like not more than 1/3^rd of PGs should be going out of the department since the normal functioning of all the medical colleges should go smoothly.