Satisfactory completion of District Residency Programme essential to appear in final PG exam: NMC Draft PGMER

New Delhi: Stating that satisfactory completion of the District Residency Programme (DRP) shall be an essential condition for the post-graduate candidates to be allowed to appear in the final examinations, the National Medical Commission (NMC) in the recently released Draft Post-Graduate Medical Education Regulations (PGMER) 2023 has laid down the details about the DRP.

"Doctors have to be trained in diverse settings including those which are close to the community. Hence, they should be trained in the District Health System / the District Hospitals," the Postgraduate Medical Education Board (PGMEB) of NMC mentioned as a preamble to the District Residency Programme.

Medical Dialogues had earlier reported that NMC proposed introducing the District Residency Programme back in 2021 with an aim of "strengthening of services of the District Health System". NMC had mentioned about the programme at the District Hospitals in the Draft Regulations on Postgraduate Medical Education Regulations 2021.

It was proposed that all the PG medical students pursuing their MD/MS in broad specialities should undergo a compulsory residential rotation of three months in District Hospitals/ District Health System as a part of the course curriculum. The Commission had clarified that such rotation would take place in the 3rd or 4th or 5th semester of the Postgraduate programme.

However, DRP could not be properly implemented due to COVID-19 pandemic and later NMC PG Board made it mandatory for all the Postgraduate broad speciality students admitted in 2021 batch onwards. Earlier this year, NMC addressed the doubts and confusions regarding the implementation of the programme and wrote to the Principal Secretary/ Secretary of Medical Education of all the States/UTs, the Directors of all the State/UT DMEs, and the Heads of all the medical institutes.

Now, releasing the Draft PGMER 2023, NMC PG Board has once again addressed the issue of the District Residency Programme and clarified that satisfactory completion of the DRP shall be an essential condition for the post-graduate candidates to be allowed to appear in the final examinations.

"Satisfactory completion of the District Residency shall be an essential condition before the candidate is allowed to appear in the final examination of the respective postgraduate course," NMC mentioned in the Draft regulations.

In the Draft, the PGMEB has specified various details about the District Residency Programme including its objectives, detailed definitions about District Hospital and District Health System, training and responsibilities of District Residents, Stipend and Leave of District Residents, training and certification, responsibilities of medical colleges/institutes, State Governments/UTs and the National Medical Commission, constitution of National/State oversight mechanisms, and the launch of the DRP.

Also Read: Got Doubts regarding District Residency Programme? Check out the clarification issued by NMC

Objectives:

The main objectives of the District Residency Programme (DRP) would be: a. to expose the post-graduate student to District Health System/ District Hospital and involve them in health care services being provided by District Health System /District Hospital for learning while serving; b. to acquaint them with the planning, implementation, monitoring and assessment of outcomes of the National Health programmes at the district level; and c. to orient them to promotive, preventive, curative and rehabilitative services being provided by various categories of healthcare professionals under the umbrella of National Health Mission. In doing so, the post-graduate medical students would also be contributing towards strengthening of services of the District Health System as specialty resident doctors working as members of the district teams.

Definition of District Hospital:

For the purpose of this programme, a District Hospital shall be a functional public sector/government-funded hospital of not less than 50 beds with facilities/staff for the designated specialties at that level/facility.

Definition of District Health System:

For the purpose of this programme, the District Health System shall include all public sector/government-funded hospitals and facilities (including community health centers, primary health centers, sub-health centers, urban health centers, 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.

District Residency Programme:

All post-graduate students pursuing MD/MS in broad specialties in all medical colleges/institutions under the purview of National Medical Commission shall undergo a compulsory residential rotation of three months in District Hospitals/ District Health System as a part of the course curriculum. Such rotation shall take place in the 3rd or 4th or 5th semester of the post-graduate programme. In case of those students who have taken admission after completion of Diploma in the relevant specialty, District Residency Programme shall take place in third semester only. Similarly, the post-graduate diploma students shall undergo the District Residency Programme in the third semester. This rotation shall be termed as ‘District Residency Programme’ (DRP) and the postgraduate medical student undergoing training shall be termed as a ‘District Resident’.

Training and Responsibilities of District Residents:

The District Resident will work under the overall directions and supervision of the District Residency Programme Coordinator (DRPC). During this rotation, the Resident doctor will be posted with the concerned/aligned specialty team/unit/ sections/services at the District Health System/ District Hospital, The clinical responsibilities assigned to the Residents would include serving in outpatient, inpatient, casualty and other areas pertaining to their specialty and encompass night duties. Post-graduate students of specialities where direct patient care is not involved will be trained by District Health System/ District Hospital teams within the available avenues in coordination with the District Health Officer/Chief Medical Officer. They would be trained in and contribute to the diagnostic/laboratories services, pharmacy services, forensic services, general clinical duties, managerial roles and public health programmes etc., as applicable. They may also be posted in research units / facilities, laboratories and field sites of the Indian Council of Medical Research and other national research organizations.

Stipend and Leave for District Residents:

The District Residents shall continue to draw full stipend from their respective medical colleges for the duration of the rotation subject to the attendance record submitted by the appropriate district authorities to the parent medical college/institution, based on methods and system as prescribed. Subject to exigencies of work, the District Resident will be allowed one weekly holiday by rotation. They shall also be entitled to leave benefits as per the rules/ guidelines of the parent college / university.

Training during DRP and Certification thereof:

a. Quality of training shall be monitored by log books, supportive supervision and continuous assessment of performance. The attendance and performance of District Residents shall be tracked by the District Residency Programme Coordinator (DRPC) of the District concerned, as well as the parent Medical College through an appropriate electronic/digital or mobile enabled system. Such monitoring systems shall also be accessible to the State/Union Territory Steering Committee and the National Coordination Cell.

b. The District Residents would remain in contact with their designated post-graduate teachers and departments at their parent Medical College / Institution by phone and e-communication for guidance, learning, and for being able to participate remotely in scheduled case discussions, seminars, journal clubs, thesis discussion, etc. and other academic activities.

c. Satisfactory completion of the District Residency shall be an essential condition before the candidate is allowed to appear in the final examination of the respective postgraduate course.

d. The District Residency Programme Coordinator (DRPC) shall issue certificate of satisfactory completion of DRP and report on the performance of the District Resident on a prescribed format to be decided by the PGMEB to the concerned medical college and the Govt. of the State/UT.

Responsibility of Medical College/Medical Institution:

It shall be incumbent upon all medical colleges/ institutions to place the post-graduate students at the disposal of the Government of concerned State/Union Territory for the District Residency Programme. The faculty of the concerned departments would provide guidance to the District Residents by phone/e-communication in accordance with Section 5.2.VI.

Responsibility of State Government /Union Territory:

The State Government /Union Territory shall implement the District Residency Programme within their jurisdiction as under:-

a. The Programme shall be coordinated jointly by the Directorate of Medical Education and the Directorate of Health Services. An Officer of the State Government /Union Territory shall be designated as the State/UT District Residency Programme (DRP) Nodal Officer. The concerned Government shall be responsible for the facilitation, oversight and supervision of the District Residency Programme.

b. The designated State/UT DRP Nodal officer shall identify and designate District Health System/ District Hospital that are suitable for such rotation in terms of availability of specific specialties, specialists, facilities and services available in consultation with the Directorate of Health Services of the State and the medical colleges, and develop a placement schedule of the Post-graduate Residents of the medical colleges due for rotation at least 6 months in advance. This official will also be responsible for grievance redressal at State level.

c. The State DRP Nodal officer shall undertake rule-based allotment of the training facilities to the Post-graduate Residents

d. The State Government shall provide appropriate amenities to the District Residents, including, amongst others, suitable accommodation, mess, transportation to work place (if living quarters is far away), security, especially for lady Residents. Accommodation could be by means of government premises or that rented by concerned State Government and should conform to prescribed norms.

e. The District Residents shall remain under the jurisdiction of respective State/ UT DRP Nodal officer where they are undergoing District Residency.

f. In case all the Post-graduate Residents of a State/UT cannot be absorbed within their respective jurisdiction, possibility of posting them to other States/Union Territories may be explored by mutual understanding in consultation with the respective Governments facilitated by the National Coordination Cell.

g. It shall be permissible for the post-graduate students from the North East Zone (NEZ) in various medical colleges/institutions in the country, to undergo District Residency Programme in their respective States.

h. The State Government/UT may consider providing additional honorarium to the District Residents as a token of recognition of their contribution to the healthcare services of the States. In addition, the concerned Governments may make provisions to incentivize postings to remote and difficult areas, and encourage volunteering by postgraduate students to serve at these places.

i. The concerned State Government shall also designate a senior official of the District Health System as the District Residency Programme Coordinator (DRPC) in each District for coordinating between the State DRP Nodal officer and the medical colleges. The District Residency Programme Coordinator shall also be responsible for orienting the Post-graduate Residents to the District health system, supervising the postings within the district, ensuring their accommodation, safety and transport needs, and for grievance redressal, etc. District Residency Programme Coordinator shall be the competent authority for sanctioning leave to District Residents.

Responsibility of National Medical Commission:

All Medical institutions will submit the DRP posting details of the students to PGMEB of National Medical Commission within one week of completion of DRP. The PGMEB of National Medical Commission will monitor the training programme and may direct necessary changes to the State Government and Medical institutions, if so desired.

Constitution of National/State Oversight Mechanisms:

a. The National Medical Commission shall constitute a National Steering Committee in consultation with the Ministry of Health and Family Welfare, Government of India to oversee the implementation of the District Residency Programme.

b. The National Steering Committee shall be chaired by President, Post-Graduate Medical Education Board (PGMEB) or his nominee. The Committee shall comprise nominated members from the Ministry of Health and Family Welfare (not below the rank of Director/Deputy Secretary), Nominee of Directorate General of Health Services (DGHS) and representatives of at least six State Governments/Union Territories. The Committee may submit quarterly reports to the Central Government.

c. The National Steering Committee shall establish a National Coordination Cell (NCC) under the PGMEB of National Medical Commission which shall be responsible for the smooth and efficient implementation of the District Residency Programme and grievance redressal at national level.

d. The Governments of State/Union Territory shall constitute a State/Union Territory level Steering Committee chaired by Principal Secretary/ Secretary (Health) and comprising Principal Secretary/Secretary (Medical Education), Director of Health Services, Director of Medical Education, Registrar of the Health University and Deans of the medical colleges to facilitate the implementation of the District Residency Programme.

Launch of the District Residency Programme:

The District Residency Programme shall be implemented with the PG (broad specialty) batch that has joined for the post-graduate course in the Academic Session 2021.

To view the Draft, click on the link below:

https://medicaldialogues.in/pdf_upload/mer-218613.pdf

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