New Delhi: Doctors joining their MD, MS and PG Diploma courses from 2020 onwards would now have to undertake a mandatory rotational duty in district hospitals for a period of 3 months, as the Medical Council of India Board of Governors ( MCI BOG) have now finalized the District Residency Programme in District Health System to this effect
The District Residency Programme will be implemented with the PG (broad specialty) batch joining in 2020, stated the MCI in recently released gazette notification, which also laid down the details of the program. To summarise the program, all PG broad specialty students will have to undergo three-month rotational duty in various clinical departments of government district hospitals having 100 beds or more. Such rotation shall take place in the 3rd or 4th or 5th semester of the Postgraduate program and postgraduate medical students undergoing training shall be termed as a 'District Resident'.
Under the program, While PG of Clinical specialties would be working under specialists at the district hospitals and would be working in outpatient, inpatient, casualty and other areas, and encompass night duties, PG medical of pre/para clinical disciplines (namely, Anatomy; Biochemistry; Community Medicine; Forensic Medicine; Microbiology; Pathology; Physiology; and Pharmacology) would be trained in and contribute to the diagnostic/laboratory services, pharmacy services, forensic services, general clinical duties, managerial roles and public health programs, etc., as applicable.
The student will be drawing full stipend/salary from their medical colleges during this duration and would also be getting a certificate at the end of their training.
The Programme shall be coordinated jointly by the Department / Directorate of Medical Education and the Department /Directorate of Health Services with the MCI BOG constituting a National Steering Committee to guide and oversee the various program aspects.
To incorporate the same, the MCI has now amended the Post-graduate Medical Education Regulations, 2000 and included a new clause,. On Clause 13, under the heading of "Training Programme", in sub-clause 13(1) following shall be added as proviso:
Provided that in respect of MD/MS students admitted with effect from academic session 2020-21, the training imparted as part of the District Residency Programme in District Health System, as provided for in sub-clause 13 (11) of these Regulations shall be considered as training imparted in a medical institution.
3. In the "Postgraduate Medical Education Regulations, 2000", in Clause 13, under the heading of "Training Programme", sub-clause 13 (11) has been added which has the following features
District Residency Programme (DRP)
(i) Preamble: Two essential tenets of postgraduate medical training are: (i) learning experiences have to be derived from and targeted to the needs of the community; and (ii) doctors have to be trained in diverse settings including those which are close to the community. The District Health System including the District Hospitals constitute the most important part of the country's public healthcare enterprise. District Hospitals represent multi-specialty facilities providing comprehensive secondary level care. Close to the communities than most medical colleges and these facilities are a major source of health services for the people.
(ii) Objectives: The main objectives of the District Residency Programme (DRP) would be
(i) to expose the postgraduate student to District Health System and involve them in health care services being provided at the District Hospital for learning while serving;
(ii) to acquaint them with the planning, implementation, monitoring and assessment of outcomes of the National Health programs at the district level; and
(iii) 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 postgraduate medical students would also be contributing toward the strengthening of services of the District Health System as specialty resident doctors working as members of the district teams.
(iii) Definition of District Hospital:
For the purpose of this program, a District Hospital shall be a functional public sector/government-funded hospital of not less than 100 beds with facilities/staff for the designated specialties at that level/facility
(iv) Definition of District Health System:
For the purpose of this program, 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 the district system engaged in running respective public health services including the implementation of national and state public health programs.
(v) District Residency Programme:
All postgraduate students pursuing MD/MS in broad specialties in all Medical Colleges/Institutions under the Indian Medical Council Act, 1956 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 Postgraduate program. This rotation shall be termed as 'District Residency Programme' (DRP) and the postgraduate medical student undergoing training shall be termed as a 'District Resident'.
(vi) Training and Responsibilities of District Residents:
a. Clinical Specialities:
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 Program Coordinator (DRPC). The clinical responsibilities assigned to the Residents would include serving in outpatient, inpatient, casualty and other areas, and encompass night duties.
b. Pre- and Para - Clinical Specialities:
Postgraduate students of pre/para clinical disciplines (namely, Anatomy; Biochemistry; Community Medicine; Forensic Medicine; Microbiology; Pathology; Physiology; and Pharmacology) will be trained by the District Hospital and Health System 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/laboratory services, pharmacy services, forensic services, general clinical duties, managerial roles and public health programs, 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.
(vii) Stipend and Leave for District Residents: The District Residents shall continue to draw full stipend/salary from their respective medical colleges for the duration 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.
(viii) 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 and 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 postgraduate teacher(s) 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 discussions etc.
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 a certificate of satisfactory completion of DRP and report on the performance of the District Resident on a prescribed format to the concerned Medical College and the Government of State/Union Territory.
(ix) Responsibility of Medical College/Medical Institution: It shall be incumbent upon all Medical Colleges/ Institutions to place the postgraduate 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 Clause 13.4 (a) of the Postgraduate Medical Education Regulations, 2000, each medical college/institution will set up a committee under the Academic Cell to coordinate and monitor implementation of District Residency Program.
(x) Application for Proportionate Enhancement of Postgraduate Seats: The Medical College/Institution may apply in accordance with the provisions of the Opening of a New or Higher Course of Study or Training (including Post-graduate Course of Study or Training) and Increase of Admission Capacity in any Course of Study or Training (including a Postgraduate Course of Study or Training) Regulations, 2000 for proportionate enhancement of MD/MS seats to the Board of Governors in super-session of the Medical Council of India to compensate for the potential compromise of work at its teaching hospital/institution due to out-posting of the postgraduate medical students/residents for the District Residency Programme. Such applications can be made after one year of the implementation of the District Residency Programme.
(xi) Responsibility of Government of State/Union Territory: The Government of State/Union Territory shall implement the District Residency Programme within their jurisdiction as under:-
a. The Programme shall be coordinated jointly by the Department / Directorate of Medical Education and the Department /Directorate of Health Services; and an Officer of the State / Union Territory Government shall be designated as the State/UT District Residency Programme (DRP) Nodal Officer. The concerned Government shall be responsible for their facilitation, oversight and supervision of the District Residency Programme.
b. The designated State/UT DRP Nodal officer shall identify and designate hospitals 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 Postgraduate 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 Postgraduate Residents using the platform developed by the Board of Governors in supersession of Medical Council of India/Medical Council of India.
d. The State Government shall provide appropriate amenities to the District Residents, including, amongst others, suitable accommodation, transportation to workplace (if living quarters are far away), security, especially for lady residents. Accommodation could be by means of government premises or that rented by concerned State Govt. 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 postgraduate residents of a State/UT cannot be absorbed within their respective jurisdiction, the 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 postgraduate 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/UT Governments may consider providing an 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 A 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 DRP the coordinator shall also be responsible for orienting the postgraduate residents to the District the health system, supervising the postings within the district, ensuring their accommodation and transport needs, and for grievances redressal, etc.. District DRP Coordinator shall be the competent authority for sanctioning leave to District Residents.
(xii) Responsibility of Board of Governors in supersession of the Medical Council of India/Medical Council of India:
The Board of Governors in Supersession of Medical Council of India shall develop a transparent electronic platform to facilitate and ensure rule-based placement of PG residents to various institutions under the District Residency Program. They shall also develop requisite norms, tools, guidelines for implementation (logbook, feedback form, learning resources, etc.), maintain a dashboard on the program, and above all, continuously monitor the quality of the training program.
(xiii) Constitution of National/State Oversight Mechanisms: (a) The Board of Governors in supersession of Medical Council of India/Medical Council of India 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 a nominee of Board of Governors / Medical Council of India. The Committee shall comprise nominated members from the Ministry of Health and Family Welfare (not below the rank of Additional/Joint Secretary), Nominee of Directorate General of Health Services (DteGHS) and representatives of at least six Governments of States/Union Territories. The Committee will submit quarterly reports to the Central Government.
(c) The National Steering Committee shall establish a National Coordination Cell (NCC) under the Board of Governors in supersession of the Medical Council of India which shall be responsible for the smooth and efficient implementation of the District Residency Programme and grievance redressal at national level.
(d) The Government 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.
(xiv) Launch of the District Residency Programme:
The District Residency Programmes will be implemented with the PG (broad specialty) batch joining in 2020.
Check out the gazette below
Also Read:Online teaching in MBBS or equivalent not allowed: MCI
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