NMC Draft Regulations details District Residency Programme for 3 Months, Here is what they say

The Draft proposes 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.

Such rotation shall take place in the 3rd or 4th or 5th semester of the Postgraduate programme, the new NMC Draft Regulations spelt out. This rotation shall be termed as 'District Residency Programme' (DRP) and the postgraduate medical student undergoing training shall be termed as a 'District Resident'.

The District Residency Programmes will be implemented with the PG (broad speciality) batch that has joined for the postgraduate course in 2021.

Medical Dialogues had earlier reported that the National Medical Commission (NMC) released the Draft Postgraduate Medical Education Regulations 2021. The Draft focused on several issues including the nomenclature of PG courses, Selection of PG students, Common Counseling process as envisaged by NMC, inclusion of District Residency Programme among others.

The inclusion of the DRP has been made keeping in mind the fact that District Health System including the District Hospitals constitutes the most important part of the country's public health care enterprise.

"Doctors have to be trained in diverse settings including those which are close to the community," NMC Guidelines mentioned while introducing this program in the Draft Regulations.

• Objectives:

NMC, the Apex medical education regulatory body has mentioned several objectives for including such a program in the Draft Regulations. They are-

1. Exposing the PG students to District Health System and through involving them in the service provided at the District hospitals while learning.

2. Making the students familiar with the planning, implementation, monitoring, and assessment of outcomes of the National Health programs at the district level, and

3. Providing them with due orientation for promotive, preventive, curative, and rehabilitative services being provided by various categories of healthcare professionals under the umbrella of National Health Mission.

During the process, "the postgraduate 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," mentioned the guidelines.

• Criteria of District Hospitals:

For the DRP, the District Hospitals should 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.

• District Health System in DRP:

The District Health System in the DRP 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.

• 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 Programme Coordinator (DRPC). 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.

b. Pre-Clinical 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/laboratories 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.

• 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 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 and other academic academies.

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.

• Responsibility of Medical College/Medical Institution:

1. The medical colleges and institutions would be liable to place the PG students in the DRP.

2. The faculty of the concerned departments would guide the students by phone/e-communication.

3. Each medical college/institution will set up a committee under the Academic Cell to coordinate and monitor implementation of DRP.

• Responsibility of Government of State/Union Territory:

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

1. Department of Directorate of Medical Education and the Department of Directorate of Health Services would jointly co-ordinate the program. An Officer of the State/Union Territory Government shall be designated as the State/UT District Residency Programme (DRP) Nodal Officer. Finally, the concerned Govt would be responsible for the facilitation, oversight and supervision of DRP.

2. The Nodal Officer after consulting State Directorate of Health Services and the medical colleges would identify and designate hospitals that suit for such rotation in terms of availability of specific specialties, specialists, facilities, and services available. They would also 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.

3. The State DRP Nodal officer shall undertake rule-based allotment of the training facilities to the Postgraduate Residents using the platform developed by the National Medical Commission.

4. The State Government shall provide appropriate amenities to the District Residents, including, amongst others, suitable accommodation, mess, transportation to workplace (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.

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

6. If all the PG residents within a State/UT couldn't be absorbed within their respective jurisdiction, after due consultation with the respective Governments possibility of posting them in other States/Union Territories may be explored. In that case, the expenses of travel, food and accommodation to District Residents should be borne by the state which utilizes their services.

7. 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.

8. The State/UT Governments 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.

9. 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 DRP coordinator shall also be responsible for orienting the postgraduate residents to the District health system, supervising the postings within the district, ensuring their accommodation and transport needs, and for grievances redressed, etc.. District DRP Coordinator shall be the competent authority for sanctioning leave to District Residents.

• Responsibility of National Medical Commission:

The National Medical Commission 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 (log book, feedback form, learning resources etc.), maintain a dashboard on the programme and above all, continuously monitor the quality of the training programme.

Constitution of National/State Oversight Mechanisms:

1. NMC after consulting the MOHFW shall form a National Steering Committee to oversee the implementation of DRP.

2. The chair of such a Committee will be nominated by NMC. The Committee shall comprise nominated members from the MOHFW (not below the rank of Additional/ Joint Secretary), Nominee of Directorate General of Health Services (DGHS) and representatives of at least six Governments of States/Union Territories. The Committee will submit quarterly reports to the Central Government.

3. The Committee shall establish a National Coordination Cell (NCC) under the NMC which shall be responsible for the smooth and efficient implementation of the DRP and grievance redressed at national level.

4. 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 DRP.

• Objections to the three-month DRP:

Although NMC has introduced the District Residency Programme with an aim of strengthening the district health system, doctors have started opposing the time duration of three months of the program.

Speaking to Medical Dialogues, Dr. J A Jayalal, President of the Indian Medical Association (IMA) had said, "IMA is against the issue of district residency for three months. We don't have the proper infrastructure at the district level to host the PG residents for three months. If a Surgery PG student is going to a district hospital, who would monitor or train them? It can be implemented for a period of one month instead."

Click here to read the Draft Regulations

Also Read: Common PG medical Counselling: What NMC guidelines say and why doctors are opposing it