The District Residency Program in India: A Community Medicine Resident’s Perspective

Sir, The District Residency Program (DRP) was launched with an idea to train doctors in diverse settings by the national medical commission in year 2023.[1,2] The stated objectives among others were to train the post graduate students of different disciplines at the secondary care level including district health system as well to help them acquire requisite knowledge about the national health programmes. However, the statement of objectives in clear terms does not seem to translate into implementation of the program at the ground level resulting in less than optimum utilization of resources. This letter to editor is based on the real-world experience of a community medicine resident gained during 3 months DRP posting. While the overall experience appears gainful but there are some glaring examples that seem to contradict the stated objectives of the program itself, which may appear localized (at times) but nonetheless worthy of attention. Exposure to district health system and services: While there were opportunities to assist in casualty and outpatient (OPD) duties, they were assigned based on the hospital’s staff need and therefore more or less adhoc in approach. The program appears to lack a default mechanism for systematic rotation that could strengthen and diversify a resident’s clinical experience. Acquaintance with national program planning, implementation, monitoring, evaluation: Much like ad hoc approach in delivering clinical experience, the residency failed to provide a systematic engagement with the National Programs. The engagement was sporadic and mid-stream with limited scope to observe or contribute in the full programmatic cycle Orientation to full spectrum of services (preventive, promotive, curative, rehabilitative): While experience in curative components was more extensive (although sporadic), the exposure to preventive and rehabilitative aspects (such as, nutrition counselling, noncommunicable disease [NCD] clinics, community outreach campaigns and mental health follow up services) remained largely overlooked Structured supervised learning: The residents were not adequately oriented regarding the objectives and expectations of the DRP. This ambiguity affected the resident’s performance and coordination with the district health authorities. Additionally, professional isolation from the parent department led to missed opportunities including inability to attend the department’s ongoing academic activities and discussions Logistic support for participation: The absence of residential accommodations, long commutes and limited transport support during night shifts remained a logistic hurdle and comprised efficient delivery of services as well generated anxiety regarding safety concerns of the resident. The success of the program depends on how rapidly we can address these and similar challenges faced in similar settings across the country. A structured orientation that outlines the program’s objectives and resident roles while addressing their concerns to ensure better engagement and learning outcomes conducted jointly between the parent institute and district hospital to align expectations will be required to begin with. Thereafter, instead of being limited to a passive observation or to ad hoc support roles, a Community Medicine resident can be employed in programmatic planning, decision making and outcome evaluation to further their skills and training. Allowing residents to virtually attend their parent department’s seminars and journal clubs during the DRP posting would help maintain academic continuity and peer connectivity. Residents from each specialty bring a distinct skill set which, if utilized effectively, can meaningfully contribute to the community. The District Residency Program needs to be dynamic through its initial years to accommodate the experiences and feedback of the residents passing through it. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.