The district residency programme: Perception of postgraduate students at a tertiary care hospital in Jaipur

INTRODUCTION

Improvement in medical education is a crucial aspect of training health professionals.¹ The National Medical Commission (NMC) has made changes in medical education in India.^1,2 The district residency programme (DRP), announced by the NMC in the year 2020 is now a requisite part of the postgraduate curriculum in India.³ During the DRP of 3 months the resident would be posted to the district hospital and trained under supervision of the DRP coordinator (DRPC).⁴ The district resident in clinical specialties is expected to undertake the clinical responsibilities assigned such as doing outpatient, inpatient, casualty and night duties while in pre- and para-clinical subjects the district residents would be trained to contribute to diagnostic/ laboratory services, forensic services, managerial roles, and public health programmes.^3,5

The current move of NMC and its utility is a matter of debate among the residents. The 3 months rotational DRP training of the total 3-year postgraduate tenure shortens their period of learning even the basic skills advocated by NMC in their postgraduate curriculum.⁶ We aimed to understand the preferences and perception of postgraduate students about the new DRP.

METHODS

A cross-sectional study was done in October 2023 by the medical education unit of a government tertiary care teaching hospital in Jaipur after obtaining permission from the research screening committee of the institute.

Participation in the study was voluntary, and the students were enrolled after sharing the participant information sheet (PIS) in English and obtaining informed consent, both digitally.

We included 350 students who had participated in the DRP during their postgraduation.

The study questionnaires were designed based on extensive literature review of the Gazette of India and NMC order enlisting various objectives of DRP training programme. A mixed methods approach was used. The questionnaire was designed to capture perception of the postgraduates on various facets of DRP training. The first 10 questions of the instrument were close ended to incorporate the quantitative elements into the research while the last 2 questions were open ended to obtain qualitative elements into the research. The questionnaire was assessed by 3 experts from pre-, para- and clinical departments for its validity and reliability and modified accordingly.

Data collection was done using Google forms. The link to the questionnaire was circulated through social media platforms (Department-wise WhatsApp and Telegram groups).

The response to the questionnaire was on a 5-point Likert scale from strongly agree (5) to strongly disagree (1). The possible score ranged from 10 to 50. The overall perception was classified as positive, neutral, or negative if the total score was 80%–100%, 60%–79%, or <60%, respectively.

RESULTS

Of 370 students who participated in the study, 20 provided incompletely filled questionnaires. Hence, these were not considered for analysis. Of the 350 students whose questionnaires were analysed, 259 (74%) were males and 91 (26%) were females. Preclinical, paraclinical and clinical subjects were considered and included Anatomy (4), Biochemistry (11), Physiology (6), Pharmacology (9), Pathology (17), Microbiology (10), Preventive and community medicine (12), Anaesthesiology (46), Dermatology (6), Forensic medicine (3), General medicine (34), General surgery (28), Immunohaematology (5), Obstetrics and Gynaecology (40), Ophthalmology (10), Otolaryngology (7), Orthopaedics (26), Paediatrics (28), Palliative medicine (2), Physical medicine and rehabilitation (6), Psychiatry (10), Radiodiagnosis (12), Radiotherapy (8), and Respiratory medicine (10). Nearly half (49%) of the participants felt that DRP training was not able to train them in monitoring or assessment of National health programmes outcome, or orient them to preventive, curative and other aspects of health services at the district level which were the laid objectives of the DRP in the Gazette. Two-third (66%) of the participants believed that DRP training had no impact on learning and knowledge of their respective postgraduate subject and it was not justified in the postgraduate curriculum as it affected their thesis work and regular postgraduate teaching schedule in their respective departments. More than half (55%) of them felt that the duration of DRP training should be reduced while the overall perception of the participants regarding DRP training was negative, with a mean score of 26.6.

DISCUSSION

In 2019, a landmark change in the medical curriculum was the introduction of a new competency-based curriculum at both the undergraduate and postgraduate levels.⁷ The present postgraduate curriculum is tightly structured—right from when to teach, what to teach, and how to teach. Every new regulation introduced in the curriculum is associated with some teething problems in the beginning; however, with periodic updating of regulations, these can be addressed. Since the DRP was launched recently, studies on the perception of postgraduates regarding this training are lacking.

Our study provides the perception of postgraduate students of a tertiary care centre. Most participants felt that the DRP training had no impact on the learning and knowledge of their subject. It was surprising that nearly three-fifths of the respondents believed that the competencies prescribed by NMC for various specialties were not addressed during the DRP training. A firm mentor/faculty contact with students is essential during postgraduate training to facilitate the students in learning skills under supervision.⁸ However, during the DRP training, the students lacked this guidance. Further, problems related to food and accommodation were issues for most students.

There may be numerous factors that affect postgraduate medical education, including the excessive workload on the faculty due to the poor doctor–patient ratio in India.⁹ The new guidelines from NMC announcing DRP training for the postgraduates can add additional burden on the faculty, as 3 years of training is too little time to learn even the basic skills that NMC advocates.⁶ Journal clubs had been an integral part of postgraduate teaching as they aroused the interest of students in research and this, in turn, fuelled evidence-based medicine and promoted better learning through discussions and debates.¹⁰ The students believed that they missed this important aspect of learning during their DRP posting.

Our questionnaire had some open-ended questions for the participants to make suggestions regarding the DRP training. The comments were quite revealing: ‘DRP training should be reduced/equally divided among three postgraduate years or eliminated completely’ and ‘DRP training has no significance during postgraduation, it should be compulsory for interns or senior residents’.

Our study suggests that students face many problems during DRP training. These may be overcome by making some changes in the existing pattern of training, for example, shortening the duration of DRP, making telecommunication possible for the students, arranging proper accommodation especially for female students, and assigning important predefined objectives and goals during the DRP training. These could include doing open online courses on various topics or writing parts of their thesis.

The main limitation of our study was that it was conducted at a single tertiary care hospital of a city so the responses obtained cannot be generalized. However, the strength is the attempt to understand students perception of the DRP training.