Postgraduate Residents’ Experience with District Residency Program from a Government Medical College in North India: A Mixed-method Study

Background: The National Medical Commission of India mandated a 3-month District Residency program (DRP) for all post-graduate (PG) residents from admission year 2021 onwards. We initiated it in our institute in September 2023, with a cohort of 2^nd year PG residents. As a quality control initiative in our institution, we explored their experiences, perceptions and suggestions for improvement. 
Methods: All PG residents of 1^st batch of District Residents answered a pre-validated questionnaire and participated in a group discussion regarding their experiences. A questionnaire-based survey (Google Forms®) and Focus Group Discussion sessions (FGDs) were carried out. Descriptive statistics were reported for quantitative data, while for qualitative data, grounded theory approach was used to generate themes and subthemes. 
Results:  A total of 52 PG residents participated in the study. Overall, 40 (76.9%) felt that they contributed to community healthcare and 44 (84.7%) performed duties in their own specialty. Twenty-nine (55.8%) felt that their time was not well utilized and rated learning opportunities available in district hospitals as unsatisfactory. A vast majority (43, 82.6%) did not report any improvement in their procedural skills. Safety concerns were reported by 20 (38.5%) residents. Various themes identified through FGD sessions included updating of diagnostic and management protocols in district hospitals, and gaining confidence in managing diverse patients. Negative themes included a lack of basic amenities, and overburdening of PG residents in the parent institution. 
Conclusion: There is an overall dissatisfaction among PG residents with their academic enrichment or procedural skill acquisition during DRP. Reduction in duration, capacity building of district hospitals, and provision of a conducive learning environment may help improve program implementation.