Duty or detour? The unfulfilled promise of the district residency programme in India

The spectrum of experience: From empowerment to exploitation

On paper, the DRP is a masterstroke, an immersion into real-world medicine without the comfort of multi-specialty support. In practice, experiences vary wildly.

Some dermatology residents return from DRP with a deeper appreciation for public health dermatology, having built rapport with patients who have never seen a skin specialist. Practicing without tertiary-level support compels them to innovate, and it becomes a lesson in improvisation, resilience, and clinical humility. These stripped-down conditions may paradoxically sharpen diagnostic reasoning and self-reliance, clinical judgment, and promote independence. The experience fosters collaboration with district medical officers, local community health workers, and administrators, and these relationships can evolve into future roles in policy, epidemiology, or community medicine. Others feel stranded, academically isolated, under-supervised, and overworked. What one district hospital cultivates as resilience, another converts into burnout. While the lived experience of residents is central, certain systemic concerns merit further scrutiny.

Beyond the paper: What’s still missing

The recently published viewpoint thoughtfully outlines both the merits and pitfalls of the DRP from dermatology residents’ perspectives.³ However, several crucial elements remain underexplored and warrant amplification:

Lack of structured curriculum and assessment- While the DRP is described as “educational,” there is no standardised national curriculum and no formal assessment strategy. This results in highly variable learning outcomes that depend more on individual initiative than institutional intent.

Incentivising teaching and mentorship: Faculty at DRP sites often function without academic credit or promotion pathways. Recognising and incentivising supervisors at these peripheral hospitals is essential to build a sustainable mentorship model.

Monitoring without consequence: The DRP is now digitally tracked, but what happens after poor feedback? There are no remedial pathways, escalation mechanisms, or defined consequences. Monitoring without meaning reduces accountability to a mere administrative exercise.

Safety and infrastructure are still afterthoughts: While the original article mentions security and housing concerns, there is a need to treat these as non-negotiable baselines, not unfortunate side effects of rural training. Without adequate housing, internet access, and functional transport, no training programme can claim to be “educational.”

Looking ahead: From mandate to mission

Many countries have implemented rural training programs with mixed success. Australia’s John Flynn Programme and the U.S. Rural Training Tracks (RTTs) show that the key ingredients for success include structured supervision, clear incentives and sustained investment in rural infrastructure. India deserves better from its postgraduate medical education, and so do its residents. For the DRP to evolve meaningfully, we need three core shifts:

Structure over symbolism: Define specialty-specific learning goals and ensure real-time academic engagement through virtual case discussions or integration with parent departments.

Mentorship over monitoring: Move beyond attendance logs. Build a culture of supported supervision, feedback loops, and academic recognition for peripheral faculty.

Safety over sentiments: Romanticising rural service cannot justify avoidable risks. Secure housing and grievance redressal must be guaranteed, not just recommended.

Reclaiming the spirit of the DRP

The DRP was never meant to be a tick-box of nationalistic virtue. At its best, it is a crucible for empathy, resilience, and clinical growth. But this vision demands thoughtful design and persistent oversight. If we wish to retain the DRP as a pillar of postgraduate training, it must stop being the “mandatory month” and start being the “meaningful mission” it was promised to be.

Ankan Gupta and Archana Singal

Content Editor and Editor-in-chief