Re-revision of NMC’s CBME guidelines urged by experts
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The revised Competency-Based Medical Education (CBME) Curriculum Guidelines for 2024 published by the National Medical Commission (NMC) released recently again ruffled feathers with experts dubbing it as ‘regressive and biased against transgender and disabled individuals’. The New guidelines released on September 12, 2024, have removed the term ‘unnatural’ while listing sexual offences but the stakeholders are objecting to it for being not according to the minimum standards of the World Federation for Medical Education (WFME) and are even defying Rights of Persons with Disabilities Act, 2016 and The Transgender Persons (Protection of Rights) Bill, 2019.
Dr Aruna Vanikar, president, Undergraduate Medical Education Board (UGMEB) says, “Modified guidelines for the academic year 2025-26 onwards regarding admission of students with ‘specified disabilities’ under the Rights of Persons With Disabilities Act 2016 concerning admission in MBBS will be notified separately.” The CBME guidelines mentioned that “The disability guidelines stipulated under CBME Guidelines 2023 dated August 1, 2023, shall be applicable for the academic year 2024-25.”
Not a disorder
The omission of current and scientifically accurate content concerning LGBTQIA+ persons in the CBME Guidelines 2024 has reversed the positive changes made following the 2022 Madras High Court order that directed NMC to remove erroneous terminology, scientific inaccuracies and obsolete medico-legal information. Moreover, the guidelines have ignored the 2018 order of the Supreme Court (SC) on decriminalisation of same-sex relationships.
L Ramakrishnan, vice-president, public health NGO SAATHII, Chennai told Education Times, “Developers of the medical curriculum and writers of medical textbooks must be updated with the progress in science. In 1990, the World Health Organisation (WHO) removed homosexuality from the International Classification of Diseases (ICD). However, medical textbooks and curricula in India continued to mention it as a psychosocial disorder. The 2019 curriculum contained the same problematic references and after certain amendments in 2022, the (NMC) adjusted the curriculum for two subjects – Psychiatry and Forensics Medicine. It seems like the commission has forgotten about it and has gone back to the older curriculum.”
Learning about LGBTQIA+ individuals’ health necessities is important for all future medical practitioners and for that to happen, changes should be reflected in all areas of medical education. Merely pretending that all patients belong to heterosexual or cisgender groups and ignoring the rights of LGBTQIA+ category individuals will not solve the purpose of National Health Policy 2017, Ramakrishnan adds.
Dr Vignesh Dhananjayan, transgender, non-binary individual, working as an intern at Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, Tamil Nadu says. “The queer community were expecting inclusivity of LGBTQIA+ rights in the CBME Guidelines 2024 but were disappointed to see that it was completely omitted. After withdrawal, we again became hopeful that NMC will take more time to analyse, consult and meet stakeholders to eliminate the mistakes as people from the queer community were portrayed in a stigmatising and discriminatory way in the withdrawn competencies.”
Removal of disability rights
Dr Satendra Singh, founder, Doctors with Disabilities: Agents of Change and Director-Professor of Physiology at UCMS & GTB Hospital, Delhi, says, “The disability act very clearly under sections 39 and Sec 40 says that inclusion of disability rights in the curriculum is mandatory for doctors, nursing and paramedical courses. It is strange to know that something which is sort of one of the best practices has been ditched. India in September 2023, at the United Nations General Assembly (UNGA) highlighted the inclusion of disability competency as one of the 17 lighthouse initiatives done by the country in achieving Sustainable Development Goals (SDG) 10. That is the kind of impact our government is trying to make. On the contrary, NMC has removed disability rights from the national medical education curriculum. Meanwhile, NMC has dedicated 8 hours to sports and there is no explicit mention of disability competencies in the MBBS foundational curriculum, which were allocated mandatory 7 hours in the CBME Guideline 2019.”
Dr Singh wrote a letter to the Minister of Social Justice and Empowerment (MSJE) expressing his dissatisfaction with the new guidelines. He informed Education Times that after receiving no response from NMC and the Ministry of Health and Family Welfare, he has now issued a letter to the Minister of Social Justice.
Necessary upgradation
Medical science evolves and accordingly, medical curriculum needs to be updated from time to time. “The doctors and developers of the curriculum at NMC need to be aware of all changes and of the current state of research and scientific understandings, which needs to be reflected in all relevant areas of medical practices and education. The newly released guidelines, if not updated, will continue to negatively affect the people from the LGBTQIA+ community, as well as the medical students from the LGBTQIA+ community who will be subjected to inaccurate and stigmatised information,” says Ramakrishnan.
To rule out unscientific and unethical medical practices, “There is a need to highlight accurate information related to LGBTQIA+ persons in medical education, as this can eliminate unscientific and unethical practices to ‘cure’ something that is not even a disease. This is also against the Mental Healthcare Act (MHCA) 2017 in India. It becomes an ethical obligation of medical educators to stay up to date with the science and change the curriculum as per the new knowledge and reflect it in textbooks and teaching,” adds Ramakrishnan.
The way forward
Including LGBTQIA+ rights in the undergraduate curriculum is the best way to sensitise medical practitioners. “The old curriculum guidelines and competencies were already a great injustice done to the queer community. To undo it we need wider sensitisations of senior faculties, resident doctors and medical postgraduates. I think the only chance to correct the past mistakes was to change the UG curriculum, which NMC has missed. Which makes us believe that NMC is no longer interested in making the medical curriculum inclusive, ” says Dr Vignesh. The way forward is simple, NMC should reintroduce the earlier MCI-adopted disability competencies in the 2024 guidelines before the new batch joins, to honour Indian laws and WFME standards, else, will be forced to take legal actions, adds Dr Singh.
Dr Aruna Vanikar, president, Undergraduate Medical Education Board (UGMEB) says, “Modified guidelines for the academic year 2025-26 onwards regarding admission of students with ‘specified disabilities’ under the Rights of Persons With Disabilities Act 2016 concerning admission in MBBS will be notified separately.” The CBME guidelines mentioned that “The disability guidelines stipulated under CBME Guidelines 2023 dated August 1, 2023, shall be applicable for the academic year 2024-25.”
Not a disorder
The omission of current and scientifically accurate content concerning LGBTQIA+ persons in the CBME Guidelines 2024 has reversed the positive changes made following the 2022 Madras High Court order that directed NMC to remove erroneous terminology, scientific inaccuracies and obsolete medico-legal information. Moreover, the guidelines have ignored the 2018 order of the Supreme Court (SC) on decriminalisation of same-sex relationships.
L Ramakrishnan, vice-president, public health NGO SAATHII, Chennai told Education Times, “Developers of the medical curriculum and writers of medical textbooks must be updated with the progress in science. In 1990, the World Health Organisation (WHO) removed homosexuality from the International Classification of Diseases (ICD). However, medical textbooks and curricula in India continued to mention it as a psychosocial disorder. The 2019 curriculum contained the same problematic references and after certain amendments in 2022, the (NMC) adjusted the curriculum for two subjects – Psychiatry and Forensics Medicine. It seems like the commission has forgotten about it and has gone back to the older curriculum.”
Learning about LGBTQIA+ individuals’ health necessities is important for all future medical practitioners and for that to happen, changes should be reflected in all areas of medical education. Merely pretending that all patients belong to heterosexual or cisgender groups and ignoring the rights of LGBTQIA+ category individuals will not solve the purpose of National Health Policy 2017, Ramakrishnan adds.
Dr Vignesh Dhananjayan, transgender, non-binary individual, working as an intern at Dhanalakshmi Srinivasan Medical College & Hospital, Perambalur, Tamil Nadu says. “The queer community were expecting inclusivity of LGBTQIA+ rights in the CBME Guidelines 2024 but were disappointed to see that it was completely omitted. After withdrawal, we again became hopeful that NMC will take more time to analyse, consult and meet stakeholders to eliminate the mistakes as people from the queer community were portrayed in a stigmatising and discriminatory way in the withdrawn competencies.”
Removal of disability rights
Dr Satendra Singh, founder, Doctors with Disabilities: Agents of Change and Director-Professor of Physiology at UCMS & GTB Hospital, Delhi, says, “The disability act very clearly under sections 39 and Sec 40 says that inclusion of disability rights in the curriculum is mandatory for doctors, nursing and paramedical courses. It is strange to know that something which is sort of one of the best practices has been ditched. India in September 2023, at the United Nations General Assembly (UNGA) highlighted the inclusion of disability competency as one of the 17 lighthouse initiatives done by the country in achieving Sustainable Development Goals (SDG) 10. That is the kind of impact our government is trying to make. On the contrary, NMC has removed disability rights from the national medical education curriculum. Meanwhile, NMC has dedicated 8 hours to sports and there is no explicit mention of disability competencies in the MBBS foundational curriculum, which were allocated mandatory 7 hours in the CBME Guideline 2019.”
Dr Singh wrote a letter to the Minister of Social Justice and Empowerment (MSJE) expressing his dissatisfaction with the new guidelines. He informed Education Times that after receiving no response from NMC and the Ministry of Health and Family Welfare, he has now issued a letter to the Minister of Social Justice.
Necessary upgradation
Medical science evolves and accordingly, medical curriculum needs to be updated from time to time. “The doctors and developers of the curriculum at NMC need to be aware of all changes and of the current state of research and scientific understandings, which needs to be reflected in all relevant areas of medical practices and education. The newly released guidelines, if not updated, will continue to negatively affect the people from the LGBTQIA+ community, as well as the medical students from the LGBTQIA+ community who will be subjected to inaccurate and stigmatised information,” says Ramakrishnan.
To rule out unscientific and unethical medical practices, “There is a need to highlight accurate information related to LGBTQIA+ persons in medical education, as this can eliminate unscientific and unethical practices to ‘cure’ something that is not even a disease. This is also against the Mental Healthcare Act (MHCA) 2017 in India. It becomes an ethical obligation of medical educators to stay up to date with the science and change the curriculum as per the new knowledge and reflect it in textbooks and teaching,” adds Ramakrishnan.
The way forward
Including LGBTQIA+ rights in the undergraduate curriculum is the best way to sensitise medical practitioners. “The old curriculum guidelines and competencies were already a great injustice done to the queer community. To undo it we need wider sensitisations of senior faculties, resident doctors and medical postgraduates. I think the only chance to correct the past mistakes was to change the UG curriculum, which NMC has missed. Which makes us believe that NMC is no longer interested in making the medical curriculum inclusive, ” says Dr Vignesh. The way forward is simple, NMC should reintroduce the earlier MCI-adopted disability competencies in the 2024 guidelines before the new batch joins, to honour Indian laws and WFME standards, else, will be forced to take legal actions, adds Dr Singh.
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