NMC drops LGBTQ reference from CBME guidelines for MBBS; will review disability component

NEW DELHI: Adhering to the orders of Madras High Court, the National Medical Commission (NMC) has issued additional guidelines to its Competency-Based Medical Education (CBME) curriculum for MBBS course.

In its latest revision of CBME guidelines 2024, the NMC has made four changes in competencies related to sexuality and gender, including the allusion to homosexuality as an abnormality.

However, even after a month of publishing the revised MBBS course guidelines, the apex medical education regulator is still reviewing the disability competencies.

The NMC in its clarification dated October 10 had said, “In light of the observations made by the Hon’ble Court of Madras, corrigendum or addendum in above CBME Guidelines, 2024, has been carried out in due consultation with the experts in the field of medical education, which is attached herewith for the perusal of the stakeholders.”

The clarification document was uploaded on NMC’s official website on October 16.

The NMC had published the CBME 2024 guidelines for MBBS curriculum on August 31 but it cancelled and withdrew them on September 5 after facing intense criticism from activists and academics. Later, on September 12, the National Medical Commission published its revised CBME curriculum guidelines, 2024, and removed the reference to sodomy and lesbianism as “unnatural sexual offences” under the “sexual offences” topic within clinical forensic medicine.

In its order on September 18, the Madras High Court had pulled up NMC for issuing a medical curriculum on gender and sexuality with outdated and inaccurate content. The court noted: “Even in the fresh guidelines, only certain issues were addressed and there were lots of areas where concerns were raised”.

NMC’s CBME revision on sexuality

On September 18, the single-judge bench of Justice N Anand Venkatesh at Madras High Court expressed its concern over the usage of the term “gender identity disorder” under the psychiatric competency. The court has ordered the immediate removal of “disorder” in the new curriculum while emphasising that “there is no psychological disorder involved in a person belonging to the lesbian, gay, bisexual, transgender, intersex, queer, asexual (LGBTQIA+) community and such a mistaken understanding must be corrected by making appropriate changes in the curriculum”.

Now, the Under Graduate Medical Education Board (UGMEB) of NMC has replaced the title of “psychosexual and gender identity disorders” competencies under the psychiatry subject of MBBS with “psychosexual disorders and sexual orientation, gender identity and expression”. Further, the required competency that the student must “demonstrate knowledge of medico-legal, societal, ethical and humanitarian principles on dealing with LGBTQA+ community”, under the new title stands deleted.

In another required competency within the MBBS subject of physiology, NMC has replaced the word “abnormalities” with “physiological alterations”. The UGMEB of NMC has replaced the competency of “explain sex determination, sex differentiation and their abnormalities and discuss the effects of removal of gonads on physiological function” with “explain sex determination, sex differentiation, and their physiological alterations and discuss the effects of removal of gonads on physiological functions”.

In pediatrics, NMC has replaced the competency, “Describe adolescent sexuality and common problems related to it”, with “Describe adolescent sexuality, diversity in sexual orientation and gender identity”.

CBME curriculum and MBBS syllabus

In its clarification, the NMC has said that an expert committee is reviewing the component on competencies related to disability. Following the Supreme Court’s directions, its decision will be notified later.

In an email to NMC, Dr. Satendra Singh, founder of ‘Doctors with Disabilities: Agents of Change’ and professor at University College of Medical Sciences (UCMS), New Delhi wrote, “It appears that NMC is confusing disability competencies in the foundation course with disability admission guidelines, which are entirely different.”

In his communication, he demanded re-introduction of the mandatory hours on disability competencies, in the foundation course, before the commencement of the new MBBS session. The NEET-UG counselling 2024 for MBBS admission is ongoing. MCC NEET-UG counselling 2024 began on August 14.

On November 1, Singh had also filed a Right to Information (RTI) application asking NMC to provide minutes of any UGMEB or NMC meeting where the decision to remove seven hours of disability competencies from the Foundation Course was taken. He filed the first appeal on October 17 as NMC failed to provide any information on the same.

“The National Medical Commission’s recent clarification highlights a concerning level of confusion among its experts, as they have conflated “admissions guidelines” for disabled students with “disability competencies” in the curriculum — two entirely distinct issues. This confusion was already pointed out to the NMC’s counsel in the Madras High Court, yet they have failed to address this critical distinction and implement the necessary revisions in the foundation course. Urgent action is required to rectify this oversight,” Singh told Careers360.

Responding to a letter dated September 13 written by Dr Singh and Air Cmde (Dr.) Sanjay Sharma (retired), managing director of Association for Transgender Health in India, the ministry of social justice and empowerment, has asked the NMC to consider representation made by the duo regarding non-inclusion of provisions of the Right of persons with Disabilities Act, 20l6 or RPDA 2016 and the Transgender Persons (protection of rights) Act, 2019 or TPA 2019 in the new NMC curriculum.

They have demanded that the NMC introduces provisions of RPDA 2016 and TPA 2019 in the longitudinal curriculum of ethics with case studies from our cultural context on disability, transgender, intersex and queer persons with focus on intersectionality.

MBBS textbooks

Clarifying regarding the changes needed in textbooks, NMC said, “since the publication of the books does not fall under the functions of NMC, there is need to direct the concerned universities to direct respective publishers to do the needful as per the modifications to be introduced by the NMC in regard to the disability guidelines. The modified disability competencies under review as mentioned above will be notified in a due course of time.”

According to the NMC, the MBBS curriculum serves as a guide for faculty in teaching, learning, and conducting assessments; therefore, it is not necessary to include each guideline verbatim in the curriculum.

“Curriculum defines competencies, suggests teaching, learning and assessment methods. Colleges and teachers are welcome to teach all regulations so that the students become competent,” it said.

In CBME guidelines, NMC has said that teaching, learning and assessment processes may be carried out in bilingual mode. It has suggested using Assamese, Bangla, Gujarati, Hindi, Kannada, Malayalam, Marathi, Odiya, Punjabi, Tamil, and Telugu languages along with English.

The Madhya Pradesh government had in October 2022 launched three MBBS textbooks – anatomy, physiology and biochemistry – in Hindi for first-year students. Despite the fanfare, very few students had bought Hindi MBBS books. Uttar Pradesh and Maharashtra also plan to teach MBBS students in Hindi and Marathi, respectively.