Gross negligence’: NMC’s new MBBS curriculum guidelines can harm 3.6 crore Indians

NEW DELHI: The Competency Based Medical Curriculum (CBME) for MBBS students, released by National Medical Commission (NMC), is being called out for ignoring the rights of persons with disabilities and persons with gender incongruence.

In its latest revision, prompted by the Madras High Court’s intervention, NMC has removed references related to the LGBTQ community. However, the commission is yet to add disability competencies.

Air Cmde (Dr) Sanjay Sharma (retd) is CEO and managing director of Association for Transgender Health in India (ATHI) – a Delhi-based organisation which, along with Dr. Satender Singh, professor at University College of Medical Sciences (UCMS), New Delhi and disability rights activist, has been opposing the NMC guidelines.

He spoke to Careers360 on NMC’s flip-flops on the CBME guidelines, impact of the latest MBBS curriculum on medical education and healthcare of disabled and transgender people. Edited excerpts below.

The Association for Transgender Health in India (ATHI) is a non-profit organisation founded on November 1, 2018, that works towards diversity and gender inclusion in India. After finding that nothing was being done about transgender healthcare in India, I got together with like-minded people, who essentially understood the need of getting transgender healthcare in India, and established ATHI.

We got involved with the ministry of health, ministry of social justice and empowerment, and National AIDS Control Organization (NACO) to get them to look at holistic transgender health. In 2019, we were involved with the community to push for the Transgender Persons (Protection of Rights) Act, 2019 (TPA).

Through our efforts, we got a section in the TPA that talks about the need for changes in medical education and also for setting up protocols, or a health manual, which was in line with the guidelines that were developed by the World Professional Association for Transgender Health (WPATH), US.

In 2020, we brought out the Indian Standards of Care for Transgender and by December 2023, we got the Centre of Excellence for transgender healthcare at All India Institute of Medical Sciences (AIIMS) Delhi.

What are the provisions in the Rights of Persons with Disabilities Act, 2016, or RPDA 2016 and TPA 2019 that make it necessary for the NMC to include disability and transgender rights in medical education curriculum?Both RPDA and TPA talk about autonomy. Both laws talk about the respect that needs to be given to these individuals and their choices. Both talk about how disabled and transgender people should not be seen as those having some disease that needs to be cured. Disability and gender incongruences are human conditions.

The TPA instructs all government agencies to make sure that the right to self-affirmation of gender is respected. It provides for reservations in jobs and the need for medical care of transgender communities. The Act says it is a medico-social issue and a health manual should be developed and protocols be followed for giving gender-affirmative care.The Act talks about the need for a change in education curriculum and asks teachers, doctors, or providers of medical care to do continuing education.

It essentially gives directions to authorities to make changes in the medical curriculum so that people with disability and gender incongruence are not seen as people with diseases. It asks them to make a health manual while following the guidelines put out by the World Health Organization (WHO) and WPATHHas NMC followed the provisions of RPDA and TPA?No, they have not. NMC’s CBME curriculum continues to have literature that identifies transgender people as having some pathology. It is majorly in the textbook of forensics but also in all medical texts, starting from the basic text of physiology.

The language of the CBME document is very derogatory when it comes to referring to these people. NMC has failed despite WHO, in June 2018, saying that gender incongruence is not a mental health issue. Despite being told repeatedly, NMC has gone on to not respect self-affirmation, not having the right language, and not having the right protocols.

I think NMC is wrong in its approach and very misinformed. It is not listening to what the courts are saying, what the WHO is saying, what medical activists are saying. So this is gross negligence on NMC’s part.