'Gender Identity Disorders' reference removed! NMC issues additional clarifications on CBME Guidelines post HC order

New Delhi: Following the observations made by the Madras High Court bench regarding the gender identity issue mentioned in the recently released Competency-Based Medical Education (CBME) 2024 curriculum, the National Medical Commission (NMC) has now issued additional clarification.

Changes Introduced by NMC in the new CBME 2024 Guidelines: 

As per the Corrigendum/addendum issued by the Undergraduate Medical Education Board (UGMEB) of NMC, the Commission has modified the topic titled "Psychosexual and Gender Identity Disorders" to "Psychosexual disorders and Sexual orientation, gender identity and expression".

It has also deleted the sub-topic that asked the students to demonstrate knowledge of medico-legal, societal, ethical and humanitarian principles on dealing with LGBTQA+ community. 

For Physiology, the Commission has modified the sub topic titled "Explain sex determination, sex differentiation and their abnormalities and discuss the effects of removal of gonads on physiological functions" to "Explain sex determination, sex differentiation, and their physiological alterations and discuss the effects of removal of gonads on physiological functions".

Apart from this, NMC has also changed the sub-topic titled "Describe adolescent sexuality and common problems related to it" under Pediatrics to "Describe adolescent sexuality, diversity in sexual orientation and gender identity."

The UG Board of NMC also referred to Page 12 of the CBME Guideline 2024 which refers to Clincian, who understands and provides preventive, promotive, curative, palliative and holistic care with compassion. In reference to the recommendation "Clinical History-taking need to include approaches that elicit information on gender, sexual orientation and behaviour in a non-judgmental manner", the Commission clarified that the relevant clause us given as under (which is already a part of existing CBME guideline):

"3.1.6 Demonstrate ability to elicit and record from the patient, and other relevant sources, including relatives and caregivers, a history that is contextual to gender, age, vulnerability, social and economic status, patient preferences, beliefs and values." NMC mentioned that this has already been there from 2019 and remains as such in the subjects being taught to the Indian Medical Graduates.

Disability Competencies: 

Referring to the Disability competencies, the Commission mentioned that these are under the review by the expert committee in pursuance of the directives issued by the Supreme Court and added, "Hence the same will be notified in a due course of time."

Changes Required to be Made in the Textbooks: 

NMC clarified that since the publication of the books does not fall under the functions of NMC, there is a 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, it added.

In this regard, NMC referred to an instance of the assumptions that all clients seeking gynaecological services are heterosexual cis-women need to be dropped and clarified that "This word (heterosexual) has not been used in the CBME document."

Inclusion of Medico-Legal Knowledge on Homosexuality, Bisexuality, Gender Incongruence and Dysphoria in Medical Education: 

Referring to this, NMC added that the said competencies are well taught at the school level and do not fall under the purview of the MBBS curriculum.

Madras HC Order: 

Medical Dialogues had earlier reported that taking note of the CBME 2024 guidelines, the Madras HC had expressed concerns about using the term "Gender Identity Disorder" in the new MBBS curriculum.

The HC bench comprising Justice N. Anand Venkatesh had clarified that there is no psychological disorder involved in a person belonging to the LGBTQIA+ community and held that "such a mistaken understanding must be corrected by making appropriate changes in the curriculum. Unfortunately, once again the work “disorder” has found its place even in the new curriculum and it has to be immediately removed."

Further, the court also highlighted several other concerns raised in this regard by Dr. L. Ramakrishnan in an article titled 'Curriculum Content Disorder' and directed the Apex Medical Commission to submit a report before the next date of hearing and make the necessary changes/inclusions in the curriculum before that. The matter has been listed for further hearing on 06.01.2025.

NMC Notice: 

Following the HC order, NMC issued a notice and issued additional clarification in the CBME 2024 guidelines. "In light of the observations made by the Hon’ble Court of Madras, the Corrigendum/ addendum in above CBME Guidelines, 2024 has been carried out in due consultation with the experts in the field of medical education," NMC UG Board mentioned in the notice.

"The various regulations are applicable as and when they are published and NMC circulates it to all the colleges. The contents of the MBBS curriculum are a guide to the faculty for teaching, learning and for carrying out assessment, hence each guideline cannot be added verbatim in 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 further clarified.

To view the NMC notice, click on the link below: 

https://medicaldialogues.in/pdf_upload/nmc-clarification-257248.pdf

Also Read: CBME Controversy Continues: Madras HC seeks report from NMC on Inclusion of 'Gender Identity Disorder' term in New MBBS Curriculum