Lesbianism 'unnatural sexual offence', transvestism a 'sexual perversion': New MBBS curriculum guidelines draws flak

New Delhi: The recently released Competency-Based Medical Education (CBME) 2024 guidelines have drawn flak as two activists representing the disabled and transgender people recently wrote to the Union Health Minister and the National Medical Commission (NMC) alleging how these guidelines violated the Rights of Persons with Disabilities Act (RPDA) 2016 and the Transgender Persons (Protection of Rights) Act (TPA) 2019.

As per the activists, the newly released MBBS curriculum listed sodomy and lesbianism as "unnatural sexual offences" and also removed the Disability Competencies, which should have been longitudinally throughout the curriculum in AETCOM, from the guidelines. An RTI has also been filed in respect to the latter.

Highlighting these irregularities, Dr. Satendra Singh from Doctors with Disabilities: Agents of change (India), co-chair of the International Council for Disability Inclusion in Medical Education, and Disability Core Group, National Human Rights Commission (NHRC), and Air Cmde (Dr) Sanjay Sharma (Retd) CEO & Managing Director of Association for Transgender Health in India (ATHI) mentioned in a joint statement that if NMC does not respond to their objections, they will write to the World Federation of Medical Education seeking a temporary suspension of the NMC's recognition "for the violations of WFME standards and the laws of India (RPDA 2016 and TPA 2019) until the necessary requirements are fulfilled."

Medical Dialogues had earlier reported that NMC recently published the Competency-Based Medical Education (CBME) 2024 curriculum laying down the guidelines for the MBBS course. 

Lesbianism, Sodomy are Listed as "Unnatural Sexual Offences": 

Under the Curriculum for Forensic Medicine, the CBME 2024 has listed "lesbianism" and "sodomy" as "unnatural sexual offences", which according to the activists is a violation of the TPA 2019.

Further, it identified "transvestism" (cross-dressing) as a "sexual perversion". Claiming that these instances violate the judgments of the Supreme Court and High Courts and also the TPA 2019, the activists mentioned in their letter directed to the Union Health Minister Shri J P Nadda and the NMC Chairperson, "...the NMC is in violation of the TPA 2019. After being admonished by the Madras and Kerala High Courts, the NMC Secretary issued a letter to all medical universities dated 13 Oct 2021, instructing them not to approve content that contains ‘unscientific, derogatory and discriminatory information on LGBTQ community’. Dr. Vijayendra Kumar, Chairperson of this committee, is also a member of the twomember committee of the Undergraduate Medical Board (UGMB) finalizing that, in forensic medicine CBME 2024 (page 222), “sodomy” and “lesbianism” are sexual offenses (FM Competency number 8.4), and “transvestism” (cross-dressing) is a “sexual perversion” (FM Competency number 8.7). These are in direct conflict with the Supreme Court’s NALSA judgment, the TPA 2019, and constitute contempt of the Madras and Kerala High Court judgments. The contempt petition against the NMC and UGMB will be addressed separately."

Medical Dialogues had earlier reported that the Madras High Court in 2021 had highlighted the need to revamp the existing medical courses' curriculum and making them up to date. The bench had observed that medical courses in India reaffirm queerphobia and discrimination against the LGBTQIA + communities.

Also Read: NMC directs major changes in Medical Education Curriculum, Textbooks to make them LGBTQIA friendly, details

The court then adverted to the report submitted by a transwoman doctor, which stated that currently, for undergraduate students studying Forensic Medicine as part of the MBBS course, the medical curriculum describes sodomy and lesbianism as sexual offences, and 'transvestism' (cross-dressing) as a 'sexual perversion'.

Upset by the report, the court said it reflected how queerphobia was being reaffirmed as legitimate throughout the education of a doctor who might go on to become a psychiatrist or any physician who a person might approach from the community. The bench pointed out that the knowledge about a patient's gender identity and sexuality may be of interest to a doctor, physician and a mental health professional if it is pertinent in cracking the course of treatment, but the course of treatment cannot be one which aims to "cure" their gender identity or sexuality itself.

Back then, the Court had sought NMC to file a report as to how it would handle the issue in the future by carrying out necessary changes in the curriculum. Thereafter, in a similar order, the Kerala High Court directed the NMC to review the queerphobia text in MBBS course textbooks.

Considering these directions issued by the Madras High Court, the NMC had issued an advisory for all stakeholders, authors of medical academic textbooks, and institutions stating that "While teaching UG & PG students wherever the issue of gender or similar kind arise, the mention of Clinical history or complaints or signs/symptoms, examination findings or history about nomenclature shall not be taught in such a way that it becomes/perceived in any way derogatory/ discriminatory/ insulting to LGBTQIA+ community."

Later, NMC also removed the word "unnatural" from the classification of sexual activities including sodomy, buccal coitus, and lesbianism from the subject of Forensic Medicine & Toxicology of MBBS course.

Following this, an expert committee of NMC made suggestions to modify the CBME MBBS curriculum to make it LGBTQIA+ ( Lesbian, gay, bisexual, and transgender) Community-friendly.

Also Read: MBBS Syllabus: NMC removes word 'Unnatural' as classification for intercourse, sparks debate

Removal of Disability Competencies from MBBS Curriculum: 

Another issue that the activists have pointed out is that even though disability rights as mandatory disability competencies were introduced in the CBME 2019 guidelines, there is no mention of the same in the Foundation Course of the MBBS Curriculum, which has now been reduced to just two weeks.

Referring to this, the letter mentioned, "Based on Dr Singh’s judicial advocacy, disability rights as mandatory disability competencies were introduced into the Foundation Course of CBME 2019. The efforts were acknowledged on page number 55 of the patented NMC document. The inclusion of these mandatory disability competencies was highlighted as one of 17 lighthouse initiatives by UN India to showcase progress UN Sustainable Development Goals (SDG 10: Reduce inequality within and among countries) during the SDG mid-point review at UNGA78 in New York on 22nd September, 2023. This best practice from India was echoed by the National Council on Disability in the USA, which wrote to accrediting bodies (ACGME and Joint Commission) in 2021 regarding Disability Competency training for medical professionals. The World Health Organization’s most evidence based guidelines, the “ Global Report on Health Equity for Persons with Disabilities, 2022” also mandated disability competency training for all health worker training programs, developed in consultation with people with disabilities. This was further substantiated in our paper in The Lancet in 2023."

"However, the Foundation Course, initially a month long, has now been reduced to just two weeks, with sports given eight protected hours, yet no mention is made of the seven hours dedicated to Disability Competencies. These competencies should have been integrated longitudinally throughout the curriculum in AETCOM but are conspicuously absent from the 2024 curriculum," the letter further mentioned.

As per the activists, Section 39 (2)(f) of the RPDA mandates the inclusion of the rights of persons with disabilities in the curriculum of universities, colleges, and schools. Section 47 (1)(b) further requires the integration of disability as a component in all educational courses for university teachers, doctors, nurses, and paramedical personnel.

"This is a mandatory requirement, which the NMC has blatantly disregarded," they claimed in the letter.

Also Read: LGBTQIA+ friendly MBBS curriculum: Here is what the NMC's expert committee recommends

Further mentioning that an RTI has also been filed in this regard, the letter added, "We provided detailed suggestions on effectively incorporating disability and trans-affirmative competencies into the Foundation Course, Curriculum Support Implementation Program (CISP) at the Nodal/Regional Centers, and the Basic Course in Medical Education (BCME) in our letters to the NMC Secretary on 17th April, 29th August, and to the Regional Center MAMC on 22nd April 2024. Yet, none of these were acknowledged. An RTI on this matter was filed on 1st September 2024."

Activists Plan to Seek Temporary Suspension of NMC's WFME Recognition: 

They have urged the Union Health Minister and the NMC Chairperson to "correct this wrong which not only directly impacts the interests of persons with disabilities, the transgender and gender-diverse individuals, persons with differences in sexual orientation and persons with differences in sex development, but also damages the image of our nation in the international fora".

In the letter, the activists have requested for the removal of the illegal content from the CBME 2024 and the reintroduction of the mandatory disability and queer-affirmative competencies at the earliest- not just in the Foundation Course but longitudinally in AETCOM.

"Failure to obtain justice from your high office will leave us with no choice but to lodge a formal complaint with the Recognition Committee of the WFME for substantial noncompliance with the WFME Global Standards for Quality Improvement: Basic Medical Education 2020, specifically concerning Curriculum (2.3), Students (4.1, 4.2), Quality Assurance (7.1), and Governance (8.2). Seeking the temporary suspension of the NMC’s recognition by the WFME for the violations of WFME standards and the laws of India (RPDA 2016 and TPA 2019) until the necessary requirements are fulfilled," they added.

Also Read: MBBS Now in Local Languages including Hindi! NMC allows Teaching, Learning, Assessment Using Bilingual Mode