LGBTQIA+ friendly MBBS curriculum: Here is what the NMC's Expert Committee recommends
New Delhi: The Expert Committee of the National Medical Commission has made suggestions to modify the Competency Based Medical Education MBBS curriculum to make it LGBTQIA+ ( Lesbian, gay, bisexual, and transgender) Community friendly.
Issuing a notice in this regard, the Apex Medical Education regulatory body NMC has notified all the heads of medical colleges, Registrars of Medical Universities, and the Directors of all the Medical Education Boards of India about recommendations made by the Expert Committee to modify the CBME curriculum.
"In pursuance to the order dated 31.08.2021 passed by the Hon'ble High Court of Madras in W.P.(c) No. 7284 of 2021 titled Ms. S. Sushnia & Anr. Ms The commissioner of Police & Ors., an Expert Committee was formed by Undergraduate Medical Education Board to address the issues related to LGBTQIA+ Community. The Expert Committee, after detailed discussion and deliberation, recommended to make modifications in Competency Based Medical Education curriculum," read the NMC notice dated August 18, 2022.
Medical Dialogues had last year reported that the Madras HC had highlighted the need of revamping 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.
At that time, the court had pointed out that medical professionals often apply treatment methods on transgenders which are more of a conversion therapy camouflaged as medical and mental health support.
The court had 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'.
Back then the court had sought the NMC to file a report as to how it will be going to handle this issue in the future by carrying out necessary changes in the curriculum.
Consequently, complying with the suggestions and views put forward by the HC bench, the NMC had issued an advisory for all the medical institutes across India. It had directed the concerned authorities as well as authors to amend the information in the textbooks and not recommend those textbooks and data with unscientific and discriminatory information about virginity, LGBTQIA+ Community, and homosexuals.
On the basis of the HC order, an expert panel had also been constituted by the President of NMC's UG Medical Education Board, Dr. Aruna Vanikar. The panel consisted of following members: Dr Vijendra Kumar, Member-UGMEB; Dr Prabha Chandra, Senior Professor, Psychiatry, NIMHANS; Dr Surekha Kishore, Executive Director, AIIMS, Gorakhpur and Dr Indrajit Khandekar, Professor, Forensic Medicine, MGIMS, Sevagram.
The panel suggested several changes in the MBBS syllabus including removing the word "unnatural" from the classification of sexual activities like sodomy, buccal coitus, lesbianism from the subject of Forensic Medicine & Toxicology of MBBS course.
Now, NMC has notified the medical institutes across the country about the modifications recommended by the Expert Committee. Such modifications mainly covers the subjects including Forensic Medicine Competency and Psychiatry Competency.
NMC notice in this regard read, "In view of the court orders in W.P.(c) No. 7284 of 2021 titled Ms. S. Sushma & Anr. Vs The Commissioner of Police & Ors., the expert committee formed by Undergraduate Medical Education Board recommended modifications in the competencies (CBME) of Forensic Medicine subject Nos. FM 3.16, FM 3.13, FM 3.17, FM 3.18 and competencies of psychiatric subject Nos. PS 13.1 to 13.7) as follows:"
| Sr | Existing competency | Modified Competency |
| Forensic Medicine Competency | ||
| 1 | FM3.16 Describe and discuss | FM 3.16: |
| adultery and unnatural sexual offences- sodomy, incest, lesbianism, buccal coitus, bestiality, indecent assault and preparation of report, framing the despatch of trace evidences in such cases. | Describe and discuss informed consent in sexual intercourse. Describe and discuss histories of gender and sexuality-based (sexual orientation) identities and rights in India. Describe history of decriminalisation of 'adultery' and consensual adult homosexual sexual behaviour. Describe sexual offences with its medicolegal significance- - forced/non-consensual penetrative anal sex forced/non-consensual oral sex sexual acts with animals/ bestiality/zoophilia,forced/non-consensual insertion of fingers or objects, forced/non-consensual touching or groping or disrobing (`indecent assault'). | |
| 2 | FM3.13: Describe different types of sexual offences. Describe various sections of IPC regarding rape including definition of rape (Section 375 IPC), Punishment for Rape (Section 376 IPC) and recent amendments notified till date | FM3.13: Describe various sections of IPC & CrPC related to definition of rape and sexual assault, medical examination of rape victim and accused of rape, police information by the doctors and medical care with recent amendments notified till date (i.e., Section 375 IPC, 166 B IPC, 357 C & 164 A, 53 A of CrPC). Describe the relevant provisions of POCSO act related to medical examination, emergency medical care and police information. |
| FM3.17: Describe and discuss the sexual perversions fetishism, transvestism, voyeurism, sadism, necrophagia, masochism, exhibitionism, frotteurism, Necrophilia. | FM3.I7. Describe the difference between Paraphilia and Paraphilic disorder. Describe paraphilic disorder as per as per the latest guidelines of DSM & ICD and describe medico-legal implications of paraphilic disorder by referring scientific literature and legal justification (if any). Describe and discuss the various paraphilias in the context of informed consent during any sexual interaction. | |
| 4 | • FM3.18 Describe anatomy of male and female genitalia, hymen and its types. Discuss the medico- legal importance of hymen. Define virginity, defloration, legitimacy and its medicolegal importance. | FM3.I8 Describe legitimacy and its medicolegal importance. Describe and discuss how 'signs' of virginity (so called 'virginity test', including finger tests on female genitalia) are unscientific, inhuman and discriminatory. Describe and discuss how to appraise the courts about unscientific basis of these tests if court orders it. |
| 5. | FM14.14: To examine & prepare report of an alleged accused in rape/unnatural sexual offence in a simulated/ supervised environment | FM14.14: To examine and prepare report on an alleged accused person in cases of various sexual offences in a simulated/ supervised environment. Demonstrate an understanding of framing the opinion, preservation and despatch of trace evidences in such cases. Describe and discuss personal opinions and their impact on such examinations and the need for objectivity/neutrality to avoid prejudice influencing the case. |
| 6. | FM14.15 To examine & prepare medico-legal report of a victim of sexual Offence /unnatural sexual offence in a simulated/ supervised environment. | FM 14.15 To examine and prepare medicolegal report on an alleged victim of various sexual offences in a simulated/ supervised environment. (Guidelines and Protocols of Medico Legal Care for Survivors Victims of Sexual Violence. Ministry of Health & Family Welfare, GOI- with latest modifications if any). Demonstrate an understanding of framing the opinion and preservation and despatch of trace evidences in such cases. Describe and discuss sympathetic/ empathetic examination and interview of victims of sexual assault, including presence of trusted adult figwe in cases of minor victims. |
| Psychiatry Competency: | ||
| 7. | Topic Name: Psychosexual and gender identity disorders (Vol II Page 210) | Topic Name: Human sexuality; Gender incongruence or Gender dysphoria; Gender non-conformity; Differences of sex development (DSD) or Intersex; Paraphilia and Paraphilic disorders; Sexual dysfunctions. |
| 8 | PS 13.1: Enumerate and describe the magnitude and etiology of psychosexual and gender identity disorders. | PS13.1: Demonstrate an understanding of difference |
| PS13.2 Enumerate, elicit, describe and document clinical features in patients with magnitude and etiology of psychosexual and gender identity disorders. | between sex and gender/ biological and social construction of personhood; | |
| PS 13.3 Enumerate and describe the indications and interpret laboratory and other tests used in psychosexual and gender identity disorders | Demonstrate an understanding of gender identity; | |
| PS 13.4 Describe the treatment of psychosexual and gender identity disorders including behavioural, psychosocial and pharmacologic therapy. | Demonstrate an understanding of transgender, gender non-conformity, and other gender diverse identities. | |
| PS13.5 Demonstrate family education in a patient with psychosexual and gender identity disorders in a simulated environment. | Demonstrate an understandinaz, of sexual/sexuality identity, sexual orientation, sexual desire; | |
| PS13.6 Enumerate and describe the pharmacologic basis and side effects of drugs used in psychosexual and gender identity disorders. | Demonstrate an understanding of the wide variety of sexual orientations and desires; Describe and demonstrate an understanding of the differences in sex development in individuals who don't fit into the biological binary of male or female. | |
| Demonstrate an understanding of common myths and misconceptions about LGBTQIA + identities like Hijra, Intersex. | ||
| Demonstrate an attitude of openness and respect for all genders and sexualities. Demonstrate an understanding of common psychosocial stressors faced by members of LGBTQIA+ communities in India. Demonstrate Knowledge about basic tenets of LGBTQIA+ affirmative counselling. | ||
| PS13.2: Demonstrate the ability to assess the gender identity of an individual and distress caused (if any) due to the individual's own gender identity in a simulated environment. | ||
| PS13.3: Describe and understand how to discuss sexual orientation, sexuality identity, gender identity, as well as intersex identity (differences in sex development) as part of routine history taking. | ||
| P513.4: Demonstrate in simulated environment the ability to educate and counsel individuals or family members about intersex variations, sexual orientations, sexuality identities, gender incongruence, gender dysphoria, and gender identities. Demonstrate knowledge that conversion therapy practices for sexual orientation or gender identity or on people with intersex variations are unethical. | ||
| PS13.5: Describe differences between Gender Incongruence and Gender Dysphoria. Describe and demonstrate an understanding of the biological and gender binaries, rejection of gender binary, gender non-conforming, gender non-binary, androgynous, and other identities. | ||
| PS13.6: Describe and discuss Gender Dysphoria. Enumerate criteria to diagnose Gender Dysphoria according to the latest psychiatric classifications (refer to WPATH guidelines} and when to refer an individual to a mental health professional. | ||
| PS13.7 Discuss situations where there is a role for mental health support in Gender Dysphoria i.e., discussing with family, deciding on hormonal treatments or Sex Reassignment Surgery (Gender Affirming Care or Gender Affirmative Therapies or Gender Confirmation Surgery). Demonstrate in simulated environment the ability to educate and counsel individual and family members about various types of sexual orientation being normal. | ||
| PS 13.8 Demonstrate in simulated environment the ability to educate an individual and family members that the gender of an individual can be different than the sex assigned at birth and also educate about the difference between sex and gender of an individual. Demonstrate the ability to assess gender incongruence in an individual with intersex variations due to their gender identity. Demonstrate knowledge and ability to educate family members that unnecessary medical interventions on individuals with intersex variations are unethical. | ||
| PS13.9: Describe the difference between Paraph ilia and Paraphilic disorder. Describe different paraphilias. Describe and discuss the importance of informed consent during any sexual interaction. Describe and discuss impact of personal opinions on working with people who express paraphilias. | ||
| PS13.10: Describe the prevalence & etiology of paraphilic disorders. | ||
| PS 13.11 : Enumerate criteria for the diagnosis (diagnostic criteria) of paraphilic disorders according to the latest psychiatric classification. | ||
| PS13.12: Demonstrate in the simulated environment the ability to educate the individual/family members that paraphilia in itself is not a disease and may not require clinical intervention. | ||
| PS13.13:Enumerate the reasons for specialist referrals for any of the cases. | ||
| PS13.14: Describe the stages and differences in the human sexual cycle. | ||
| PS13.15: Enumerate the diagnostic criteria of various sexual dysfunctions corresponding to the stages of the human sexual cycle. | ||
| PS13.16: Describe the management (till the level of MBBS graduate domain) and reasons for specialist referral in cases of sexual dysfunction. | ||
To view the official notice, Click here : https://medicaldialogues.in/pdf_upload/doc00039820220822155626-184022.pdf
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