PG Medical Courses Lack LGBTQ+ Upgrade: Psychiatrists Express concern

New Delhi: Three psychiatrists have expressed their concern that the postgraduate medical education curriculum in India does not reflect legal advances or the consensus among professional psychiatric organisations over the issues concerning lesbian, gay, bisexual, transgender, queer-plus (LGBTQ+) individuals.

These psychiatrists have raised concerns regarding the inadequate coverage of LGBTQ-related topics and outdated terminology in the PG final-year psychiatry theory question papers, which according to these three psychiatrists underline an urgent need to upgrade psychiatry residency programmes in medical colleges.

The question papers received by PG psychiatry residents under the National Board of Examinations (NBE), the National Institute of Mental Health and Neurosciences (Nimhans) and the Kerala University of Health Sciences (KUHS) over a 10-year-period from 2013-2023 were analyzed by these doctors.

Altogether 2,373 questions were screened and the psychiatrists noted that only 11 (0.46 per cent) questions were related to LGBTQ+ topics. The proportions of LGBTQ+ questions were 0.5 per cent in the NBE papers, 0.67 per cent in the NIMHANS papers, and 0.15 per cent in the KUHS papers.

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As per the latest media report by Telegraph India, the study was led by a clinical research fellow and senior resident in psychiatry at Kasturba Medical College, Manipal, Jithin T. Joseph. It was published this week in the Asian Journal of Psychiatry.

Most of the questions in the study concerned gender incongruence (54 per cent) or homosexuality (19 per cent). There were some questions that used outdated terminology such as "sex-reassignment surgery" or "sex change operation" instead of Gender Affirming Medical and Surgical Treatment, or GAMST, the accepted terminology.

Commenting on this, Sreya Mariyam Salim, a senior resident in the psychiatry department at the Government Medical College, Manjeri (Kerala), and a study co-author said, "In current psychiatry practice, LGBTQ+ identities are regarded as normal variations — not disease or illness."

"The questions asked in the papers did not reflect the understanding of the LGBTQ+ concepts in current psychiatric practice," mentioned A.M. Miller, senior resident at Nimhans, Bangalore and the third co-author of the study.

However, questions designed to evaluate the comprehension of the candidates regarding the normality of gender identity and sexual orientation and affirmative care for LGBTQ+ individuals were remarkably absent.

Further, the Daily adds that the study did not find any difference in the pattern of questions before and after decriminalisation of homosexuality in India.

Meanwhile, back in 2018, the Indian Psychiatric Society asserted that homosexuality and lesbianism are mere variations in sexual orientation and not illnesses. Back then, a task force of psychiatrists had expressed their concerns regarding the distress experienced by lesbian, gay, bisexual, or transgender individuals while coming in terms of their own sexual identities.

The recent study analysed the exam questions to highlight the requirement to improve the PG psychiatry education to equip mental health providers with appropriate understanding for delivering affirmative and inclusive care to LGBTQ+ individuals, the authors mentioned.

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