Non-inclusion of disability, transgender rights in CBME Curriculum: Centre serves notice to NMC
New Delhi: After the Madras High Court's concerns regarding the way of addressing the gender identity issues in the new Competency-Based Medical Education 2024 curriculum, now the Union Ministry of Social Justice and Empowerment has sought a response from the National Medical Commission (NMC) over the non-inclusion of disability and transgender rights laws in the new MBBS curriculum.
Writing to the Secretary of NMC, the Department of Social Justice and Empowerment mentioned in an Office Memorandum, "The undersigned (NMC) is directed to the representation made to Hon’ble Minister of Social Justice & Empowerment by Shri Siddhartha Singh, Doctors with Disabilities and Air Cmde (Dr.) Sanjay Sharma (Retd.), CEO and MD Association for Transgender Health vide letter dated 13.09.2024... and to say that you are requested to examine this matter on priority and submit your reply within 15 days."
Earlier, 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) had written to Dr. Virendra Kumar, Union Minister for Social Justice and Empowerment highlighting the non-inclusion of provisions of the Rights of Persons with Disabilities Act, 2016 and the Transgender Persons (Protection of Rights) Act, 2019 in the new National Medical Commission curriculum.
In the letter, a copy of which is with Medical Dialogues team, these activists mentioned that even in the revised CBME 2024 curriculum, the Commission failed to honor the RPDA 2016 and TPA 2019, despite acknowledging their mistakes in the media.
They highlighted that in the 466-word document, there was no mention of key terms such as "dignity" or "transgender". As per the doctors, during the teo-week foundation course, while 8 hours of protected time is dedicated to "sports", but there is no explicit mention of disability competencies which were mandatory in the 2019 curriculum (7 hours), but are now removed.
Further, they had also pointed out that the subject Psychiatry in the curriculum referred to "gender identity disorders" and the subject Physiology described differentiation/intersex variations as "abnormalities". Meanwhile, the subject of Pediatrics failed to address gender incongruence, dysphoria, or non-heterosexual orientations not mentioning SOGIESC, the activists had pointed out, further adding that the subjects in the CBME curriculum solely focused on the management of "disability" without acknowledging diversity, as outlined in the UNCRPD.
Madras High Court's Observations:
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's Clarification:
Following the Madras HC order, NMC issued additional clarification on the CBME 2024 curriculum. Issuing a corrigendum/addendum in the CBME 2024 curriculum, NMC modified the topic titled "Psychosexual and Gender Identity Disorders" to "Psychosexual Disorders and Sexual orientation, gender identity and expression".
It 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."
Among other issues that were addressed by NMC in the Corrigendum, the Commission also clarified that the Disability Competencies were under the review of the expert committee in pursuance of the directives issued by the Supreme Court and assured that they would be notified in a due course of time.
Activists Write to NMC:
Previously, writing to the NMC, Dr. Satendra Singh and Dr. Sanjay Sharma had mentioned that the Commission was confusing disability competencies in the foundation course with admission guidelines for students with disabilities and both of them were different.
Once again they wrote to NMC Secretary and NMC Counsel in the pending case before the Madras High Court and mentioned that "Disability competencies are the skills and attributes essential to providing quality health care to people with disabilities. The Disability Competencies provide a set of learning objectives targeting specific, measurable skills and behaviors required to provide quality health care to individuals with disabilities."
They also claimed that they did not receive any of the responses from NMC to any of their representations. Apart from this, the activists also addressed the additional clarifications issued by NMC and mentioned that in the clarification, NMC "wrongly stated" that disability competencies were under the review of the apex court.
In this regard, the doctors clarified that "It is the admission guidelines for students with disabilities which are sub judice." Further, the letter added, "We therefore, once again highlight that NMC's recent clarification highlights a concerning level of confusion among its experts, as they have conflated "admission guidelines" for students with disabilities with "disability competencies" in the curriculum (mandated under section 39(2)(f) and 47(1)(b) of the Rights of Persons with Disabilities, Act 2016) - two entirely distinct issues. We once again request NMC to reintroduce mandatory 7 hours of disability competencies in the two weeks of foundation course. Urgent action is required to rectify this oversight."
