In the latest version of the CBME guidelines 2024, the NMC made four changes in competencies related to sexuality and gender. One such change is by mentioning homosexuality as an abnormality. It has been a month since the revised MBBS course guidelines were released from the portals of the apex medical education regulator, but the issue of competencies on disability remains a quandary.

The NMC, in its clarification dated October 10, stated, “In view of the observations made by the Hon’ble Court of Madras, corrigendum or addendum in the above CBME Guidelines, 2024, has been carried out in due consultation with the experts in the field of medical education, which is attached herewith for the perusal of the stakeholders.”

The clarification document was uploaded on NMC’s official website on October 16.

The NMC published the guidelines for CBME 2024 for the MBBS curriculum on August 31, which it cancelled and withdrew on September 5 in the wake of the scathing criticism that activists and academics had showered upon this piece of draft. The National Medical Commission later published its revised CBME curriculum guidelines, 2024, on September 12, from which it removed the reference to sodomy and lesbianism as “unnatural sexual offences” under the “sexual offences” topic within clinical forensic medicine.

In its order on September 18, the Madras High Court sued NMC for issuing a medical curriculum on gender and sexuality with outdated and inaccurate content. The court noted: “Even in the fresh guidelines, only certain issues were addressed, and there were many areas where concerns were raised.”

NMC’s CBME revision on sexuality

On September 18, a single judge bench of Justice N Anand Venkatesh at Madras High Court showed its concern over the usage of the term “gender identity disorder” under the psychiatric competency. The court directs that the “disorder” of the new curriculum be removed forthwith and makes it amply clear that “there is no psychological disorder involved with being a member of the lesbian, gay, bisexual, transgender, intersex, queer, asexual (LGBTQIA+) community and such a mistaken understanding must be corrected by making appropriate changes in the curriculum”.

Now, The Graduate Medical Education Board (UGMEB) of NMC has replaced the title of “psychosexual and gender identity disorders” competencies under the psychiatry subject of MBBS with “psychosexual and sexual orientation, gender identity and expression”. Moreover, the compulsory competency that the student must “demonstrate knowledge of medico-legal, societal, ethical and humanitarian principles on dealing with LGBTQA+ community”, under the new title stands deleted.

In another competency needed in the MBBS subject of physiology, NMC has used the word “abnormalities” instead of “physiological alterations”. The UGMEB of NMC has replaced the competency of “explain sex determination, sex differentiation and their abnormalities and discuss the effects of removal of gonads on physiological function” with “explain sex determination, sex differentiation, and their physiological alterations and discuss the effects of removal of gonads on physiological functions.”

NMC changes the competency for a description of adolescent sexuality and common problems related to it with “Describe adolescent sexuality, diversity in sexual orientation and gender identity” in the field of paediatrics.

Conclusion:

For the past few weeks, the new National Medical Commission guidelines regarding CBME in the MBBS curriculum have sharply drawn criticisms related to competencies of gender, sexuality, and disability. The NMC also drew flak from activists and academics who were vociferous on this issue. Even after implementing changes after the Madras High Court intervention, outdated terminologies and content were not changed.

This court decision reassures inclusivity but is far from a sound understanding of LGBTQIA+ issues, leaving no doubt about what reforms medical education needs. As the debate on the guidelines unfolds, stakeholders expect NMC to explain the kind of curriculum to adapt to conform with the progressive standards of the medical profession.

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