NMC announces revisions to CBME guidelines after Madras HC raised concerns about the term “Gender Identity Disorder” in the MBBS curriculum
The National Medical Commission (NMC) has announced revisions to the Competency-Based Medical Education (CBME) guidelines after the Madras High Court raised concerns about the inclusion of the term “Gender Identity Disorder” in the MBBS curriculum.
The high court recently raised significant concerns regarding the Competency-Based Medical Education (CBME) guidelines, particularly focusing on the inclusion of the term “Gender Identity Disorder” in the new MBBS curriculum.
The bench, led by Justice N. Anand Venkatesh, emphasised that this terminology perpetuates a misunderstanding of LGBTQIA+ identities as psychological disorders, which contradicts contemporary understandings and legal frameworks surrounding gender and sexuality.
Guidelines issued
In response to the observations made by the high court, the NMC has issued a corrigendum to the CBME Guidelines 2024, published on 12 September 2024. The key changes are as follows:
1. Psychiatry Curriculum Update: The section previously titled “Gender Identity Disorder” has been revised to “Psychosexual disorders and Sexual orientation, gender identity, and expression.”
Competency PS 9.2, which asked students to demonstrate knowledge of medico-legal, societal, ethical, and humanitarian principles regarding LGBTQIA+ communities, has been removed.
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2. Physiology Revision: The section on sex determination has been updated. The new guideline states, “Explain sex determination, sex differentiation, and their physiological alterations and discuss the effects of removal of gonads on physiological functions,” replacing the previous focus on abnormalities.
3. Paediatrics Curriculum Changes: The sub-topic under paediatrics now reads, “Describe adolescent sexuality, diversity in sexual orientation, and gender identity,” instead of the earlier focus on common problems related to adolescent sexuality.
4. Disability Competencies: The NMC indicated that disability competencies are currently under review by an expert committee, following directives from the Supreme Court. The revised guidelines on this matter will be released in due course.
5. Clinical History-Taking: The guidelines reaffirm the existing recommendation for clinicians to include non-judgmental approaches that elicit information on gender, sexual orientation, and behaviour during patient history-taking. This approach has been in place since 2019 and continues to be part of the training for Indian Medical Graduates.
6. Textbook Revisions: The NMC clarified that changes to medical textbooks fall outside its jurisdiction. ”Regarding the changes that needs to be made in the textbooks, since the publication of the books does not fall under the functions of NMC, there is need to direct the concerned universities to direct respective publishers to do the needful as per the modifications to be introduced by the NMC in regard to the disability guidelines. The modified disability competencies under review as mentioned above will be notified in a due course of time,” NMC said.
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Also, For instance, assumptions that all clients seeking gynaecological services are heterosexual cis-women need to be dropped. It clarified that the word heterosexual has not been used in the CBME document.
7. Medico-Legal Knowledge on LGBTQIA+ Issues: The NMC stated that knowledge regarding homosexuality, bisexuality, gender incongruence, and dysphoria is already addressed at the school level and does not fall within the scope of the MBBS curriculum.
The NMC emphasised that these revisions were made in consultation with experts in medical education to align the MBBS curriculum with contemporary views on gender and sexuality, ensuring that medical education in India adheres to ethical and inclusive standards.
Criticism and Continue withdrawal
CBME guidelines, issued in August, sparked a controversy after the NMC reintroduced lesbianism, sodomy, and other acts as unnatural sexual offences in the forensic science and toxicology curriculum of MBBS students.
Earlier, the syllabus included the requirement: “FM8.4: Describe and discuss adultery and unnatural sexual offences—sodomy, incest, lesbianism, buccal coitus, bestiality, indecent assault—and the preparation of reports, framing of opinions, and preservation and dispatch of trace evidence in such cases.”
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It also called for the description and discussion of sexual perversions, including fetishism, transvestism, voyeurism, sadism, necrophagia, masochism, exhibitionism, frotteurism, and necrophilia.
On 5 September, the NMC announced that the circular notifying the guidelines “stands withdrawn and cancelled” with immediate effect. It added that the guidelines would be “revised and reissued in due course.”
However, rights activists remained skeptical, as they believed that the NMC had a history of making sudden reversals. On 12 September guidelines, lesbianism, sodomy, and other such acts are out of the MBBS curriculum.
(Edited by Ananya Rao)
