The most recent changes in the Competency-Based Medical Education (CBME) Curriculum by the National Medical Commission (NMC) have been criticized by activists from disability/ transgender communities. The controversy involves the stripping of certain provisions required under the Rights of Persons with Disabilities Act (RPDA), 2016, and the Transgender Persons (Protection of Rights) Act (TPA), 2019. These provisions were incorporated in prior formats of the curriculum as an effort to prepare healthcare professionals with appropriate knowledge to serve designated vulnerable populations.
Leaders like Dr. Satendra Singh, Chairperson of the Central Advisory Board on Disability, and Dr. Sanjay Sharma, CEO of the Association for Transgender Health in India, expressed their discontent in a letter addressed to the Union Minister for Social Justice and Empowerment, Dr. Virendra Kumar. They pointed out that the curriculum that came out on August 31, 2024, did not include disability and transgender rights, and the failure was contrary to Supreme Court guidelines and previous regulations.
A Step Backward for Inclusivity
The most arguable change is that the revised curriculum removes disability competencies and other essential areas as part of transgender health. However, by accepting the arguments from activists, the NMC recalled the altered guidelines on Teachers’ Day, September 5, 2024, but reintroduced them on September 12 without changing the problematic sections. Most importantly, terms such as ‘dignity’ and ‘transgender’ were not found in the entire 466-page document.
Further, while the curriculum includes eight hours of sports, it no longer requires seven hours of disability training as the previous curriculum did. Terms like gender identity disorders and intersex being referred to as abnormalities continue to promote the old-fashioned and unaccepting attitudes to these groups.
Broader Implications
The lapse in these competencies is not only a loss for minority groups, but it also erodes India’s contributions to international projects like the United Nations Sustainable Development Goal 10 (SDG 10) on reducing inequality. The RPDA, 2016 was very clear on the inclusion of disability rights in the educational curriculum for Doctors, Nurses, and Paramedical personnel implying that the exclusion of disability groups from the CBME curriculum is not only unlawful but also unethical.
The gender bias of the curriculum worsens the invisibility of transgender health issues, which are not addressed despite the specific TPA provisions of 2019. The Act clearly mandates medical schools to incorporate some aspects of Transgender health and even to produce health manuals for medical sex reassignment. However, the gender perspective presented in the new curriculum is still far from progressive, in contrast to the legislation adopted.
Activist Pushback and Calls for Reform
The disability and transgender rights activists have called upon the government to consider these omissions before a new MBBS session commences in October 2024. They have called for the restoration of disability competencies and the use of cases that deal with vulnerable groups in the longitudinal ethics curriculum.
As outlined by Dr. Satendra Singh and Dr. Sanjay Sharma in their letter, it remains impossible to identify most of the health issues that disabled and Transgender individuals face in their lifetime while the curriculum remains a far cry from healthcare inclusion in India.
The Debate Over Sodomy and Lesbianism in the Curriculum
Worse still, the NMC further angered the community especially lesbians, gays, bisexuals, and transgendered persons for bringing back sodomy and lesbianism as unnatural sexual offenses in its curriculum on August 31. Due to pressure from various LGBTQ+ rights organizations, these contentious clauses, as well as subject matters like hymen types and virginity examination, were subsequently withdrawn in the update released on September 12. However, the inclusion and exclusion of these topics exposed some of the gaps in the NMC’s approach to diversity and sexual rights in education.
With the changing scenario of medical education in India, the omission of concerns that marginalized groups face is gravely concerning. Since activists have been pushing for the needed reforms, the NMC needs to reflect on how it prepares future physicians to be inclusive in their delivery of care. The revision of the CBME curriculum is an opportunity for India to break out of the denial that for the Indian population, there is no need to incorporate diverse knowledge in healthcare while failing to meet the basic standards of care for a mass.
