Ever since the previous update on NMC’s (National Medical Commission) changes in their guidelines for MBBS syllabus (Bachelor of Medicine, Bachelor Of Surgery), CBME (Competency-Based Medical Education); as of September 12, 2024. The NMC has made required changes to the curriculum by removing references to lesbianism and sodomy as “unnatural sexual offenses”.
However, on September 19, Medical Dialogues reported that the Madras High Court raised concerns regarding the NMC’s usage of the term “Gender Identity Disorder” to describe genderqueer/trans/non-binary gender identities. This terminology has since been revised, as of October 20, 2024, according to NMC’s website.
Also read: MBBS: Master’s in Bigotry & Bias Studies?
What Are The New Guidelines?
The update in NMC guidelines has been addressed across 7 sections and subsections in the doc, highlighting changes made to previously exclusionary and discriminatory language used while referring to queer and disabled identities.
Note: The NMC does not have any authority over the textbooks used as part of MBBS programs, however, Justice Venkatesh of Madras High Court has been advocating for inclusive changes in medical education for a few years now.
You can read the NMC’s exact report on their updated guidelines on their website here.
What we have understood:
1. References to ‘Gender Identity Disorder’ to describe trans-ness and gender dysphoria has been replaced with “Pyschosexual Disorders And Sexual Orientation, Gender Identity, And Expression”, prompting the question – why is gender diversity & sexuality being grouped with psychosexual disorders?
2. The earlier focus on “abnormalities” in reference to varied physiological sex characteristics has been rectified. A question about it now reads: “Explain sex determination, sex differentiation, and their physiological alterations and discuss the effects of removal of gonads on physiological functions.”
3. Pediatric section has also been revised.Textbook now reads: “describe adolescent sexuality, diversity in sexual orientation, and gender identity.”
4. Disability Competencies, the NMC has notified that changes are being reviewed by an expert committee, as directed by the Supreme Court. This comes on the heels of the Supreme Court’s recent judgment (on October 15, 2024) on a petition filed by a medical aspirant who was disqualified from pursuing a medical course, despite clearing the National Entrance & Eligibility Test (NEET). This was done in accordance with the Graduate Medical Education Regulation, which states that people quantified as having over 40% disability will be ineligible for admission into medical school. The Apex court’s ruling stated that such a blanket treatment to disqualified disabled folx from medical education cannot be allowed
5. Patient History, which was introduced to the guidelines from 2019, that every MBBS graduate has to undergo training to learn how to take down a patient’s medical history without being judgemental about the information shared by the patient.
6. As for textbooks, the NMC has clarified conveniently that changes in the medical textbooks fall outside its jurisdiction.
7. The word “Heterosexual” has not been used in the entirety of guidelines. They have further clarified that any patient/client seeking gynecological treatment are not to be assumed as heterosexual cis-women.
8. Medico-Legal knowledge on the LGBTQIA+ issues are already addressed at school level, and doesn’t fall within the scope of the MBBS Curriculum. It’s unclear whether this knowledge is allegedly address at the high school level or medical school level. On both counts, it is insufficient, if not abysmally absent.
What Does The Court Say?
The Madras High Court has given the NMC until January 6, 2025, to make necessary changes to its guidelines. With a 4-month timeline to revise and address outstanding issues, all eyes will be on the court’s next hearing scheduled for January.
The updated guidelines, published on September 12, 2024, led the court to remark that, “only certain issues were addressed.” The court is now urging the NMC to make further revisions. It’s almost surprising that the NMC does not already have a dedicated team or an expert committee in place to ensure that this back-and-forth with the court does not persist—or are they deliberately stalling?
What Does Gaysi Say?
To truly make progress, perhaps a committee with expertise and lived experience in queer and disabled sensibilities should be brought onboard to help the NMC make these reviews and revisions effectively. It is essential that those drafting these guidelines are deeply sensitized to queer and disabled experiences and committed to creating lasting, meaningful change in the system.
Queerness is not something that needs to be medically erased, it has always existed and will continue to exist. The real question is, how easy are we making it for people to coexist? The same goes for disability. It’s not new, but as more people access diagnosis and ask for accommodations, the medical field has the opportunity to demonstrate humanity-first growth. A medical institution’s goal should be to build systems that support people with disabilities, helping them live fully in our world by building systems of care.
