New Delhi: The National Medical Commission (NMC) Thursday withdrew its contentious Competency Based Medical Education Curriculum (CBME) guidelines for 2024 after vehement protests by activists who have called the guidelines “outdated” and “archaic”.
The 2024 guidelines for the undergraduate forensic medicine curriculum were supposed to replace the earlier 2019 guidelines in the upcoming academic session and apply to one lakh medical students across medical universities in the country.
The activists who opposed the guidelines have underlined that the guidelines portrayed lesbianism and sodomy as sexual offences, including sadism, necrophilia and voyeurism. That violated the Transgender Persons (Protection of Rights) Act (TPA), 2019—aimed at protecting the rights of people identifying as LGBTQ (lesbian, gay, bisexual, transgender and queer)—they have said.
Moreover, they have said that the guidelines violated the rights of those who fall under the purview of the Rights of Persons with Disabilities Act (RPDA), 2016, since they removed from the foundation course what is called the seven hours of disability competencies—regarded as best practice globally for providing healthcare to persons with disabilities.
In a letter to Union health minister J.P. Nadda and the NMC chairman, this week, two organisations, the International Council for Disability Inclusion in Medical Education (ICDIME) and the Association for Transgender Health in India, called the guidelines “outright ableist and queerphobic”.
Moreover, the guidelines contravened judgments by the Madras and Kerala High Courts and the World Health Organization’s (WHO) Global Report on Health Equity for Persons with Disabilities, 2022, the appeal to the health minister and the NMC chairman said. ThePrint has a copy of the letter.
Dr. Satendra Singh, the co-chair of ICDIME, told ThePrint that disability rights, as mandatory disability competencies, were introduced into the foundation course in 2019. However, in the now-withdrawn, 2024 guidelines, the course was reduced to just two weeks, with eight protected hours kept for sports but no mention of the seven hours for disability competencies.
“This violated section 39 (2)(f) of the Rights of Persons with Disabilities Act, 2016, which mandates the inclusion of the rights of the disabled in the curriculum of educational institutions,” Singh said.
ThePrint contacted NMC spokesperson Dr Yogender Malik over phone calls, and this report will be updated when a reply is received.
A senior member of the undergraduate board of the NMC (UGMB) who was instrumental in framing the guidelines said that the framing of CBME 2024 took nearly two months and included seeking inputs from over 100 experts in medical colleges across India.
The member, who did not wish to be named, told ThePrint, “There was some oversight on our part, and we deleted certain parts (related to disability competencies) from the 2019 guidelines which we should not have deleted and repeated some clauses (related to LGBTQ) from the 2019 guidelines which we had removed in 2022 following judicial orders.”
There will be some tweaking in the now-withdrawn guidelines before the revised version is released soon, the UGMB member further said.
ICDIME co-chair Singh said the move to put the 2024 guidelines on hold is an interim relief but added a caveat—what revisions the NMC makes in the new curriculum remains to be seen.
“That’s because the NMC is a master at doing flip-flops and taking U-turns and has become a laughing stock in the medical fraternity,” Singh, who teaches at the University College of Medical Sciences in Delhi and is also a member of the National Human Rights Commission’s Disability Core Group, told ThePrint.
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Several violations
The letter by disability and transgender organisations this week underlined that RPDA (Research in Dance and Physical Activity) aims at the integration of disability as a component in all educational courses for university teachers, doctors, nurses, and paramedical personnel.
“This is a mandatory requirement, which the NMC has blatantly disregarded,” it said.
Detailed suggestions on effectively incorporating disability and trans-affirmative competencies into the foundation course have been shared with the commission several times this year.
On the violation of TPA, 2019, the letter said that after being admonished by the Madras and Kerala High Courts, the NMC secretary issued a letter, dated 2021, to all medical universities, instructing them not to approve content that contains “unscientific, derogatory and discriminatory information on LGBTQ community”.
However, the guidelines issued early this week again suggested that “sodomy” and “lesbianism” are sexual offences and “transvestism” (cross-dressing) is a “sexual perversion”.
“These are in direct conflict with the Supreme Court’s NALSA judgment, the TPA 2019, and constitute contempt of the Madras and Kerala High Court judgments. The contempt petition against the NMC and UGMB will be addressed separately,” the letter said.
Additionally, the letter stressed that the proposed curriculum defied the World Federation for Medical Education’s (WFME) Global Standards for Quality Improvement: Basic Medical Education, 2020.
Established in an initiative of the WHO and the World Medical Association, the WFME, in 2023, awarded the NMC recognition status for ten years.
“However, the recognition committee has the discretion to require a full review within this period if there are concerns about the sustainability of the accreditation process’s quality. Any such complaint regarding the dilution of standards could lead to temporary suspension, withdrawal of recognition, or denial of the recognition status,” the letter further said.
The WFME monitors recognised agencies throughout the duration that they are recognised, the letter pointed out. The agencies complete a status report annually, starting six to eighteen months after formal recognition, and for the NMC, this status report is due soon, added the letter.
It demanded the removal of the “illegal” content from the CBME 2024 and the reintroduction of the mandatory disability and queer-affirmative competencies at the earliest—failing which the two organisations threatened to take a legal route.
The move forced the NMC to withdraw the latest version of the CBME—not the first time of late that the NMC has gone back on a decision.
A similar controversy erupted when the NMC mandated doctors to prescribe generic drugs or face penalties last year, forcing the medical education regulator to put on hold the professional conduct regulations published in 2023.
Similarly, in November 2023, after strong protests from southern states, the NMC put on hold its decision to set up more MBBS colleges and add more undergraduate seats based on the populations of states.
(Edited by Madhurita Goswami)
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