The NMC has done well to rethink the revisions to the CBME. It must do more to reinstate dignity of all citizens at the heart of medical education.
In 2022, following a Madras High Court order, the National Medical Commission (NMC) took welcome steps towards making the competency-based medical education (CBME) curriculum more progressive and non-discriminatory. It modified modules that characterised sodomy and “lesbianism” as unnatural sexual offences and removed the “two-finger test” as a test for virginity, among other changes. These modifications and deletions were seen as part of a wider move to afford all citizens, irrespective of their gender and sexuality, equality and dignity within the medical system. Which is why the decision to reverse those changes in August — rolled back on Thursday — bringing back definitions of virginity and “defloration”, removing the distinctions between consensual sex between queer individuals, adultery and offences like incest and bestiality, as well as doing away with a seven-hour training module on disability, were inexplicable and disheartening.
The revised curriculum also ran counter to existing laws regarding the health and well-being of the LGBTQI+ community and other marginalised groups, like persons with disabilities. For example, the Transgender Persons (Protection of Rights) Act, 2019 and the Rights of Persons with Disabilities Act, 2016 both mandate a review of the medical curriculum to address the healthcare needs of disabled and transgender persons. These provisions were made keeping in mind the gap in access and quality of healthcare between these groups and their fellow citizens. The outdated definitions of “virginity” and transvestism (defined as a “sexual perversion”) served to further stigmatise communities that have, historically, had limited or no access to social, economic and medical infrastructure. As a study by Initiative for Health Equity Advocacy And Research (iHEAR), published earlier this year, showed, thanks to a health system that is designed for cisgender and able-bodied persons in the binary of male and female, queer and transgender individuals often end up self-medicating or turning to quacks, further risking their lives and well-being. Many delay or avoid accessing healthcare because of negative experiences in the past.
With the second batch of students under the CBME system likely to enrol in October, a new generation of doctors awaits training. In a medical system that has been slow to act on legal mandates such as the provision of transgender wards and washrooms in all government hospitals by 2022, sensitivity among healthcare workers can make the crucial difference. The NMC has done well to rethink the revisions to the CBME. It must do more to reinstate dignity of all citizens at the heart of medical education.
