NEW DELHI: The National Medical Commission (NMC) recently released new guidelines for the Competency-Based Medical Education (CBME) curriculum to shape the MBBS course of study for the 2024-25 academic session ensuring that it is in line with global standards. An excerpt on objectives of the Indian graduate medical training programme from the CBME Guidelines 2024 reads, “The undergraduate medical education program is designed with a goal to create an Indian Medical Graduate (IMG) possessing requisite knowledge, skills, attitudes, values and responsiveness, so that she or he may function appropriately and effectively as a physician of first contact of the community while being globally relevant.”
However, the new guidelines don’t seem to be in line with global standards.The ‘Competencies’ section in the NMC’s CBME Guidelines 2024 fails to achieve the global relevance that the curriculum aims to achieve. The recent guidelines reintroduce sodomy, lesbianism and transvestism as sexual offences. This is a step back from NMC’s earlier decision to remove them from the curriculum following a 2022 Madras High Court order. At that time, the revised curriculum also aimed to differentiate between sexual fetishes, such as voyeurism and exhibitionism, and mental disorders related to these interests. Additionally, it denounced the two-finger test for virginity as unscientific, inhuman, and discriminatory.
The reason behind the NMC’s decision to revert to the previous classification despite Madras High Court’s directives, remains unexplained. The syllabus was revised as it was ‘time to have a relook at all aspects of the various components in the existing regulations and guidelines,’ NMC noted in its CBME Guidelines, 2024.
Decoded: Competencies in the CBME Guidelines 2024
Competencies refer to the specific knowledge, skills, attitudes, and values that a medical graduate must acquire to perform effectively in real-life situations. In the context of the CBME Guidelines 2024, competencies are the abilities that an Indian Medical Graduate (IMG) must demonstrate upon completing their education to function as a primary care physician who is responsive, globally relevant, and effective as the first point of contact for the community.
The competencies included in the CBME guidelines have been framed for seven subjects: Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, Microbiology, Forensic Medicine & Toxicology. Each of these subjects comes with multiple topics and every topic is mapped to a set of competencies. Within each subject the average number of topics covered is 16, and the average number of competencies under each topic stands at around 121.
In the domain of Forensic Medicine and Toxicology, there are a total of 14 topics covering 158 competencies. One of the topics in this subject is Sexual Offence. Sodomy, lesbianism and transvestism (cross dressing) are listed under this topic.
Sodomy and lesbianism through the lens of CBME guidelines
The 2024 NMC guidelines take a step backward by defining lesbianism and sodomy as ‘adultery and unnatural sexual offences’ under the topic of Sexual Offence. These terms are grouped alongside serious crimes like incest, buccal coitus, bestiality, and indecent assault. The guidelines further require students to develop competencies in discussing and analysing these ‘offences,’ covering their legal, forensic implications, and evidence management.
This approach starkly contrasts with the 2018 Supreme Court verdict that decriminalised same-sex relations by repealing Section 377 of the Indian Penal Code. The Court’s decision was a historic affirmation of LGBTQ+ rights, emphasising that sexual orientation is a personal choice and should not be subject to state interference. The ruling also made it clear that criminal law should not be used to stigmatise or discriminate against individuals based on their sexual orientation.
By reintroducing same-sex relations into the domain of criminalised behaviour, the NMC guidelines not only undermine the progressive stance established by the Supreme Court but also risk perpetuating outdated stigmas that the legal system had decisively rejected.
Crossdressing in the prism of perversion
In the newly released 2024 CBME curriculum guidelines, transvestism, or cross-dressing has been described as a ‘perversion’ under the Sexual Offence section. Alarmingly, it is grouped alongside voyeurism, a violation involving sexual gratification from non-consensual observation, and necrophilia, a pathological attraction to corpses. Students are expected to develop competencies in analysing these so-called perversions for handling medico-legal cases.
This classification is deeply concerning, especially when viewed against the progressive stance taken by Indian courts. In the landmark National Legal Services Authority v. Union of India (2014) case, the Supreme Court recognized transgender individuals as a “third gender,” ensuring distinct rights and directing governments to provide social welfare schemes for their protection. Furthermore, the Bombay High Court, in the Anjali Guru Sanjana Jaan v. State of Maharashtra & Ors. (2021) case, upheld the right to gender self-identification, reinforcing the recognition of transgender rights.
While the legal precedents are clear–transgender and gender non-conforming individuals deserve protection and recognition–the NMC’s guidelines are outdated and regressive. By tagging cross-dressing as a perversion, these guidelines not only disregard established judicial rulings but also gleefully reinforce unacceptable stereotypes.
However, the new guidelines don’t seem to be in line with global standards.The ‘Competencies’ section in the NMC’s CBME Guidelines 2024 fails to achieve the global relevance that the curriculum aims to achieve. The recent guidelines reintroduce sodomy, lesbianism and transvestism as sexual offences. This is a step back from NMC’s earlier decision to remove them from the curriculum following a 2022 Madras High Court order. At that time, the revised curriculum also aimed to differentiate between sexual fetishes, such as voyeurism and exhibitionism, and mental disorders related to these interests. Additionally, it denounced the two-finger test for virginity as unscientific, inhuman, and discriminatory.
The reason behind the NMC’s decision to revert to the previous classification despite Madras High Court’s directives, remains unexplained. The syllabus was revised as it was ‘time to have a relook at all aspects of the various components in the existing regulations and guidelines,’ NMC noted in its CBME Guidelines, 2024.
Decoded: Competencies in the CBME Guidelines 2024
Competencies refer to the specific knowledge, skills, attitudes, and values that a medical graduate must acquire to perform effectively in real-life situations. In the context of the CBME Guidelines 2024, competencies are the abilities that an Indian Medical Graduate (IMG) must demonstrate upon completing their education to function as a primary care physician who is responsive, globally relevant, and effective as the first point of contact for the community.
The competencies included in the CBME guidelines have been framed for seven subjects: Anatomy, Physiology, Biochemistry, Pharmacology, Pathology, Microbiology, Forensic Medicine & Toxicology. Each of these subjects comes with multiple topics and every topic is mapped to a set of competencies. Within each subject the average number of topics covered is 16, and the average number of competencies under each topic stands at around 121.
In the domain of Forensic Medicine and Toxicology, there are a total of 14 topics covering 158 competencies. One of the topics in this subject is Sexual Offence. Sodomy, lesbianism and transvestism (cross dressing) are listed under this topic.
Sodomy and lesbianism through the lens of CBME guidelines
The 2024 NMC guidelines take a step backward by defining lesbianism and sodomy as ‘adultery and unnatural sexual offences’ under the topic of Sexual Offence. These terms are grouped alongside serious crimes like incest, buccal coitus, bestiality, and indecent assault. The guidelines further require students to develop competencies in discussing and analysing these ‘offences,’ covering their legal, forensic implications, and evidence management.
This approach starkly contrasts with the 2018 Supreme Court verdict that decriminalised same-sex relations by repealing Section 377 of the Indian Penal Code. The Court’s decision was a historic affirmation of LGBTQ+ rights, emphasising that sexual orientation is a personal choice and should not be subject to state interference. The ruling also made it clear that criminal law should not be used to stigmatise or discriminate against individuals based on their sexual orientation.
By reintroducing same-sex relations into the domain of criminalised behaviour, the NMC guidelines not only undermine the progressive stance established by the Supreme Court but also risk perpetuating outdated stigmas that the legal system had decisively rejected.
Crossdressing in the prism of perversion
In the newly released 2024 CBME curriculum guidelines, transvestism, or cross-dressing has been described as a ‘perversion’ under the Sexual Offence section. Alarmingly, it is grouped alongside voyeurism, a violation involving sexual gratification from non-consensual observation, and necrophilia, a pathological attraction to corpses. Students are expected to develop competencies in analysing these so-called perversions for handling medico-legal cases.
This classification is deeply concerning, especially when viewed against the progressive stance taken by Indian courts. In the landmark National Legal Services Authority v. Union of India (2014) case, the Supreme Court recognized transgender individuals as a “third gender,” ensuring distinct rights and directing governments to provide social welfare schemes for their protection. Furthermore, the Bombay High Court, in the Anjali Guru Sanjana Jaan v. State of Maharashtra & Ors. (2021) case, upheld the right to gender self-identification, reinforcing the recognition of transgender rights.
While the legal precedents are clear–transgender and gender non-conforming individuals deserve protection and recognition–the NMC’s guidelines are outdated and regressive. By tagging cross-dressing as a perversion, these guidelines not only disregard established judicial rulings but also gleefully reinforce unacceptable stereotypes.
