NMC: Sodomy, lesbianism ‘sex offences’; 75% attendance in electives must for NExT exam

NEW DELHI: The National Medical Commission’s (NMC) new Competency-Based Medical Education Curriculum guidelines (CBME 2024) require MBBS students to be taught that sodomy and lesbianism are “unnatural sexual offences”. These are part of the “sexual offences” topic within clinical forensic medicine.

Released on August 29, the CBME also makes 75% attendance in electives – optional courses – mandatory for MBBS students to appear for the National Exit Test (NExT) and includes lessons on the role of physiotherapy and occupational therapy in managing disabilities among the elderly.

The new batch of undergraduate medical students joining medical colleges this year will write the NExT Step 1 in March 2028 and NExT Step 2 in March 2029. The 97-page CBME regulations were published on the NMC website on August 31.

Under the new guidelines governing MBBS teaching and learning, the NMC has shifted Otorhinolaryngological (ENT) and Ophthalmology subjects from part 2 of phase III of MBBS to part 1 of phase III. In regard to examiners’ appointment, the apex regulator for medical education and profession has also reduced the duration of teaching experience from four to three years.

The new curriculum has been criticised by disability activists and lesbian, gay, bisexual, transgender and queer (LGBTQ+) community activists even though the preamble to the CBME 2024 guidelines suggested they have evolved from the 2019 version, becoming “more learner-centric, patient-centric, gender-sensitive, outcome-oriented and environment appropriate.”

The CBME 2024 will supersede the earlier National Medical Commission guidelines on curriculum and will be implemented from the MBBS batch of 2024-25.

MBBS admission, duration, medium

According to NMC, the teaching, learning and assessment processes may be carried out in bilingual mode. It has suggested using Assamese, Bangla, Gujarati, Hindi, Kannada, Malayalam, Marathi, Odiya, Punjabi, Tamil, and Telugu languages along with English.

The Madhya Pradesh government had in October 2022 launched three MBBS textbooks – anatomy, physiology and biochemistry – in Hindi for first-year MBBS students. Despite the fanfare, very few students had bought Hindi MBBS books. Uttar Pradesh and Maharashtra also plan to teach MBBS students in Hindi and Marathi, respectively.

“The learning process shall include clinical experiences, problem- oriented approach, case studies and community healthcare activities,” NMC said. The MBBS course duration remains unchanged.

The NMC has asked universities to organise admission timing and process in such a way that teaching in phase I begins with induction through the foundation course at the beginning of academic year. “There shall be no admission of students in respect of any academic session beyond dates specified for each academic year. The universities shall not register any student (in MBBS course) admitted beyond the said date,” NMC said, adding that students getting admission after the last date for closure of admission shall be discharged from the course of study.

In CBME 2024, the apex medical education regulator has not set a last date for MBBS admissions. In CBME 2023, the NMC had set August 30 as the deadline.

CBME Guidelines: Foundation course in 1st year MBBS syllabus

All MBBS students will have to do a compulsory two-week foundation course to become “a learner to study medicine effectively” and must have a minimum of 75% attendance.

Dr Satendra Singh, professor at the University College of Medical Sciences (UCMS), Delhi – who advocates for disability rights amongst the medical fraternity – said that NMC has removed the mandatory seven-hour module on disability competencies from the foundation course in its new regulations, which violates the Rights of Persons with Disabilities Act (RPDA) 2016.

“Section 39(2)(f) of the RPDA mandates the inclusion of the rights of persons with disabilities in the curriculum of universities, colleges and schools. Section 47 (1)(b) further requires the integration of disability as a component in all educational courses for university teachers, doctors, nurses, and para-medical personnel. The curriculum’s sole focus on the ‘management of disabilities’ reinforces the NMC’s outdated and archaic emphasis on the medical model of disability rather than the human rights model of disability, which should be the vision of Viksit Bharat,” said Singh, a doctor with a locomotor disability.

New NMC guidelines and mentoring

The NMC has asked medical colleges to implement the mentor-mentee programme judiciously, with one mentor for every three mentees. Mentors can be professors, heads of department or assistant professors and they will be allotted their mentees during the foundation course itself, from phase 1 of MBBS.

“The mentee shall stay connected with the mentor throughout his career till he completes CRMI. Each year when 3 new mentees are added from phase 1 to the mentor, the senior batch students shall support the junior students and create a healthy sibling environment (instead of ragging),” NMC said.

This comes in the wake of the NMC task force on mental health and well-being of medical students conducting an online survey, which revealed that 27.8% of UG students and 15.3% of PG students voluntarily indicated having a diagnosed mental health disorder.

3 Phases: 1st, 2nd, 3rd, 4th-year MBBS subjects

Students will study 19 subjects in three different phases of their MBBS degree.

The four-and-a-half years of the MBBS course duration will be divided into three phases – the first and second phases lasting 12 months each, and phase three, 30 months. Phase III will again have two parts – part I lasting 12 months and part II, 18 months. Each academic year of the course will have at least 39 teaching weeks with a minimum of 39 hours a week.

The MBBS subjects will be distributed across the phases in the following pattern:

Phase 1

• Anatomy
• Physiology
• Biochemistry

Phase 2

• Pathology
• Microbiology
• Pharmacology

Phase 3 part I

• Forensic medicine and toxicology
• Community medicine
• Otorhinolaryngological (ENT)
• Ophthalmology

Phase 3 part II

• General medicine
• Pediatrics
• Dermatology, Venereology and Leprosy
• Psychiatry
• General Surgery
• Obstetrics and gynecology
• Orthopedics
• Anesthesiology
• Radiodiagnosis

NMC Guidelines for CBME guidelines 2024: Forensic medicine

Under the new CBME guidelines, the NMC requires the faculty to teach MBBS students in forensic medicine that sodomy, and lesbianism are “unnatural sexual offences” and transvestism (cross-dressing) a “sexual perversion”.

“The NMC is in violation of the Transgender Persons Protection Act, 2019. After being admonished by the Madras and Kerala High Courts, the NMC secretary issued a letter to all medical universities dated 13 Oct 2021, instructing them not to approve content that contains ‘unscientific, derogatory and discriminatory information on LGBTQ community,” said professor Singh of UCMS, Delhi.

“National Medical Commission lists anal sex, being lesbian as unnatural sexual offences; crossdressing, BDSM, fetishes as sexual perversions in its latest CBME curriculum. Three years ago, the same NMC had advised universities not to teach LGBTQ+ topics in a derogatory, unscientific way,” said Yes, We Exist (on X), a collective which raises awareness about the LGBTQIA+ community.

While AETCOM modules are included in each phase, elective courses will be taught to MBBS students in Phase 3 part II. The duration of elective courses will be one month which is further divided into two blocks of 15 days each in phase 3 part II. The electives will be mandatorily offered to students to provide them with opportunities and getting diverse learning experiences.

CBME Guidelines: Elective topics in MBBS syllabus

“Electives on topics in areas such as research methodology, research ethics, use of Artificial intelligence (AI) and computers in health and medical education, health management, health economics, Indian system of medicine, medical photography or clinical photography, global health, evidence based medicine, art and music, physiotherapy, nutrition, ethical use of technology, including artificial intelligence in medicine, literary activities may be provided by the college or institution,” NMC said.

NMC: ‘No supplementary batches in MBBS’

A university-level examination will be conducted for MBBS students at the end of each professional year and students failing to clear the regular university exams will appear in supplementary exams within six-eight weeks from the date of declaration of the results of the main examination.

“If the student fails in the supplementary examination in any phase of MBBS, the student goes to the junior batch for teaching learning as well as for university examinations. There shall be no supplementary batches,” NMC said.

No students will be given more than four attempts to pass the phase 1 examination and will have to graduate within 10 years of joining the MBBS degree programme. The 10-year duration includes medical internship.

A candidate must achieve a cumulative 50% in the university exam, with at least 40% in both theory and practical separately, to pass a subject. For subjects with two papers, a minimum of 40% in aggregate is required across both theory papers.

MBBS training, NExT exam

The NExT examination will be held at the end of the 17th or 18th month of MBBS training. Questions will be asked from general medicine, general surgery, obstetrics and gynaecology, paediatrics, and allied subjects as per NExT regulations.

The national-level NExT exam will eventually replace the National Eligibility cum Entrance Test for Postgraduates (NEET PG) and the Foreign Medical Graduates Examination (FMGE). The exam will be held for granting license to practice as a medical practitioner and for enrolment as a registered medical practitioner after completing one-year internship.