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Health & Family Welfare Ministry, Medical Council of India told to include disability competencies in MBBS curriculum

The absence of disability competencies in medical curriculum and training and the consequent impact on people with disabilities has been raised time and again. The failure to include a rights based perspective towards disabled people means that time and again they are met with apathy and indifference, not care and attention.

In a welcome step, T D Dhariyal, State Commissioner for Persons with Disabilities, National Capital Territory of Delhi has written to the Ministry of Health and Family Welfare (MoHFW) asking for this gap in the MBBS curriculum to be addressed.

An earlier letter to this effect was written by Kamlesh Kumar Pandey, Chief Commissioner, Persons with Disabilities to the Medical Council of India (MCI).

In his letter, Mr Dhariyal has said that the MBBS curriculum should be designed so as to reflect and include the basic principles and essences of essential legislations like the Rights of Persons with Disabilities Act 2016 (RPWD Act 2016).

Mr Dhariyal has referred specifically to the competencies framed by Dr Satendra Singh, Founder, Doctors with Disabilities in collaboration with the Bucksbaum Institute for Clinical Excellence, University of Chicago.

The letter to the Ministry says - "Though the curriculum of medical education courses contain disability components, yet these need to reflect the provisions in the disability specific legislations like RPWD Act 2016 and the principles and approach underlying their enactment….Students pursuing medical courses should be made aware of the key provisions of these legislations, the human rights perspective and the latest approach to disability.

The competencies proposed by Dr Singh and the UCMS as given in the Disability-Inclusive Compassionate Care: Core Competencies on Disability for Health Professions Education were arrived at after a series of focused group discussions with doctors with disabilities, disability rights activists and medical educators.

What RPWD Act 2016 says

Section 47(1)(b) of the Act mandates that disability be a component of all education courses at schools and colleges with Section 39(2)(d) specifying that orientation and sensitization towards disability and people with disabilities be a part at university and professional training.

None of this finds reflection in the MCI's revised undergraduate curriculum.

The impact, says Mr Dhariyal, is that people with disabilities are deprived of basic medical care and attention.

The need to include issues affecting persons with disabilities, especially early detection and intervention is something I had written about even when I was chief commissioner. It is important that every medical professional have this information to address the specific needs of people with disabilities. Otherwise doctors will work mechanically. With the right intervention for instance, over 30% of hearing impairments can be avoided. Introducing this early in the medical training can make a big difference and the Ministry must intervene and make sure this happens - T D Dhariyal, State Commissioner (Disabilities), National Capital Territory, Delhi

Dr B Srinivas, Additional Director General, Directorate General of Health Services agrees that building sensitivity from an early stage is important.

"Even now there are well trained doctors who are not aware of the difficulties that people with disabilities face. The MBBS curriculum should have that aspect so they are more sensitive about how to deal with such patients

One of the key aspects of the disability competencies framed was that disability must be assessed and documented on a functional basis, an amendment the MCI made after two public interest litigations were filed against them in the Delhi High Court.

Dhariyal also says the curriculum change must reflect the new laws and guidelines that have come into being regarding people with high support needs.

"There should be scope in the curriculum to include further change and it should be the responsibility of the institute imparting the course to include these changes. There must be a mechanism for that.

Hopefully with two statutory bodies coming forward to take the lead, the MoHFW will look into the matter to ensure the medical curriculum is updated to reduce the barriers that people with disabilities face in accessing clinical and preventive services.

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