Push to include competencies framed by disabled community, experts in MBBS curriculum
The need to train medical students in treating disability and people with disabilities has been raised time and time again. Finally there appears to be some move in this direction. Experts are asking the Medical Council of India to include the disability competencies framed after a series of discussions with the disabled community in the MBBS curriculum and training.
The inclusion of a rights-based perspective towards disabled people in the medical curriculum and training is vital to ensure disabled patients are treated with empathy.
This is mandated by law as well. Section 47(1)(b) of the RPWD Act says disability should be a component of education courses at schools and colleges, while Section 39(2)(d) specifies that orientation and sensitisation towards disability and people with disabilities should be a part of university and professional training.
Finally, there seems to be some movement forward due to the tireless efforts of disability rights advocate Dr Satendra Singh, and founder of Doctors with Disabilities. Dr Singh, along with the Bucksbaum Institute for Clinical Excellence, University of Chicago framed a set of Disability Competencies after focused group discussions with disabled people, doctors with disabilities, disability rights activists and medical educators.
Responding to a petition by Dr Singh, the Chief Commissioner for Persons with Disabilities (CCPD) wrote to the Secretary General, Medical Council of India Board of Governors (MCI BoG) for compliance. After this, the MCI BoG sent a letter to the deans of all medical colleges and institutions in India to follow the provisions.
Dr Singh has urged the CCPD to direct the MCI BoG to include the Disability Competencies in the curriculum. In a letter, he has said,
As Section 39(1)(f) of RPDA mandates the Government in consultation with Chief Commissioner to ..ensure that the rights of persons with disabilities are included in the curriculum in Universities, colleges and schools. I request your Office to recommend our CRPD-compliant disability competencies to the Medical Council of India and Directorate General of Health Services, MoHFW, so that disability as a human rights issue is covered in the MCI curriculum. - Dr Satendra Singh, Doctors with Disabilities
The MCI BoG is mandated to include disability rights into the new curriculum in consultation with the CCPD while the United Nations Convention on Rights of Persons with Disabilities clearly says that people with disabilities must be involved in policy decisions. Until now, the MCI BoG had shown little initiative, forcing a formal complaint.
The next challenge is the inclusion of the competencies in the MBBS curriculum. Since the curriculum for the coming session is out, there is the option of including them as an elective subject in the third year. Every medical college has the option of choosing two electives depending on the avenues open to them. One of the immediate options available is to include the disability competencies there.
However, having them as electives is not enough points out Dr Amir Khan Maroof, Associate professor, Community Medicine, University College of Medical Sciences and a member of Medical Humanities Group, which was involved in framing the competencies.
"We are looking at how we can incorporate the disability competencies in the existing curriculum throughout the course. Having them as elective subjects will deprive many students so this needs to be incorporated in the entire curriculum. We have to plan the operational model, says Dr Khan adding that this is vital as every disease leads to some sort of disability. "If we train medical students to handle disabilities, we are empowering them as doctors. When a doctor sees a patient at the OPD, he looks at the clinical aspect and goes away but the patient expects more. If he/she is unable to use one of their hands, they expect to be helped by the doctor. That part is not addressed, currently.
Another aspect the training needs to address is affordability given that patients come from varying backgrounds. "If they are trained to look at various aspects of disability from the start, that will make a difference. As doctors move up, they can apply the lived experience, adds Dr Khan.
The other immediate option being looked at is introducing disability competencies at the foundation course where students are prepared for the MBBS programme. "We could look at it a sensitization session, says Dr Singh, "where three to four hours could be spent on orienting students to different types of disabilities.
Various studies have shown that a disability-centered approach in medical education helps build greater empathy. There is a need to train health professionals in skills beyond technical competence.
"What we realised during the focused group discussions with Doctors with Disabilities was that no one was listening to them, says Dr Khan. "It was in listening to them that we developed the competencies. They were sharing their lived experiences and that made us realise that they should be the one teaching us. The medical curriculum must reflect that, and disability competencies will help change the picture.