Neurosurgery and cardiology were one of the earliest surgical and medical superspecialities to be started in India in the 1940s and 1950s [8, 9]. Apart from cardiology, clinical haematology, clinical immunology, critical care medicine, endocrinology, gastroenterology, hepatology, infectious disease, medical genetics, medical oncology, nephrology, neurology, therapeutic medicine, and rheumatology have sprouted from the broad specialty of general medicine over the years. General surgery branched out into neurosurgery, cardiothoracic vascular surgery, endocrine surgery, surgical gastroenterology, surgical oncology, urology, plastic surgery and recently trauma surgery, hepato-pancreato-biliary surgery and minimally invasive surgery. In paediatrics, paediatric rehabilitation, paediatric nephrology, paediatric critical care, paediatric emergency medicine, paediatric endocrinology, paediatric haematology, paediatric hepatology, paediatric neurology, paediatric nephrology, paediatric oncology, paediatric pulmonology, paediatric cardiology and paediatric gastroenterology courses have been started in various teaching colleges. DM courses in critical care, cardiac anaesthesia, neuro anaesthesia, onco-anaesthesia and paediatric anaesthesia have been initiated in India. MCh in cosmetic gynaecology, gynaecological oncology and reproductive medicine and surgery have been initiated from the broad speciality of obstetrics and gynaecology. Similar in otorhinolaryngology where MCh course in head and neck surgery have been started at few centres in India. The superspecialisation in all the above has already happened based either on disease, tissue or skill/ equipment subsets.

Orthopaedics: interested graduates can obtain education in orthopaedics by means of two major pathways in India. The entry into either of these programmes is through a national competitive exam on the basis of which they gain entry into orthopaedic education system. Master of Surgery in orthopaedics (MS Orthopaedics) is a three-year residency programme (junior residency) run in university teaching hospitals and the students are awarded the degree after the completion of a successful training with an exit examination which is based on curriculum varying from university to university in its finer details. The second pathway is Diplomate of National Board in orthopaedics (DNB Orthopaedics) which allows entry through a similar national-level competitive exam followed by a three-year residency in non-university teaching hospitals with an exit examination which is standardised on a national level. Both the pathways require completion of a thesis to be eligible for the exit examination. The curriculum of both the pathways are on par with the course structure recommended by the National Medical Commission of India [10,11,12]. Further training in the form of senior residency is available at select teaching university hospitals which can be for a maximum period of six years. The number of vacancies for senior resident is limited as compared to junior residency, hence all those with MS Orthopaedics or DNB Orthopaedics may not receive senior residency training. The senior resident is given more autonomy as compared to junior resident in the overall care of the patient.

Beyond this, structured subspecialty training programmes are offered by National Board of Examinations (Arthroplasty, Hand and Microvascular Surgery, Spine and Sports Medicine) in the form of Fellow of National Board (FNB) [13, 14]. The duration of these courses is of two years with no more than 10 vacancies all over the country. These programmes are conducted by non-university hospitals and does not require a thesis as a prerequisite for eligibility for the exit examination. Recently, Master of Chirurgiae (MCh) programmes in Paediatric Orthopaedics, Spine Surgery, Joint Replacement and Reconstruction and Hand Surgery have been initiated by few university teaching hospitals in the country which have been approved by the National Medical Commission [15]. The number of these seats is very few, a total of 85, as compared to a total of 2661 MS Orthopaedics and DNB Orthopaedics seats [7, 15, 16].