A quiet obituary for medical diplomas

The National Medical Commission has drawn the curtain on postgraduate diploma courses in medicine. It’s communication makes 2026 to 2027 the last academic year for admissions; from 2027 to 2028, no fresh admissions will be permitted. Existing seats are to be converted into broad speciality MD or MS seats. This is not merely a regulatory closure. It is the end of a medical institution that served India for nearly a century.

Colonial beginnings

Modern medical education in India did not begin as a people’s project. In the colonial period, Western medicine was first built around the East India Company, European troops, British civil servants, and the military establishment. The ordinary Indian population came later. The sepoy, jail inmate, plantation worker, and urban poor entered the system mainly when illness affected labour, military efficiency or epidemic control. Pre-Independence India had hospitals and colleges, but not a people-centred health system. The universities of Calcutta, Bombay, and Madras, established in 1857, provided medical education within a university framework. Yet training remained uneven across provinces.

Indian planning

Before Independence, an Indian response came from the National Planning Committee, appointed in 1938 under Jawaharlal Nehru. Its National Health Subcommittee, chaired by Col. S. S. Sokhey, was a plan by Indians for Indians. It treated health as a State responsibility. Sokhey wanted medical colleges to have postgraduate and research departments. Students specialising in particular lines were to receive a diploma upon completion of defined study and hospital work. Those proceeding further could undertake research and obtain a doctorate. Postgraduate studies were also expected to include hygiene, public health, preventive medicine, and maternity and child welfare. Sokhey’s diploma linked clinical specialisation, public health and rural needs.

Subsequently, the Bhore Committee was appointed in 1943, chaired by Sir Joseph Bhore. It was still a committee of the colonial government. Yet its report became a major blueprint for independent India’s health services. Bhore found that postgraduate medical education was weak. Many universities had started postgraduate degrees and diplomas, but often without adequate teaching facilities. The only exception was the University of Madras, which had well-defined training for diplomas in obstetrics and gynaecology and ophthalmology. Government diplomas existed in tuberculosis, radiology and clinical laboratory sciences. Courses in public health and maternity and child welfare were available at the All India Institute of Hygiene and Public Health, Calcutta. Diploma subjects in the clinical and public health fields showed India’s needs. They were building blocks of secondary care.

Two pathways

Bhore made a useful distinction. One pathway was for consultants and specialists, with years of training leading to an MD or MS. The other was for practitioners who wished to practise a speciality without claiming the full academic status of a specialist. For them, Bhore suggested 12 to 18 months of training under guidance (later expanded to 24 months), followed by a diploma. This was not a shortcut. It was a response to scarcity. A new nation needed doctors who could perform Caesarean sections, give anaesthesia, manage tuberculosis, treat children, read X-rays, handle eye disease, and provide ENT and orthopaedic care outside medical college hospitals.

Bhore also understood the danger of weak diplomas. The British Goodenough Committee had warned that poorly regulated diplomas could encourage immature specialisation. Bhore, therefore, wanted a Central Committee for Postgraduate Medical Education to lay down standards and coordinate postgraduate training across the country. This warning remains relevant even today. The diploma was useful only when it meant structured training, supervised hospital work and clear competence.

Mudaliar review

The Mudaliar Committee, formerly known as the Health Survey and Planning Committee, was established in 1959 to review developments following the Bhore Committee. By then, India had entered the Five-Year Plan era. Mudaliar said that reorganising and improving district headquarters hospitals was the most important step for improving medical care. It wanted specialist services in major clinical departments, with laboratory and X-ray support for taluk hospitals and primary health centres. This is where diploma-trained doctors mattered. Mudaliar advocated postgraduate diploma courses because they could produce more specialised personnel than the basic doctor for district and taluk hospitals.

The diploma doctor became a familiar figure in India’s secondary care, working in district hospitals, mission hospitals, municipal hospitals, railway hospitals, taluk hospitals and small private hospitals. Back then, India did not have the luxury of placing a medical college in every district. Even today, not every district has a medical college with all specialist departments.

In earlier decades, districts were larger, transport was slower, and referral pathways were weaker. A medical college might be several hours away. For many families, reaching it was a question of money, distance and time. Secondary care also could not stop at the district headquarters. Sub-district hospitals, taluk hospitals and larger community hospitals required doctors with specialist skills. They needed more than a general MBBS doctor, but did not always have the environment of a teaching medical college. A Caesarean section, emergency laparotomy, complicated fracture, sick child, cataract camp, tuberculosis clinic or X-ray diagnosis could not wait for an ideal specialist network. In many such settings, the diploma doctor was the available specialist hand.

Regulatory end

The case for ending diplomas is not without merit. Medicine has changed. Specialist training is now expected to include longer residency, structured competencies, research methods, audits, thesis work, ethics and modern diagnostics. The NMC’s move reflects a preference for standardising postgraduate education, improving recognition, aligning qualifications with contemporary standards, and using institutional capacity more effectively. There is also a career fairness issue. Diploma holders often did much of the work of specialists but remained disadvantaged in teaching appointments and progression.

India may be right to move toward a uniform MD or MS framework. But the end of diplomas should not erase their history. They were born of a specific Indian problem: how to produce service-ready doctors for secondary care when the country had too few specialists, too few medical colleges, and too many underserved districts. The new MD and MS seats must preserve that service orientation.

The postgraduate diploma deserves an obituary. It was one of the quiet instruments through which India carried specialist care beyond the walls of its great medical colleges. Its name may disappear from admission brochures, but its lesson should not be forgotten in policy.

(Dr. C. Aravinda is an academic and public health physician. The views expressed are personal. aravindaaiimsjr10@hotmail.com)