Prospects for change in medical education in the twenty-first century.

With Health for All as a social goal and a reference point, medical schools must create new alliances within the health sector and with other sectors bearing on health. The future role and responsibility of the medical school should reflect the likely essential features of the future health system and the aptitudes that medical practitioners will have to possess. Medical schools should be encouraged not only to shape their educational programs accordingly, but also to devote energy and resources to the considerable task of creating opportunities for this new practitioner. Quality in medical education results from a coordinated effort to ensure relevance and efficiency in the education of future doctors and to ensure these doctors' optimal fit in society. Implicit in the notion of quality is a special consideration for social accountability. A medical school shows social accountability through its commitment to addressing issues, or helping solve problems, identified jointly with society as priorities for both the present and the longer term, in the expectation that the medical school's action will benefit in part the local community and in part the country as a whole or the international community. Indicators of quality in medical education, as well as measurement tools, must be developed and tested in various sociocultural contexts. A taxonomy to assess the social accountability of medical schools is proposed.