A dramatic adaptation of medical education to meet indigenous needs and circumstances has occurred in the People's Republic of China in the context of a highly structured health care delivery and medical referral system, entailing a reduction in curriculum length from 6 to 3 years. Although general directions and guidelines are set centrally by Peking, considerable autonomy and flexibility exist in individual schools. The innovative approaches used include training medical students in countryside and factories as well as medical schools, combining traditional Chinese and modern Western medicine, opening hospital-run medical schools, and using unconventional methods of producing medical doctors. On graduation the students generally return to the communities from which they came. Although the total number of medical graduates still falls short of national requirements, the problem of maldistribution of physicians has been alleviated in China. Medical care is now readily available in rural areas, where 80% of the population resides.