Internationally, medical education has increasingly been the subject of scrutiny and debate. This article represents a review of the burgeoning literature on medical education. The focus is on encouraging teachers to improve the quality of students' learning. The educational rationale for some of the major current developments is considered. Change imposes significant challenges for teachers and students, although there are helpful examples from the literature. The curriculum must be internally consistent, based on well-defined educational principles and effectively managed. Goals or outcomes--broadly defined--must be debated and determined so that they are clear to staff, students and the community. Several interrelated issues must be considered and resolved--student selection, specification of content, identification of core clinical skills and broader academic and professional behaviours. The most effective educational processes must be determined in order to support active learning. Problem-based learning is now well established and its underlying principles are discussed. Assessment of students must encourage learning and ensure that well-defined academic and professional skills are achieved. Programmes must be subject to evaluation so that the quality of the experiences of students, staff and patients is progressively improved. In order to develop effective skills in teaching and in the management of programmes, teachers need to be supported by good staff development.