This paper is based on one which was prepared to support the World Conference of the World Federation for Medical Education in August 1988. It is designed to provide a broad perspective on the essential elements of an educational change process. The paper covers the stages in designing a change strategy and highlights the difficulties that any change agent is likely to encounter. A review of the history of change in education and organizations is followed by discussion of the need for change and the ability to change. Reasons for resistance to change are presented and discussed. Implementation and reinforcement of change are considered before a final section on evaluation.