The task of preparing doctors to respond optimally to present and future health needs requires that medical education be consonant with these needs but also that medical practice find its proper place in a changing world. To ensure that their graduates can practise medicine to the satisfaction of health authorities, health consumers and the graduates themselves, medical schools should see their responsibility as extending beyond the provision of appropriate educational programmes and learning processes. Their involvement in the improvement of health care organization and delivery in partnership with other major constituencies in the health sector is seen as an important requirement to ensure better coordination in the development of medical education and medical practice. Because changes in medical education and medical practice should go hand in hand, joint action is recommended, particularly in assessing quality and testing strategies for institutional change. 1994 Blackwell Publishing