Undergraduate medical education didn't undergo major changes since the Flexner report in the beginning of this century and has since been copied without important modifications worldwide. The bulk of the medical education is given by subject specialists and general practice is only marginally covered. The result is that the training of medical doctors has become inappropriate and that a change is urgently needed. The aim is on the one hand to improve the clinical skills of doctors, on the other hand to prepare doctors for enhanced roles and to have some community perspective. Innovations such as problem-based learning and community-oriented education took mainly place in new medical schools. The need to change medical education is however greater in established medical schools, but innovation seems more difficult to reach there, although some successful experiences are described. Most innovations failed to tackle reform of the health system in which new graduates will function. This is probably one of the main reasons for their limited results. Five presentations to the Colloquium illustrate the difficulties and possible successes of change in undergraduate medical education.