A century after Flexner's report on medical education in North America, the main challenge in the 21^st century for the education of health professions resides in the responsibility of educational institutions for a greater contribution to improving health systems performance and people's health status. This will be achieved not only by tailoring educational programs to priority health problems, but also by a stronger involvement in anticipating health and human resources needs of a nation and in ensuring that graduates are employed where they are most needed delivering the most pressing services. A new paradigm of excellence for academic institutions is needed, as well as new sets of standards and accreditation mechanisms to promote and evaluate their capacity for a greater impact on health.

From 10 to 13 October, 65 delegates from medical educational and accrediting bodies around the world met in East London, South Africa to finalize the Global Consensus on Social Accountability of Medical Schools (GCSA) whose agreement follows. This was the culmination of a twoyear process of engagement with an International Reference Group (IRG) of 130 organizations and individuals seen as leaders in medical education, accreditation and social accountability.

Facilitated by a Steering Committee of 20 international experts, the IRG members participated in a three-stage Delphi process over eight months leading up to the GCSA. Initially, forty-three pages of raw data were gathered responding to three open ended questions:

1. How should a medical school improve its capacity to respond to future health challenges in society?
2. How could this capacity be enhanced, including the use of accreditation systems for selfassessment and peer review?
3. How should progress towards this end be assessed?

Through two further rounds and the facilitated meeting, themes were extracted and consensus reached on ten thematic areas. Each area and its contents was thus derived from a grassroots process that ensured the consensus was built up from the experience and expertise of the IRG members through a process of gradual refinement, negotiation and consensus.

Area 1: Anticipating society's health needs
Area 2: Partnering with the health system and other stakeholders
Area 3: Adapting to the evolving roles of doctors and other health professionals
Area 4: Fostering outcome-based education
Area 5: Creating responsive and responsible governance of the medical school
Area 6: Refining the scope of standards for education, research and service delivery
Area 7: Supporting continuous quality improvement in education, research and service delivery
Area 8: Establishing mandated mechanisms for accreditation
Area 9: Balancing global principles with context specificity
Area 10: Defining the role of society