International standards in medical education or national standards/primary health care--which direction?

This paper examines the concept of 'international standards' in undergraduate medical education and concludes that, with one material exception, these do not exist. It also examines the two major forces which sustain these non-existent standards. It contends that programmes of undergraduate medical education are only likely to become relevant to people's health needs, health policies and priorities if and when the concept of 'international standards' is jettisoned and replaced by the concept of 'national standards'. The final section of the paper identifies five strategies which might be used to 'unfreeze' programmes of medical education and render these more responsive to both 'planning in relation to national needs' and to assist these programmes to become more responsive to 'educational innovation and change'.