Medical education reform can make an important contribution to the future health care of populations. Social accountability in medical education was defined by the World Health Organization in 1995, and an international movement for change is gathering momentum. Priority community needs are generally not well reflected in existing medical curricula. Medical schools have often been concerned more with prestige, research competitiveness and training doctors for narrow specialist careers in urban areas. Orthodoxies in medical education have been challenged where the gap between a community's health care needs and the availability of doctors has been greatest-notably in rural areas and, in Australia, in Aboriginal communities. At a time of growing crisis in health care systems, the need to focus on addressing health inequalities and delivering effective, affordable, people-centred health care is more important than ever. While change can be enabled with policy levers, such as funding tied to achieving equity outcomes and systems of accreditation, medical schools and students themselves can lead the transformation agenda. An international movement for change and coalitions of medical schools with an interest in socially accountable medical education provide a "community of practice" that can drive change from within.