This paper presents four aspects of health professions education at McMaster University: (1) a review of the key elements of the history and distinctive approach of the Doctor of Medicine (M.D.) program; (2) a description of the process and substance of curriculum change over the past decade, focusing on a major revision of the M.D. program that began in 1983; (3) a summary of the findings of follow-up studies of McMaster M.D. program graduates; and (4) an analysis of the current context within which the Faculty of Health Sciences (of which the M.D. program is a part) is operating and a description of strategies for renewal that are being implemented. The evidence and experience to date support the assertion that satisfactory--and in some ways special--physicians can be prepared using the "McMaster approach" to medical education, but that continuous review and periodic major revisions of the educational program are both necessary and possible; they must occur in concert with developments in other sectors of Faculty of Health Sciences activities.