This paper begins with historical and other reflections on the nature and importance of quality in medical education. It then identifies and discusses missions of medical school - which include teaching, research, medical service, continuing education, and social advocacy - and notes that these elements should by complementary and indeed synergistic. Components of quality, both of a medical graduate and of a medical school, are then considered. After discussing the use of examinations to assess quality of graduates, the paper concludes by calling for a total quality approach to medical education, and output.