This paper reports the results of a Delphi probe of the perceptions of medical school deans regarding the most significant changes in medical education and in the health care system which they expect to influence medical education over the next 20 years. The study, conducted in the first quarter of 1974, included an analysis of 54 potential changes distilled from over 440 suggestions. A composite view of the probability of occurring, impact on the system and percentage of deans favoring the change are presented. In general, the future is believed to hold more positive changes than negative ones, and those most likely to occur will come about in the near term. The results disclose few surprising conclusions but provide a structural description of areas of consensus and disagreement among deans.