Frenk, J. et al. (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet (London, England). [Online] 376 (9756), 1923–1958.The Commission's major findings are presented in four subsections. The first describes a century of educational reforms, grouped into three generations. The next two subsections present our diagnosis based on the major categories of the conceptual framework. Analysis of institutional design relies mainly on quantitative data to present a global analysis of institutions, graduates, and financing, followed by key stewardship functions such as accreditation, academic systems, faculty development, and collaboration for shared learning. We then examine instructional design, focusing on the purpose, content, method, and outcomes of the learning process. Challenges are categorised according to the four Cs explained in the conceptual framework: criteria for admission, competencies, channels, and career pathways. In the final subsection we cut across institutions and instruction by examining the challenges of local adaptability in an interdependent globalising world. In view of the huge diversity of health and educational systems, we address the question, how can instructional and institutional design achieve effectiveness in diverse contexts while at the same time harnessing the power of global pools and flows of knowledge and other resources?