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A nationwide external quality evaluation was carried to identify strengths, good practices and areas in need of development. The enhancement-led evaluation process included a self-evaluation report by the universities; evaluation interviews and visits by the evaluators; an evaluation report; a feed-back seminar. The evaluation focused on the management and planning of education, the learning philosophy and defining evaluating outcomes; the education resources and pedagogical training; the constructive alignment of education; the continuous development of education.Key strengths included good cooperation between units, pedagogical training of the trainers, investment in web-based learning and the repetitive evaluations. Areas needing development included clarifying of the learning philosophy, broadening the learning outcomes to cover competences, achieving higher visibility, diversifying practices for learning assessment and feedback. Also, evaluators suggested more reflection practices to support professional growth; advancing pedagogical training of trainers; increasing the throughput of students and promoting the specialty to medical students. Genuinely interactive virtual learning was emphasised. Scientific research on and international approach of developing education were encouraged.After the report the learning philosophy was clarified in the new curriculum, reflection was included in the logbook and a project started to develop evaluation of the learning outcomes as competencies and EPAs. A pedagogical web-based course and a guidebook for trainers were published. The universities have worked also on the external challenges: the changes in working life, the upcoming national reform of specialist medical education and the continuity of funding. High quality in medical education is essential. An external evaluation may substantially help to meet this challenge.