The DREEM provides useful diagnostic information about medical schools, whether it is in developing or western developed countries.

A national competence framework has been developed by medical schools in the Kingdom of Saudi Arabia. The framework has seven domains - approach to daily Practice, Dr and patient, Dr and community, communication skills, professionalism, Dr and information technology, Dr and research. The framework will guide curriculum development and assessment in the Kingdom and ensure that medical education adapts to changing needs. The creation of a national framework promises the delivery of equivalent standards between medical schools while at the same time guaranteeing the schools' autonomy.

Medical education has been changing rapidly in Saudi Arabia. Within a decade, the number of medical colleges increased from 5 medical schools with traditional disciplined-based curricula to 21 medical colleges with varied curricula ranging from the traditional to more innovative, problem-based, communityoriented programmes. The private sector has started investing in higher education generally and medical education in particular. Also other government sectors that provide advanced health services have started established new medical colleges. The expansion of quantity in medical education has been associated with a drive for greater quality assurance. Accreditation of higher education institutes began with the establishment of the National Commission for Academic Assessment and Accreditation in 2005. This review focuses on documenting developments in Saudi medical education up to 2008 and discussing the future potential and challenges facing the sector. 1Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia (Correspondence to A. Telmesani: telmesan@gmail.com

Background: Medical education in Saudi Arabia is facing multiple challenges, including the rapid increase in the number of medical schools over a short period of time, the influx of foreign medical graduates to work in Saudi Arabia, the award of scholarships to hundreds of students to study medicine in various countries, and the absence of published national guidelines for minimal acceptable competencies of a medical graduate.

Using portfolios as a developmental learning and formative assessment tool in the early undergraduate years was found to contribute to students' ability to create their own clinical skills guidelines in later years, as well as to engage in and appreciate reflective learning.