Innovation Processes in Medical Education is the first empirical study to investigate the barriers to successful educational change. Using a qualitative case study approach, it examines the factors that have either supported or impeded change in four medical schools: Case Western Reserve, University of Illinois, McMaster University, and Michigan State University. Following an overview of the historical forces that led to the current structure of the medical school curriculum, the authors discuss their research methodology and data, and analyze their attempts at innovation in each of the four cases, examining the relative merits of each effort. A matrix is developed that will help medical school innovators establish implementation strategies by showing them how to arrive at optimal strategies based on the specific context in which they work.