"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.