This article reports a comparative case study of six selected USA medi
cal schools, undertaken to identify factors that facilitate or obstruc
t innovation in medical education. The findings suggest that the cultu
re of each medical school results from a combination of intra-institut
ional and external factors. Together these forces influence substantia
lly the fate of educational innovations. The institutional culture inf
luences critical elements such as educational philosophy, leadership a
nd resources provided in support of innovation. Equally important, the
culture shapes the level and type of change a school considers and im
plements. The findings also suggest that the availability of resources
and the creative impetus present in schools giving priority to resear
ch can benefit the educational goals and facilitate educational change
.