Numerous study commissions have contended that departmental territoriality and lack of coordinated planning are stagnating contemporary medical education . As a cure , these commissions have recommended the creation of centralized academic management units empowered to oversee revitalization of the curriculum through a series of reforms , including better definition of graduation competencies , community-based training , interdisciplinary courses , problem-based learning , and modernization of evaluation strategies . To determine the extent to which these recommendations were being adopted , in 1990 the authors sent a questionnaire on curriculum committee functions , current innovation efforts , and future priorities to academic administrators and members of medical school curriculum committees at 143 North American medical schools . Responses were received from administrators ( primarily associate deans for academic affairs ) at 118 schools and committee members ( primarily faculty ) at 111 schools . Recommendations for enhancing curriculum committee effectiveness were also elicited . The authors conclude that centralization of curricular management has occurred at very few institutions , and that the commonly mentioned reforms are being adopted at a modest pace . The results are analyzed in light of theories of the institutional change process and strategies for introducing educational innovations into established institutions .