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Abstract
Some of the factors facilitating and impeding educational development in an established and research-orientated medical school are briefly described. During the past 16 years, the Karolinska Institute has undergone a process of change from traditional forms of teaching and assessing, to more problem-orientated, integrated, and student-centred approaches. A new curriculum has been implemented with earlier patient contact and the introduction of new subjects of relevance for the health needs of today. These innovations could be regarded as modest, but what has been achieved positively is a climate increasingly in favour of change. Examples are the introduction of criteria for assessing teachers' competence for promotion, the establishment of an academic department for research and development in medical education, and discussions have been initiated on establishing a problem-based parallel track. The author's personal perceptions of events contributing to a climate favouring change constitute an integral part of this paper.