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How should active learning be implemented in a somewhat fixed environment, such as a medical school with a predefined curriculum and teachers? Some problems to be solved are (1) teachers rarely recognize their lectures styles as being inefficient, (2) teachers may not have any personal incentive to change their teaching style, (3) changes should be collaborative, and involve all hierarchical segments of the school, (4) tracking real outcomes and results, among others. How has this transition worked in your schools? Any suggestions to those whose medical schools are still crawling in this sense, but that are eager to ignite change?