To determine whether medical educators perceive a need for change in medical student education, we analyzed data from a 1989 survey of 1369 respondents from all US schools of allopathic medicine. Except for basic sciences faculty, a majority of educators stated that "fundamental changes" are needed in medical student education in the United States. Nearly three fourths of deans and associated deans reported the need for "fundamental changes" or "thorough reform." At least 79% of educators voiced support for six specific reforms, such as rewarding teaching excellence and increasing clinical education in ambulatory and community settings. While slight majorities supported reducing class size and centralizing governance, substantial proportions stated that they would "work against" such reforms. Most educators reported that a broad base of support within the school would be essential for change. The survey suggests a restlessness among the leaders of medical education.