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The Interdisciplinary Generalist Curriculum (IGC) Project required significant collaboration and cooperation at many levels of leadership to accommodate early clinical experiences in the curriculum. Three elements of institutional change are discussed: the context for desired early clinical experiences in medical education, structural elements required of the IGC Project schools, and leadership within the demonstration schools. Lessons learned from these interdisciplinary projects include the importance of supportive leadership from the top levels, establishing broad buy-in across sectors of the school, creating a team administrative structure that fosters participation by all groups, and central (rather than departmental) administration. The processes needed to establish collaborative leadership and full participation by the generalist departments and cooperation of diverse constituencies, such as basic science faculty, were labor-intensive and required more time to ensure successful program implementation. Uniformly, strong support at the highest levels of the organization, especially the medical schools' deans, was cited as a key element in the success of the IGC Project. An interesting unanticipated outcome of the project was the movement of the interdisciplinary course administration into a central location (dean's office) by the end of the project for all schools. This change may reflect a practical advantage for administration of interdisciplinary programs located at the level of the school or college, rather than housed within departments.