The purposes of this sequential, mixed-methods, multiple-case study were to understand how fully-accredited medical schools in the United States operationalize the accreditation standard for self-directed learning (SDL), and to recommend an innovative framework for guiding SDL implementation across the continuum of medical education programs. The main investigation relied on a survey in Phase 1 to collect quantitative and qualitative data, followed by a multiple-case study in Phase 2 to collect qualitative data to gain deeper insights into the overall organizational context and capacity for SDL implementation at the local level. Two cases for Phase 2 were identified through analysis of the quantitative data collected with the survey instrument in Phase 1. A low survey response rate of 10% in Phase 1, and an unexpected high number of declined invitations to participate in Phase 2 (n = 6), were the most significant limitations to this study. However, considering the totality of the findings for this study, there are salient commonalities among the schools for implementing SDL across the continuum of medical education, which may be helpful for many programs struggling to meet LCME expectations for SDL. Commonalities included: (a) definitions of SDL aligned or closely with the LCME's definition; (b) explicit statements of where, when, and how SDL skills are implemented and experienced throughout the curriculum; (c) specific activities implemented to facilitate SDL objectives using clinically-relevant, active learning pedagogy with vertical and horizontal integration; and (d) evaluating implementation and identifying barriers that may impede SDL experiences for all stakeholders. The findings highlight the need for medical schools to increase capacity for SDL implementation at all levels of the organization including optimizing experiential learning opportunities, scaffolding and spiraling SDL throughout the curriculum, and investing time and resources for continuous SDL faculty development. Planning for SDL implementation across the continuum of medical education will be different for each year or phase of a program, and unique for each medical school. It is recommended SDL implementation be explicit and strategic, integrating SDL skills acquisition, development, and refinement throughout the medical education program. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]