Interactive, multimedia cases with technology supports present new ways of teaching and learning in teacher education. In this mixed-methods, naturalistic study, the authors investigate how and what participants learn from multimedia cases and, in particular, how instructional implementation affects learning outcomes from multimedia cases. Multimedia cases with technology supports were implemented in 20 different higher education courses with varying University of Missouri-Columbia instructional modes involving 251 pre-service and practicing teacher education students from four different universities. Results indicate that how multimedia cases are integrated into courses makes a difference in case-based learning outcomes and that these differences are evidenced in both quantitative and qualitative data. Overall, significant learning occurred for all instructional implementation groups with one exception--limiting use of cases to context for additional course assignments was not effective. Implications for teacher education are explored. (Contains 7 tables and 4 figures.)