The survey item content was based on existing literature and expert opinion (see below). Item response formats were yes-or-no, multiple-choice, fill-in-the-blank, and free-text responses. The survey questions addressed various topics related to VMS programs, including organizational aspects, program objectives, and practical issues pertaining to running these programs. Survey content validity [10] was determined by reviewing themes in the literature regarding VMS programs [1-9,11] and by soliciting input from authors of this study (PSM, LLM, LJO, MCL, JMB, TJB, and MJK) who collectively have more than 120 person-years of experience in medical education and more than 60 person-years of experience in administering a large VMS program [12]. Furthermore, survey content was based on an iterative approach among the author-experts, whereby an initial list of survey questions was submitted by all members, and questions were added or deleted based on consensus reached through ongoing discussions over a period of 3 months. Nonresponding medical schools were recontacted and encouraged to complete the survey. Data collection concluded in February 2007, followed by analysis of the answers to the survey questions.