Lifelong learning tailored to individual clinical practice.

For decades, critics have contested the value of continuing medical education (CME), as well as the efficacy of many CME studies, pointing to methodologic flaws that preclude valid assessment. Although testing for knowledge before and after participation in a given educational program usually shows that physicians learn facts,1the effect of education on performance in practice and ultimately on patient care has been difficult to establish. Nevertheless, direct observations indicate that, after graduation, physicians incorporate new skills and new knowledge into their practices. In 1973, Caplan2pointed out, "Scientific proof of effectiveness rests upon varying types of evidence." Citing an old example, he asked, "How many physicians whose formal medical education occurred pre-1940 today treat syphilis with arsphenamine [Salvarsan] or lobar pneumonia with type-specific antisera? Their switch to penicillin (behavior) testifies that somehow they learned something new (education)." Numerous modern examples corroborate such adoption of medical advances. Cardiologists