The direction of continuing medical education in North America and elsewhere has changed in response to the new perspective that has emerged from contemporary studies of learning and change. The nature of this new perspective is evident from a comparison of the common elements of CME in the 1980s with the approach that is now being used. Traditionally a CME programme was an educational event that applied appropriate resources and methods to fulfill set instructional objectives. Such programmes were often considered to be good if the information was valuable, the lecturer skilful, and the setting comfortable. Too often, however, there was little or no actual effect on medical practice, even though all three conditions were met.