This chapter is about the difficulties faced by professionals to keep up-to-date with their domain knowledge and practical skills, and the frequent gap between professionals' actual practice and the best possible practice. In this chapter this gap and the associated processes are viewed primarily through the lens of the physician and his or her participation in continuing medical education (CME). This chapter considers the best evidence and clinical practice, as well as the current system of monitoring and maintaining clinical competence captured as CME credits. It proposes a model of how the best evidence can be translated and transformed into practice so that we may measure and optimize the professionals' observable performance.

To understand these issues more fully, it is necessary to understand how physicians – and indeed most professionals – keep themselves up to date. Described by Nowlen's seminal book (1988) nearly 20 years ago, the individual passes through a series of steps in education, licensure, and certification on the road to the status of a professional.