Over many generations doctors have kept up to date in ways which reflect their own learning styles. The current fashion for formalised and policed continuing medical education may prove ineffective unless it is recognised that individual needs must be taken into account. Attendance at formal courses based on lectures and papers may not suit a large proportion of those who attend to acquire the necessary points to satisfy their royal college. The ability to show that health care teams are up to date should come from effective clinical audit, which should also identify local educational needs.