Wearenow looking beyond postgraduate training whichendswhenjunior doctors attain consultant status. Medical education isopen-ended. Itisa continuum whichextends fromundergraduate through postgraduate or vocational training to continuing medical education forcareer, orpermanent,grades. Inhis'President's Review' published last yearin theProceedings oftheRoyal College ofPhysicians ofEdinburgh (RCPE), TonyToftreminded usof thecynical viewsofThorntonWilder, theUS novelist anddramatist whodiedin1975. Doctors are mostly imposters. Theolder a doctor isandthe more venerated heis, the more hemustpretend toknoweverything. Ofcourse they grow worsewithtime. We hopethat this caustic appraisal isnottrue butwe have toaccept that promotion toconsultant statusdoesnotmean that a doctor isproperly equipped withskills andknowledge sufficient for a professional lifetime. Wehave tokeeplearning and a recentseries ofwell-publicized disasters have demonstrated thecompelling necessity forconsultantstokeepabreast withmedical advances and complex techniques. Theprofession iscurrently having abadpressandwe have aresponsibility to society toshowthat we takestepstoremain efficient, knowledgeable andup todate. Thoughthere havebeencalls inthepopular pressfordoctors, like airline pilots, tobesubject to spotchecks andregular re-examinations, these wouldbeextremely difficult. Training medical students andpostgraduates isalready a heavy burden on our overstressed health service. The mostpracticable solution istheintroduction ofa formalized systemofcontinuing medical education (CME)forhospital consultants andthose inthe staff grades. Tothis endtheJoint Declaration of theRoyalMedical Colleges andtheir faculties in Edinburgh gavesupportforsystematic schemes of CME tobesetupandimplemented during 1994. If CME becomes mandatory (andindeed this isthe trend inNorthAmerica andAustralia) anddoctors' educational activities become thesubject of scrutiny bytheColleges andprofessional bodies, then this will ensurethat all doctors will, atthe very least, staywithin a safety netofclinical competence. IntheUK themainproblem istofree clinical time foreducational activities. Inarecent surveyby theRoyal College ofPhysicians ofLondon, 96%of those replying gave'toolittle time' asa reasonfor their inability tokeep up todatewiththecurrent information overload. Thisisundoubtedly dueto theheavy clinical caseloads whichclinicians are expected toundertake intheNational Health Service. With1.4doctors per1,000 population the UK hasoneofthelowest doctor/patient ratios in theWestern World sowe canhardly beregarded as