EDITORIAL

CME on the cusp of change The quality of patient care reflects the performance of doctors, nurses and associated healthcare professionals. Their performance depends not only on clinical competence but also on behavioural factors related to ambition, integrity, ethical considerations, career advancement, age, well-being and healthcare infrastructure. To optimise these various elements of medical performance, most advanced countries subscribe to the concept of continuing professional development (CPD) of which the main tool is continuing medical education (CME). The providers of most European CME are the national and European medical specialist societies, hospitals/local employers, government health departments and commercial companies. There is also an emergent "CME provider " community that develops education under strictly observed ethical rules (as typified by members of the Good CME Practice group1 and BMJ Learning2). This all sounds sensible and straightforward, but there is an elephant i