The American College of Chest Physicians comprehensive review of continuing medical education is an ambitious attempt to summarize a vast and heterogeneous literature. Nevertheless, there appear to be some consistencies; multiple media and instructional methods appear to be consistently better than single approaches, and multiple occasions work better than one-shot events. While this appears, at first glance, to be perfectly reasonable, one must be careful to treat media and method separately. Other research has shown that many media manipulations can reduce, not enhance, learning. In a similar vein, while the role of simulation in continuing medical education is largely unexplored, applications must be considered with clear understanding of what can and cannot be achieved with simulation.