First, the EBG committee noted that the CME literature, especially as it applies to quality improvement, cost-effectiveness, and other dimensions of its place in healthcare, occupies terrain not always identified by the search strategies outlined in this methodology, and the EPC could have employed more comprehensive databases already created for this purpose. First, the University of Toronto's Research and Development Resources Base in CME9 and the Best Evidence Medical Education Collaboration10 could provide substantial contributions in future systematic reviews. Second, restricting the search to the United States and Canada excludes a sizable body of research generated in other countries with very similar CME and training requirements, including the United Kingdom, Australia, New Zealand, and the Netherlands. Third, the formal US CME provider accreditation process regulates the provider but does not address the manner, methods, or instructional techniques of education, the subject of this report. Fourth, nonrandomized trials with comparator groups were included, allowing volunteer bias that may skew results. Fifth, limiting the search to those studies involving 15 or more physicians excludes studies with fewer subjects but adequate statistical power, as in small group or individualized learning; these are important, but often-neglected areas of CME. Finally, the EPC did not include specific search terms such as clinical practice guideline, performance practice, and quality improvement.