Journal of Legal Education (Association of American Law Schools)

Gundlach, Jennifer A.

Niles, Mark C.

Journal of Legal Education, Volume 73, Number 1 (Fall 2024)
*Jennifer A. Gundlach is the Emily and Stephen Mendel Distinguished Professor of Law and 
Clinical Professor of Law at the Maurice A. Deane School of Law, Hofstra University. She 
received her BA from Kenyon College in 1993 and her JD from the Washington College of Law at 
American University in 1996.
**Mark C. Niles is a Professor of Law at St. John’s University. He received in BA from Wesleyan 
University in 1988 and his JD from Stanford Law School in 1991. 
Book Review
David M. Becker, Lessons Learned: Stories of a Teacher and Teaching, Durham, NC: 
Carolina Academic Press, 2019, pp. 192, $24 (paperback)
Reviewed by Jennifer A. Gundlach* and Mark C. Niles**
Perhaps the most remarkable feature of Lessons Learned, a fictional story 
about a long-time law professor and his relationships with students and 
colleagues over the course of fifty years of teaching, is that it feels nostalgic 
and modern at the same time. In the preface, longtime and now deceased 
Washington University School of Law Joseph H. Zumbalen Professor of 
the Law of Property Emeritus David M. Becker1 acknowledged that either 
a “third person non-fiction” or “an embellished autobiography” would have 
been a more conventional approach to his subject, but he chose a fiction story 
because it allowed him “to depart from personal experience and real life, and 
to disguise and borrow from others, and especially to completely fabricate.”2 
What Becker did not acknowledge is that in using the first-person narrative 
form, he separated his work from the customary scholarly lens of most legal 
academics and deeply personalized the lessons taught throughout. In doing 
so, he exemplified one of the greatest of lawyering skills: the art of storytelling. 
Accepting these qualifications, it is difficult (if not impossible) to approach 
this work (which consists of nine loosely connected first-person essays, seven 
told by the fictional professor, E. Randall Mann, and two by his former 
student and research assistant, Billie Williams) as something other than a 
memoir from a law professor whose career in academia has spanned more than 
five decades. Topics that receive insightful and instructive attention include 
1 Professor Becker passed away on April 17, 2023, having taught at the Law School for 50 
years and received numerous awards and honors for his service and teaching. Washington 
University in St. Louis, The Record (May 18, 2023), https://source.wustl.edu/2023/05/
obituary-david-m-becker-professor-emeritus-of-law-87/. 
2 David M. Becker, Lessons Learned: stories of a teacher and teaching ix (2019).
241Book Review: Lessons Learned: Stories of a Teacher and Teaching
faculty/student relations, including mentoring and professional development; 
effective pedagogical approaches; changes in the legal market over time and 
their impact on student expectations and ambitions; and entry into and success 
within academia by law professors.
Lessons Learned feels most nostalgic when it discusses Mann’s entry into legal 
academia and what the academy looked like when he got there. As the story 
opens, it is the mid-twentieth century and Mann is working at a family law firm 
started and managed by his trailblazing mother. He receives a letter from an 
elite law school soliciting his application for a full-time teaching position. He 
has been recruited as a result of the post-World War II “anticipated enrollment 
increases” at the school and the need to hire “the best young faculty available.” 
Mann was identified as a faculty candidate through a canvas of “my law school 
and several others [seeking] names of several graduates from recent years whom 
they highly recommend for teaching.” Mann responds to the solicitation with 
appropriate humility and even disbelief, given his lack of what he perceives to 
be the qualifications for an academic position (expertise on many subjects, or 
even one, and the ability to command and control classroom discussion).
Several elements of this recruitment process are surprising (if not shocking) 
to legal academics from a later generation. First, while Mann’s race is never 
mentioned in the piece (a notable omission that adds to the dated feel), one 
can only assume that he is white, and that this kind of canvassing of past 
professors was unlikely to generate women candidates or candidates of 
color, both because so few of them attended law schools during this period 
and because those few who did were unlikely to rise to the top of a list of 
“qualified” candidates generated by a group of all but exclusively white male 
professors. Second, not only is past scholarly production, or even the capacity 
to generate effective scholarship, not listed as one of the qualifications, there is 
no indication that scholarship will be an important (or even tangential) aspect 
of the job. Third, the nature of the position that the law school is seeking to fill 
is not discussed. Will it be tenured? Tenure-track? Something with limited if 
any presumption of contract renewal? What will be the criteria for continued 
employment if there is the possibility for long-term status? Nothing other than 
the ability to effectively manage a law school classroom (with a “standard” 
four-course load for his first year of teaching) appears to be on the minds of 
the law school or the applicant. 
There are certainly valid critiques of this means of finding and hiring 
candidates for law school academic positions, the limited focus on diversity 
and scholarly engagement perhaps being the most damning. But the almost 
exclusive focus in the hiring process on the classroom and the assurance of 
the appropriate educational experience for students, as opposed to what often 
appears to be similarly exclusive attention to scholarly production in most 
modern job searches, is provocative. It poses a vital question for modern legal 
academics: While something has clearly been gained by increased expectations 
for scholarly engagement and production among law school faculty, has 
242 Journal of Legal Education
something of equal (or even greater) value in quality teaching been lost in the 
process? 
The most archaic feature of the law school that Mann enters after his 
successful application process (even beyond what one must again assume is a 
stark lack of diversity) is how small the faculty is—a total of nine presumably 
full-time professors. Mann discusses the law school’s culture of multiple 
weekly lunches with five or six of these nine colleagues. It is difficult to imagine 
how a faculty of that size could teach the academic program at a law school 
even then, let alone now. But one thing appears certain—the range of course 
offerings (let alone scholarly and cultural perspectives) must have dwarfed 
that available at even moderately sized modern law schools (and perhaps 
larger law schools of the era?). Again, the benefits of collegiality that could 
be expected to flow from such a small community of professors with frequent, 
even daily, face-to-face engagement must be balanced against the dramatic 
cultural, pedagogical, and scholarly limitations that it mandated. And a 
similar question seems appropriate again: Do the benefits of a larger faculty 
outweigh the drawbacks? And if we can reasonably answer “yes,” we must 
still face the follow-up questions: How big is too big, and how small is big 
enough? And it should be noted that, given recent downturns in law school 
enrollment, smaller law school faculties may already be more modern than 
archaic and perhaps even more so in the years to come.
Another feature of Lessons Learned that makes the reader nostalgic is Becker’s 
emphasis on the interpersonal relationships that he built with students over 
the years, either through discussions of course material in his office or pickup 
basketball games or tennis matches. In past articles he has shared some of 
the characteristics of successful and effective teachers, among them the ability 
to connect with and know students, the positive chemistry they have in the 
classroom, and accessibility outside of the classroom.3 One cannot read the 
book without understanding that Becker understands deeply “the true joy of 
teaching.” With that joy comes the “glorious and shared moments when a 
student struggles, responds, and finally catches on,” when “a teacher really 
knows that he has made a difference.”4 But it also comes from the personal 
relationships that we build with our students, and that we retain long after 
they graduate. Becker credits now-deceased Supreme Court Justice Antonin 
Scalia as observing that the shelf life of a law review article is short, but the 
“impact of a good teacher upon a student is endless.”5 
The relationship between Professor Mann and his on-again, off-again 
research assistant Billie Williams is another aspect of the story that feels dated, 
but provocatively so. In the story, Williams (whose race is again not disclosed), 
3 David M. Becker, Teaching Teachers About Teaching Students, 87 Wash. U. L. rev. 1105, 1112-24 
(2010).
4 David M. Becker, Some Concerns About the Future of Legal Education, 51 J. LegaL edUc. 469, 483 
(2001) [hereinafter Becker, Some Concerns].
5 Id. at 483 n.14.
243Book Review: Lessons Learned: Stories of a Teacher and Teaching
is also an outlier from the majority of law students, but in a different sense. 
She is a highly ranked student who has a “full ride” scholarship through law 
school and is on the “fast track” to a top law firm. She acknowledges that 
competition and “survival of the best” are what drove her. The first essay, 
written in Williams’s voice, begins with Mann’s invitation to serve as his 
research assistant. Williams initially ignores it, and reconsiders it only when 
she learns about the scarcity of summer jobs available to students who have 
just completed their first year.
When Williams shares about the extent of Mann’s efforts to connect with 
her, one can’t help but long for a law school environment in which professors 
spend the time to emotionally invest in their students outside of the classroom. 
Parts of these exchanges demonstrate Mann’s privilege and associated 
blurring of appropriate power dynamics (the sipping of espressos over elegant, 
multicourse meals one on one with the student, for example). And yet, the 
reader can’t escape recognizing the inherent value that it brings to Williams’s 
personal and professional development, as she would attest. How might the 
culture of law school change if more professors expressed genuine curiosity 
by asking Mann’s simple question, “What makes you hum?,” to understand 
what inspires their students? The relationship between teacher and student as 
portrayed by Becker challenges us to consider the impact it would have on our 
students if more professors carried their teaching beyond the classroom walls 
by challenging students on an individual basis to move beyond assumptions, 
to think strategically and analytically with respect to their own lives as well as 
the law. These vignettes suggest what is potentially lost when professors retreat 
from engaging in a more dynamic way outside the classroom with all, or at 
least some, of our students.
And yet, what Becker fails to acknowledge in the book are the risks that 
can come from delving too deeply into our students’ personal lives. Although 
Williams’s initial reaction to Mann’s probing questions is “how dare him!,” 
she grows to appreciate Mann over time and to treasure the relationship that 
they have, despite her initial discomfort. But not all students would have such 
a reaction, and not all professors may be equipped to build those kinds of 
relationships with their students and to navigate the delicate balances required 
for that kind of personal engagement. Indeed, many faculty could run the 
risk of inappropriately crossing interpersonal and professional boundaries, 
particularly if, as is the case in the book, a more senior male professor begins 
by asking that a younger female student call him by his first name or asking 
that she give him a ride home after a game of tennis (or suggesting the tennis 
match at all). The time may have passed when this kind of personal, individual, 
and even intimate professor/student relationship depicted in the book would 
be appropriate. And again, as with much of the book, this reality could foster 
equal measures of nostalgia and relief in the reader.
In addition to its provocative picture of a bygone daysdof legal education, 
Lessons Learned has a great deal to teach legal scholars and law students alike 
about the importance of language and the role it plays in our central function 
244 Journal of Legal Education
of educating students. Some of Becker’s lessons are artfully learned rather than 
taught by Professor Mann, and have great (or greater) resonance today than 
they did decades ago—for law students and all citizens. For example, he learns 
this from an important mentor, Mr. BB, as a young adult in the second essay:
What we say, and how we say it, shapes our existence within 
family, community, country, and the world. Words are like the 
finest of jewels, to be valued and treasured. They can cause joy, 
pain, sorrow; indeed all human emotions. They convey ideas big 
and small, complex and simple, and dangerous and secure. They 
can function like a scalpel or sledge hammer, or a sword or shield. 
These passages will resonate with law faculty as well as law students, 
especially given the current climate in our country. 
Perhaps the most lasting impact of reading this work (even beyond the 
nostalgia it engenders) is the sense of the overwhelming seriousness with which 
the author reflects on his role as a teacher and the goals of legal education. One 
clear message is that not all law school reforms intended to benefit law students 
have succeeded. Perhaps proponents of reform of the legal academy have been 
too eager to push for change without considering all of the consequences, 
particularly on the personal and professional development of the various 
students who are the intended beneficiaries of the reform. 
Anyone who has read Professor Becker’s past work will recognize these 
concerns. Of course, it was not until much later in his tenured life that Becker 
began (or felt free) to write about legal education, as opposed to topics in his 
area of expertise of property law. He has expressed concern, for example, “that 
the best of what law schools have accomplished during the last century will 
be abandoned and disappear completely over time, while also recognizing the 
areas where law school has improved, such as diversity, curricular innovation, 
and interdisciplinary influences.”6
Becker lamented that with the advent of technological communications 
such as online course pages and e-mail, many law professors have reduced the 
face-to-face time that they spend with students “with open doors and liberal 
office hours.”7 He took issue in the book, as in past work, with the idea that 
one of law professors’ primary goals is “information delivery” rather than, as 
he would argue, the teaching of analytical skills and process by encouraging 
experiential, applied learning through the use of hypotheticals and the 
problem method.8 Although technology can enhance learning, he raised valid 
concerns that too often it is used to simply “serve up” legal rules and doctrine 
to students in an efficient manner.
6 Id. at 469-70.
7 Id. at 477; David M. Becker, My Two Cents on Changing Times, 76 Wash. U. L. rev. 45, 60-65 
(1998) [hereinafter Becker, My Two Cents].
8 Becker, Some Concerns, supra note 4, at 477; Becker, My Two Cents, supra note 7, at 67-69.
245Book Review: Lessons Learned: Stories of a Teacher and Teaching
If there is one thing that we would most hope to bring to today’s legal 
academy from the seemingly distant past of Lessons Learned, it would be a 
reemergence among law faculty of a commitment to the centrality of their roles 
as teachers and mentors, in addition their impact as scholars. In this sense, 
what is past may well be prologue (or at least should be).9
9 William Shakespeare, The Tempest, Act II, Scene 1.


English

Book Review of Lessons Learned: Stories of a Teacher and Teaching

Paul, Jeremy R.

Wilf, Steven

Fifty More Ways to Promote Scholarship Within a Law School Community

Franklin, Kris

Book Review of Getting to Maybe: How to Excel on Law School Exams

McMahon, Graham T.

657
Journal of Legal Education, Volume 72, Number 3 & 4 (2024)
Evolution of Continuing Medical 
Education in the United States: 
Implications for the Legal 
Community
Graham T. McMahon*
Continuing Medical Education as a Foundational Value for Doctors
Medical science evolves at an astonishing pace. Physicians seek to provide 
optimal care for their patients based on the best available evidence and 
treatments, almost all of which will have changed dramatically from the time 
physicians trained in medical schools and specialty training programs. While 
physicians want to learn, and value learning, they are also facing enormous 
pressure in a rapidly changing health care environment and are increasingly 
burned out and exhausted. Clinicians expect high-quality, relevant, and 
effective education that is independent of commercial bias and expect that, 
when possible, their participation meets the variety of expectations of the 
state licensing boards, specialty certification, hospital credentialing, and 
other regulatory requirements.1,2 Education that’s inadequate, inefficient, or 
ineffective, particularly when participation is driven by mandates, irritates 
physicians who are forced to revert to “box-checking” behavior that’s 
antithetical to durable, useful learning. The continuing medical education 
(CME) system is designed to respond to those high expectations and flexibly 
respond to an extraordinary diversity of specialized training needs for a 
sophisticated audience. 
Accreditation System for CME
The Accreditation Council for Continuing Medical Education (ACCME) 
was established as a national accrediting body in 1981, evolving from a system 
1 McMahon GT. Advancing Continuing Medical Education. JAMA 2015;314(6):561-2. DOI: 
10.1001/jama.2015.7094.
2 McMahon GT. What Do I Need to Learn Today? The Evolution of CME. N Engl J Med 
2016;374(15):1403-6. DOI: 10.1056/NEJMp1515202.
*Graham T. McMahon, M.D. M.M.Sc., is President & CEO of the Accreditation Council 
for Continuing Medical Education; Adjunct Professor of Medical Education and Medicine 
(Endocrinology), Northwestern University Feinberg School of Medicine. 
658 Journal of Legal Education
that had been managed by state medical societies in the preceding decades.3 
As physicians began to travel to learn, and national programs of specialty 
education became necessary, state-specific regulation became redundant and 
impractical. Furthermore, the escalating efforts by pharmaceutical and device 
manufacturers to control and influence what a physician was hearing and 
learning necessitated a national leadership authority with stringent standards 
and a public voice to protect the integrity of continuing medical education.4 
The ACCME is a nonprofit service organization based in Chicago that 
accredits organizations that offer CME. The organization’s mission is to 
reflect and meet the needs of the public and to maintain the integrity of the 
system for educational providers and their learners. The ACCME sets the 
standards for education that accelerates learning, change, and growth 
in health care while creating a framework that supports, inspires, and 
motivates educators to achieve their full potential. 
The ACCME sets eligibility for educational providers and requires 
eligible organizations to demonstrate compliance with the standards for 
educational design, implementation, operation, and protection of the learner 
from marketing.5 Once an organization achieves accreditation it can offer 
an unlimited number of activities and issue an unlimited number of credits 
without submitting those activities for review or approval to the ACCME. 
The ACCME regularly selects activities for audits, responds to complaints, 
and holds educational providers accountable for maintaining those standards. 
In addition to providing training and sharing best practices with the 
community, the ACCME also sets goals for the community: It awards 
commendation status to CME programs that address the integration of 
health data, interprofessional collaborative practice, individualized learning 
activities, CME research, and higher levels of outcomes measurement.6 
Accredited CME Providers
The ACCME accredits organizations in the United States and around 
the world. The community of 1620 accredited CME providers delivers over 
230,000 activities and over one million hours of instruction each year in myriad 
specialties and competencies;7 this system offers an array of resources to 
promote quality, safety, and the evolution of health care where physicians 
and health care teams live, work, and learn. Accredited CME providers 
3 ACCME. History of ACCME (https://www.accme.org/history).
4 McMahon GT. Independence from industry cannot be compromised. J Eur CME 
2017;6(1):1393296. DOI: 10.1080/21614083.2017.1393296.
5 ACCME. Standards for Integrity and Independence (https://accme.org/accreditation-rules/
standards-for-integrity-independence-accredited-ce).
6 McMahon GT. Incentivising Higher Level Outcome Achievement in Continuing Education: 
Five-Year Experience from the ACCME Commendation Criteria. J CME 2023;12(1):2141937. 
DOI: 10.1080/21614083.2022.2141937.
7 ACCME. ACCME Data Report. 
659Evolution of Continuing Medical Education in the United States: 
Implications for the Legal Community
represent a range of organizations from national physician membership 
organizations to publishers, insurance companies, law firms, military 
and government organizations, and academic and rural hospitals.7 Some 
specialize in local, community-based health issues, others focus on national 
and international health priorities, and others advance interprofessional 
continuing education and team-based care. The geographic distribution 
and diversity of CME providers provides access to education addressing 
local, national, and international health care priorities to clinicians and 
teams where they live and work. 
Accredited CME Activities
The ACCME does not regulate CME through educational formats but 
instead asks accredited educational providers to focus on learning outcomes. 
The days of the didactic slide-delivered presentation appear increasingly 
numbered; instead, learning is recognized as being best achieved through 
problem-solving, case studies, and small-group discussions.8 Some learning 
goals are best achieved through online delivery, self-assessment activities, 
or the facilitation of discussion through webinars and other formats. CME 
increasingly is designed to improve skills and performance, and many activities 
aim to specifically affect patient outcomes. Of the more than 230,000 learning 
activities offered by accredited organizations each year, approximately forty 
percent are designed to achieve improvements in physician performance, and 
sixteen percent are designed to improve patient outcomes; many objectively 
measure those changes.7
During the COVID pandemic, educational organizations flexed and 
modified their educational programming dramatically into online formats, 
and use of those formats has persisted even as participation in live activities 
has almost entirely recovered.7 Educators are deploying new information 
and communication technologies in accredited CME programs, using 
simulation centers, games, blended learning (combining digital and face-to-
face formats), social media, and other applications.9 Technology lends itself 
to learner-controlled training that accommodates diverse learning styles and is 
particularly well suited to clinicians who are comfortable in the digital world. 
As new technologies emerge, physicians and educators need the freedom 
and encouragement to develop new learning methods. Most learners need a 
combination of educational opportunities to stay current with best practices.9
8 O’Brien BC, Patel SR, Pearson M, et al. Twelve tips for delivering successful interprofessional 
case conferences. Med Teach 2017;39(12):1214–20. DOI: 10.1080/0142159X.2017.1344353.
9 Davis DA, McMahon GT. Translating evidence into practice: Lessons for CPD. Med Teach 
2018;40(9):892–95. DOI: 10.1080/0142159X.2018.1481285.
660 Journal of Legal Education
Protecting Learners from Marketing and Promotion of Pharmaceuticals 
and Medical Devices
Physicians are in a unique position, controlling public access to regulated 
pharmaceuticals and medical devices. These industries are profit-motivated 
businesses and seek to engage with, inform, and market to prescribers using 
sophisticated strategies. 
To protect learners from the influence of industry and guarantee physicians 
that what they are learning is appropriate and correct, the ACCME’s Standards 
for Integrity and Independence include requirements for content and faculty 
selection, disclosure, identification and resolution of conflicts of interest, 
and management of commercial support without constraining the sharing 
of innovations and developments.5 The ACCME provides oversight through 
regular, recurring accreditation reviews, which include three sources of data—
randomly selected activity files, interviews conducted by trained surveyors, 
and self-study reports—along with a complaints process; the entire medical 
community helps prevent, detect, report, and remediate commercial bias. The 
ACCME provides ongoing guidance and educational resources to support 
compliance with these requirements. The importance of ensuring that CME 
activities are free of commercial bias is a critical priority for the ACCME and 
is under continual review.
Credit System and Requirements
The system for assuring the public of physician competence in the United 
States is based on the principles of professional self-regulation and shared 
accountability among regulatory bodies and physicians. The system is 
multilayered. State medical regulatory boards have a mandate to protect the 
public’s health, safety, and welfare through the proper licensing, discipline, 
and regulation of physicians. Many of these state boards require physicians 
to demonstrate their professionalism by engaging in their own professional 
development and to maintain and build their skills in a rapidly changing world 
by participating in accredited CME.10 Physicians interact with their regulatory 
stakeholders—licensing bodies, certifying bodies, credentialing bodies—and, as 
part of that interaction, must demonstrate engagement in accredited education 
by earning credit. State licensing boards, specialty certifying boards, hospital 
senior executives, and public health leaders recognize accredited CME as a 
partner in quality improvement and use education as a strategic resource to 
drive change. 
Only ACCME-accredited organizations are entitled to award American 
Medical Association (AMA) Physician’s Recognition Award (AMA PRA) 
Category 1 Credit that meets the requirements of all state medical licensing 
10 Federation of State Medical Boards. Continuing Medical Education, Board-by-Board 
Overview (https://www.fsmb.org/siteassets/advocacy/key-issues/continuing-medical-
education-by-state.pdf).
661Evolution of Continuing Medical Education in the United States: 
Implications for the Legal Community
boards, specialty certifying boards, hospital medical staffs, credentialers, 
health system accreditors, insurers, payors, and others. 
Funding of CME
The resources used to support CME—including commercial support—
deserve scrutiny and stewardship to protect the independence of content from 
any external support. Accredited providers reported approximately $3.4 billion 
in income in 2022. Review of this data shows that only eight percent of CME 
activities received commercial support, representing eighteen percent of all 
interactions. About twenty-six percent of total CME revenue is derived from 
commercial support; registration fees (fifty-two percent), exhibits (nineteen 
percent), government grants (two percent), and institutional allocations make 
up the majority of the revenue. Physicians perceive low rates of commercial 
bias in CME and see no association between the extent of commercial support 
and the degree of perceived bias in CME activities.11 
The ACCME charges accredited providers an annual accreditation fee to 
support its mission to assure and advance quality learning for health care 
professionals that drives improvements in patient care. Its operations are also 
funded by registration fees from education events such as Learn to Thrive 
(the annual ACCME meeting) and the Accreditation Workshop. There is no 
additional fee to accredited providers to report learner credit data, and there 
is no fee to the state licensing board or the physicians for access to the learner 
credit data. ACCME provides resources and technical support to accredited 
providers to assist with the administrative effort to report learner credit data. 
Digitization of CME Data
The ACCME, state medical licensing boards and specialty certifying 
boards share a responsibility and commitment to serving the public trust. This 
collaboration supports that commitment by decreasing the administrative 
burden of CME reporting for physicians, enabling them to spend less time 
tracking and uploading CME credits and more time on quality learning and 
patient care. The ACCME together with its partners, including the Federation 
of State Medical Boards, has digitized CME data to eliminate the need for paper 
reports or manual counts and is doing so reliably and securely.12 CME credit 
data is verified by the CME provider (primary source verification); there is no 
self-reported data in the system. Providers enter CME credit data throughout 
the year, and that data is available for each physician, each licensing board, 
and other permitted stakeholders to review in a single national data repository. 
Validation rules are in place, along with quality checks to ensure that the data 
is accurate. Safeguards are in place to protect personal information as well.
11 Steinman MA, Boscardin CK, Aguayo L, Baron RB. Commercial influence and learner-
perceived bias in continuing medical education. Acad Med 2010;85(1):74-9. DOI: 10.1097/
ACM.0b013e3181c51d3f.
12 McMahon GT, Chaudhry H.J., Regulators Collaborate to Digitize CME for America’s 
Doctors. J. Med. Reg. 2023;108(4):25–30. DOI: https://doi.org/10.30770/2572-1852-108.4.25.
662 Journal of Legal Education
Changes in the System
The evolution of learning design and the adoption of online learning as the 
primary method for engaging in CME has been dramatic. Online learning 
is readily accessible, and relatively inexpensive technology can facilitate 
interaction. By answering polling questions on their smartphones, for example, 
participants can learn how their attitudes, knowledge, or problem-solving 
skills compare with those of their peers. Given the opportunity to interact 
with colleagues, professionals can measure themselves against colleagues 
and norms and provide one another feedback while building collaborative 
relationships. Faculty development has been and is needed to support these 
modest educational innovations and sustain the necessary change.
Increasingly, physicians (like lawyers) are expected to practice in teams, 
and interprofessional continuing education gives them opportunities to learn 
from, with, and about colleagues and to build the competencies needed for 
successful collaboration. In their governance role, the organizations that 
accredit the provision of CME have the opportunity to facilitate team-based 
learning. Barriers between accreditation systems and professions must be 
overcome to achieve this shared mission. The continuing education accrediting 
organizations in medicine (the ACCME), pharmacy (the Accreditation 
Council for Pharmacy Education), and nursing (the American Nurses 
Credentialing Center) have collaborated to develop a joint accreditation 
system to facilitate interprofessional continuing education, now incorporating 
a common approach and process across ten health professions that has been a 
nexus for cultural change inside health systems.13 
Patients are also part of the team, and including patients as CME speakers 
can engage physicians’ hearts as well as their minds and reinforce the reasons 
our work matters.14 Patients’ stories often provide insights that clinicians can 
immediately apply in their practices. The same principle could readily apply 
to involving legal clients in CLE. 
13 Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration 
to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev 
2017;6(6):CD000072. DOI: 10.1002/14651858.CD000072.pub3.
14 McMahon GT. Learning Together: Engaging Patients as Partners in CPD. J Contin Educ 
Health Prof 2021;41(4):268–72. DOI: 10.1097/CEH.0000000000000388.
663Evolution of Continuing Medical Education in the United States: 
Implications for the Legal Community
Key Lessons Learned
When regulators and the educational community collaborate to create a 
single national integrated system, the whole profession benefits. It’s no longer 
realistic or current for regulators to be reviewing slide presentations and 
speaker bios to determine educational adequacy: Regulators must relinquish 
the fixed structural requirements and formats for professional education and 
instead focus on learning outcomes. Regulators and accreditors can create 
the right conditions for maximizing educators’ flexibility and promoting 
innovation; when alignment is created, the entire professional education 
community can flourish, as it has in medicine. It’s not tolerable to perpetuate 
a checkbox and compliance approach to something as essential to professional 
practice as continuing education: Doing so creates cynicism that is antithetical 
to the learning the community needs and is looking for. To be effective in a 
world where education needs to be flexible and nimble, regulators, accreditors, 
and educators must create a national framework of standards, use a provider 
accreditation model (trust-and-verify, rather than review-and-approve), 
implement a system of accountability, and allow a single credit system to flow. 
A national digital system of credit tracking allows professionals to spend their 
time learning (rather than in compliance) and allows regulators to view with 
permission the attainments of their licensees but also the performance of the 
system as a whole. 
Increasingly, educational design needs to evolve to the changing needs of 
learners by embracing the advances in educational technology to maximize 
retention using adaptation, repetition, and personalization.
Conclusion
Professionals can learn and change and do so best when they can access 
effective learning experiences. Creating a continuing education industry 
that delivers those experiences necessitates regulatory evolution that allows 
educational providers the flexibility to innovate and meet diverse needs across 
constituencies. The experience in medicine is that various stakeholders have 
to collaborate, and some must relinquish traditional roles to ensure the system 
can flourish to meet the needs of a changing profession. In doing so, those in 
the profession learn more and practice more effectively, and the people they 
serve all across the country get the service and support they need to deliver on 
our professions’ missions of health and justice for all.  
664 Journal of Legal Education
Figures
Continuing Education by the Numbers in 2022
Accredited Providers 1620
  Hospitals 785
  Membership organization / society 320
  Medical School 152
  Publishing or education company 151
Educational Activities 230,184
   Enduring printed or online material 108,508
   Live course 85,056
   Workplace-based case conferences 27,384
665Evolution of Continuing Medical Education in the United States: 
Implications for the Legal Community
The Regulatory System for CME in the United States 


Evolution of Continuing Medical Education in the United States: Implications for the Legal Community

Taylor, Lisa Sonia

Beginning at the End: A Roadmap for Mandatory Diversity Continuing Legal Education

Eldred, Tigran W.

Walker Wilson, Molly J.

Innovative Approaches to On-Demand Continuing Legal Education Ethics Training: A Case Study

Caudill, David S.

Law-and-Literature Studies as a Basis for High-Quality Ethics CLE Programs

Hall, Danielle M.

Technically Speaking: How to Improve Technology CLEs to Meet the Needs of Lawyers and Get Them to Attend

Boothe, Nicky

George, Erika

McGee, Kellyn O.

Mindfulness in the Law School Environment

Carpenter-McKinney, Adrian

Continuing Legal Education for the Newly Barred Attorney: A Law School’s Responsibility for Generation Z in the Workplace

Not a member yet