Continuing medical education (CME) has many unique challenges when compared with education in other parts of the surgical training continuum. Recently, there has been considerable attention to improving CME, including some emerging research examining the role of simulation. The small group of published studies suggests that simulation can be used for the purpose of instruction and evaluation and that practicing physicians are generally accepting of this technology. However, this research also identifies a number of areas where simulators still lack clinically important features necessary for optimal instruction. Further, there is varied and mixed evidence for the validity in the measurement systems available in some simulators and a lack evidence of acceptable reliability. CME should be designed using all of the elements thought to be necessary for an effective educational course. Simulation is one of the instructional tools that can and should be used to enhance the educational impact of such a course. Future research about the use of simulation in a CME setting should be better grounded in the relevant theories and should reflect a growing understanding of the unique learning attributes of practicing surgeons. © 2008 Elsevier Inc. All rights reserved.