INTRODUCTION: Continuing medical education (CME) is an important resource physicians use to maintain their clinical competence. While many options for CME programs are available, there are few measures of their impact and few measures for physicians to use to systematically gauge their efforts in maintaining competence. This study initiates a process designed to identify key attributes of an ideal CME institution, defined as one that facilitates ways for individual physicians to maintain their competence. METHOD: Using a nominal group technique (NGT), two sessions were conducted with panels of experts in the field. The NGT systematically elicits and prioritizes panelists' responses to a specific question. A larger review panel then rated the importance of each attribute. RESULTS: Panel I: Highest priority attributes: Develops programs based on gaps in healthcare outcomes (8 votes); Has ready access to performance data (6 votes); Has measurement capability that enables tracking individual practice and program performance (6 votes). Panel II: Highest priority attributes: Has adequate resources to accomplish objectives (5 votes); Conducts outcomes assessments (5 votes); Links CME and continuous improvement (5 votes); Employs staff that is able and willing to "think out of the box" (5 votes). The highest rated attributes of the larger panel were: links CME and continuous improvement; develops and promotes programs based on gaps in healthcare outcomes and evidence-based content; and has access to needs data. DISCUSSION: Using an expert panel to define the key attributes of an ideal CME institution creates a roadmap for excellence. An ideal CME institution is one that provides CME that demonstrates effectiveness in supporting physicians' efforts to maintain competence.