It is increasingly recognised that neither general medical nor specialist qualification marks the cessation of the need for continuing reinforcement and renewal of the well-known tripod of education, namely knowledge, skills and attitudes. It can be argued that experience is the great teacher and the day-to-day work of the graduate ensures a continuing updating. This is only partially correct since new knowledge and practices, together with changes in working relationships, may pass by the educationally isolated, leaving a person hidebound, prejudiced and reactionary on an island surrounded by a speeding torrent of change. Unthinking response to these pressures may not be the way to deal with the situation but an awareness of these changes, so that the choice of response is made from strength rather than weakness, is an essential aspect.