Medical advances make continuing medical education (CME) necessary. Thirty practicing internists and 14 medical residents completed questionnaires and tests of critical appraisal knowledge designed to compare attitudes, behaviors, and skills for maintaining current knowledge. Eighteen internists were then given practical guidelines for "keeping up" with the literature, and this group and a control group were restudied 4 months later. Internists and residents perceived largely the same informational needs and performed similarly on tests of critical appraisal knowledge. Internists preferred reading journals and attending CME courses; residents relied on rounds and textbooks. Internists spent no more time reading than residents and reported only enough CME to maintain hospital privileges. The educational intervention had little effect on the internists who attended. Despite a conviction that journal reading is the "best way to keep up," internists may not increase the quantity or quality of time spent reading. CME courses should include instruction intended to promote individualized critical reading of pertinent medical literature.