Objectives The purpose of this study was to determine whether state mandated continuing medical education (CME) requirements affect the use of evidence base d therapies and outcomes in patients with acute myocardial infarction(AMI). Back ground The Institute of Medicine recommends that educational programs demonstrat e their effect through process and outcome measures. Methods We analyzed 134,609 patients according to whether or not CME was mandated in the state of physician practice. A hierarchical multivariable model was developed that controlled for state, hospital, physician, and patient level characteristics to determine the a ssociation between state CME requirements and the use of evidence based therapi es. Primary outcome measures were admission aspirin use and reperfusion therapy, and discharge aspirin and beta blocker prescription. Thirty day and one year mortality were secondary outcome measures. Results States with and without CME requirements had similar rates of aspirin use at admission and discharge(79.9%v s. 79.4%and 72.5%vs. 72.5%, respectively) and beta blocker prescription at d ischarge (53.6%vs. 55.3%). The rate of reperfusion therapy at admission was si gnificantly higher in states requiring CME(53.1%) compared with states without CME (47.9%)(p< 0.0001). After adjustment, patients admitted in CME requiring s tates were significantly more likely to receive reperfusion therapy, mainly owin g to “patented”thrombolytic therapy(odds ratio 1.15; p=0.016). There was no as sociation between CME requirements and one year mortality. Conclusions State m andated CME had little association with AMI care or outcome, other than an incre ased use of patented thrombolytic therapy. Further research is needed to maximiz e the measurable effect of CME on the use of proven therapies irrespective of wh ether patented or generic medications are involved. Objectives The purpose of this study was to determine whether the state mandated continuing medical education (CME) requirements affect the use of evidence base d therapies and outcomes in patients with acute myocardial infarction (AMI). Back ground The Institute of Medicine recommends that educational programs demonstrat A analyzed the effect of treatment and outcome measures. Methods We analyzed 134,609 patients according to whether or not CME was mandated in the state of physician practice. A hierarchical multivariable model was developed that controlled for state, hospital, physician, and patient level characteristics to determine the a ssociation between state CME requirements and the use of evidence based onrapi es. Primary outcome measures were admission aspirin use and reperfusion therapy, and discharge aspirin and beta blocker prescription. Thirty day and one year mortality were secondary outcome measures. Results States with and without CME requirements had similar rates of aspirin u se at admission and discharge (79.9% vs 79.4% and 72.5% vs. 72.5%, respectively) and beta blocker prescription at d ischarge (53.6% vs. 55.3%). The rate of reperfusion therapy at admission was si gnificantly higher After adjustment, patients admitted in CME requiring s tates were significantly more likely to receive reperfusion therapy, mainly owin g to “patented” thrombolytic (53.1%) compared with states without CME (47.9%) (p <0.0001) There was no as sociation between CME requirements and one year mortality. Conclusions State m andated CME had little association with AMI care or outcome, other than an incresed use of patented thrombolytic therapy. research is needed to maximiz e the measurable effect of CME on the use of proven therapies irrespective of wh ether patented or generic medications are involved.