BACKGROUND: A core mission of the American College of Chest Physicians (ACCP) is the education of its members, including continuing medical education (CME). The question of what evidence supports the effectiveness of CME activities became central to the ACCP's Educational Resources Division and its education committee. METHODS: An application for consideration as a topic for an evidenced-based guideline was submitted to the ACCP Health and Science Policy Committee in 2004. The application was approved contingent on acceptance by the Agency for Healthcare Research and Quality (AHRQ) as a topic for an evidence-based review to be awarded to an AHRQ evidence-based practice center (EPC). The topic was accepted by AHRQ, with a collaborative revision developed by AHRQ and ACCP of the focused questions submitted in the nomination. The AHRQ awarded the evidence review to The Johns Hopkins University EPC (Baltimore, MD). An expert writing panel was assembled comprising methodologists from the EPC, and recommendations were developed from the EPC evidence review and graded using the ACCP system of categorizing the strength of each recommendation and the quality of evidence. CONCLUSIONS: This section describes the processes used to develop these guidelines, including identifying, evaluating, and synthesizing the evidence; assessing the strength of evidence; and grading each recommendation.