Recent research into the history of some of the most prominent and successful firms in the for-profit sector has shown that industry leadership is extraordinarily fragile. Over and over; in industries as diverse as microelectronics, steel, motorcycles, and software, leading firms whose management practices at one point were widely admired and imitated have stum-bled badly and even failed. The factor that consistently has triggered these failures has not been complacent, arrogant, or bureaucratic management. It has been the emergence in their markets of disruptivem technology—simple, convenient-to-use innovations that initially are used only by unsophisticated customers at the low end of markets. Ironically, two of the funda-mental paradigms of good management—the importance of listening closely to customers and the necessity of bringing to market a regular flow of improved products that can be sold at higher profit margins—are the reasons why well-managed companies have consistently failed when confronted by disruptive technologies in their markets. This paper asserts that in a very analogous way, disruptive innovations in continuing education for managers and for health care professionals pose a significant threat to the impact and profitability of the continuing education programs of the leading schools of medicine and business. Through their focus on the leading edges of technology, therapy, and practice, many of these programs have lost sight of a very different set of educational needs among the fastest growing health care institutions in our environment. The paper suggests that unless leading providers of continuing medical education at medical schools aggressively begin offering courses that are customized to the needs of specific health care providers, in formats and venues that are conveniently accessi-ble, they will increasingly be displaced by new providers of these services.