In Spain, the lack of homogeneous criteria among medical institutions has led to gaps between medical school, residency, and continuing medical education. The authors describe the background and early history of the Spanish medical education system, early reforms, and the start of modern postgraduate medical education. They discuss the current system, highlighting ongoing concerns about how physicians are trained, including the emphasis on lectures and traditional assessment methods; the focus of faculty on research activities rather than teaching; inadequate assessment of residents; and the lack of coordination among providers of continuing medical education. However, they also highlight ongoing reform efforts, most notably the development of a new medical curriculum that has just begun to be implemented. They conclude with a discussion of the future direction of medical education in Spain, in which the growing movement toward greater unity among European nations is likely to play a large role.