In response to the 1998 Institute of Medicine report, "Pacific Partnerships for Health ", acknowledging the need for the continuing education of health workers in the United States-Affiliated Pacific Island (USAPI) jurisdictions, the U.S. Health Resources and Services Administration (HRSA) awarded a grant (1999-2003) to the University of Washington for a continuing education project in the Pacific. When shortfalls in HRSA funding threatened continuation of the program, Pacific advocates aggressively made a case for refunding of this important project. In 2003, HRSA announced competitive funding for a new program for continuing education. The Department of Family Medicine and Community Health (DFMCH) at the University of Hawai'i (UH), John A. Burns School of Medicine (JABSOM) was awarded the HRSA Cooperative Agreement to run from September 2003 through August 2007, creating PACT the Pacific Association for Clinical Training. PACT assembled a professional, community-based advisory board, most of whom were indigenous Pacific Islanders, and conducted a continuing clinical education needs assessment in every jurisdiction, subsequently developing and delivering programs utilizing distance education relevant to the needs of each USAPI jurisdiction. Priority health areas included diabetes, oral health and geriatrics, as mandated by HRSA. This report describes the processes, accomplishments, challenges and lessons learned from the project. PACT needs assessment reports for each jurisdiction and an executive summary are published as Original Articles in this issue of Pacific Health Dialog. As funding for PACT comes to an end, it is clear that much work remains to be done in the region. "Continuing clinical education" is only one part of a continuum of human resources for health (HRH) workforce development. Continued USAPI regional, U.S. national and international collaboration and resources are needed to achieve the ultimate goal of improved health and health care delivery in the USAPI.