A case study evaluation of the Bush Clinical Fellows Program, a fellowship program designed to enhance rural physicians' midcareer development and to improve rural health care delivery, is presented. Attention is also directed to the evaluation methodology and the implications of the evaluation approaches and the results. Two major evaluation approaches were used as frameworks for program assessment: a goal-oriented approach, and a case study approach. The goal areas were: improvement of quality of leadership in rural physicians' professional and personal development; and formation of linkages between physicians in rural communities and their preceptors at host medical centers. Each fellow initially formulates goals and evaluation criteria, after which the fellow completes monthly reports detailing progress toward goals and incidents related to the process of taking a sabbatical. The evaluator and program administrator periodically conduct site visits, and interviews are conducted with fellows, policy board members, and community references. Outcomes of the fellowship program included leadership development in community health care delivery and professional and personal renewal. It is proposed that the program can be used as a prototype for continuing education of other professionals. Appended materials include a bibliography and capsules of fellows' professional data, fellowship programs, and areas of emphasis. (SW)