The purpose of this qualitative study is to form a grounded theory of the process of long-term transfer. Eight physicians were interviewed to discover if, years later, they had used what they were taught in a faculty development training program. We found that these autonomous professionals continued to apply the teaching ideas they learned. Each, in a personal way, chose to use varied ideas in different ways in several contexts. They applied ideas using intellectual skills such as planning and analyzing. They continued their applications because they perceived supportive work conditions and positive consequences. In sum, over the long term, physicians acquired knowledge and mental skill, chose to use them, and attempted application. They reflected on outcomes, decided to reuse or revise, and tried again. Thus, the process of long-term transfer was learning to use and learning from use. We examine implications for research and training.