Hawaii is synonymous with paradise in the minds of many. Few know that it is also an environment where high quality medical education is thriving. This paper outlines medical education initiatives beginning with native Hawaiian healers of centuries ago, and continuing to present-day efforts to support top-notch multicultural United States medical education across the continuum of training. The undergraduate medical education program has as its core community-based problem-based learning. The community basis of training is continued in graduate medical education, with resident doctors in the various programs rotating through different clinical experiences at various hospitals and clinics. Continuing medical education is provided by nationally accredited entities, within the local context. Educational outreach activities extend into primary and secondary schools, homeless shelters, neighbouring islands, and to countries throughout the Pacific. Challenges facing the medical education community in Hawaii are similar to those faced elsewhere and include incorporating more technology to improve efficiency, strengthening the vertical integration of the training continuum, better meeting the needs of the state, and paying for it all. Readers are invited to join in addressing these challenges to further the realisation of medical education in paradise as a paradise of medical education.