Table 3 CME for GPs in Norway

Role of primary care within the health system

General practice is the basis of health care and GPs act as gatekeepers: without a referral from them, patients cannot see specialist doctors (except private and more expensive specialists in some cities). Patients are assigned to GPs via lists. On average, a GP sees 1100 patients. Many GPs take over community health care tasks 1 day a week [24, 25].

Legal regulations

Norway uses a recertification system: specialists in general practice must be recertified every 5 years. Although they can no longer be deprived of their specialist title as of 2019, they can only bill consultations at a reduced rate if they fail to provide required evidence, e.g., with regard to further training [26, 27].

Published aims

The aim of CME in general practice is to ensure that GPs are committed to lifelong learning. In contrast to CME training, the list of learning objectives in specialized education to become a general practitioner is very long and also includes attitudes, skills and reflection on medical practice. There are no such clearly defined learning objectives for CME training.

Actual content

GPs must plan about 40 days per 5-year period for CME activities. The following training activities are obligatory: 100 CME credits from courses on six topics. One course should be on acute medicine (including resuscitation). 20 CME credits through 2 full-day practice visits to (or from) another GP practice. 20 CME credits through regular participation in a general practice CME group. A further 160 credits are made up of freely selectable courses and a comprehensive list of continuing education activities (teaching, research, etc.).

Operationalisation

Most of the training is organised or supported by the Norwegian Medical Association. The Norwegian General Medical Association is entrusted with quality assurance. All continuing education must be approved by a specialty-specific committee of the Norwegian Medical Association. Each specialty - including general practice - has its own committee. The training programme is submitted to this committee, which approves or rejects it. CME training and specialized education to become a GP is often combined [28].

Funding and sponsorship

Most of the costs of training in Norway are covered by the Norwegian Medical Association’s training fund. As a rule, GPs have to pay the course fees for the training themselves but may be reimbursed travel expenses. Profit-oriented training companies play only a minor role. Although pharmaceutical companies organise training for GPs, they do not contribute CME credits for recertification.

Evaluation

Norwegian Medical Association training courses are evaluated by the participants. Approved online courses usually end with a knowledge test. After practice visits, GPs must write a report. In the course of the new regulations on general practice continuing education and training issued in 2019, the evaluation of continuing education has also been put into focus.