Table 5 CME for GPs in Germany

Role of primary care within the health system

Although general practice centred care is gaining in importance as a model in numerous German regions, it is not being implemented across the country. In addition to general practitioners in solo and joint practices, and medical care centres (MVZ), there are practices containing specialists in numerous disciplines. Patients can consult specialists in addition to their general practitioner, without the need for a GP referral or coordination.

Legal regulations

The Model Continuing Education Regulation (Musterfortbildungsordnung) of the German Medical Association (Bundesärztekammer) of 29.05.2013 regulates formal criteria for CME in Germany. The respective federal state medical associations follow these as far as possible. Since there is almost no institutional accreditation, each CME event is usually certified individually by the respective medical association. Thus, there is no uniform federal state or national system for providers of CME. Germany is largely characterised by an unregulated CME system [35].

Published aims

The Model Continuing Education Regulation of the German Medical Association defines the goal of CME as follows: “The continuing education of physicians serves to maintain and continuously develop professional competence in order to guarantee high-quality patient care and ensure the quality of medical professional practice” [36]. This broad definition leaves a lot of room for variation in content and structure.

Actual content

With 250 CME credits in 5 years, the Model Continuing Education Regulation determines the necessary scope of CME. In addition, it regulates, among other things, the evaluation and recognition of continuing education measures. While the medical associations do not have any defined learning objectives or curricula, some stakeholders have developed more or less elaborated subject matter catalogues or syllabi and formulated overarching learning objectives [35, 37].

Operationalisation

There is no overarching coordination of training foci or events in Germany. Rather, the German CME system can be described as a juxtaposition of numerous qualitatively very heterogeneous offers [38, 39].

Most of the existing organisations and institutions operate regionally or locally. The certification of continuing education programmes is carried out exclusively by the responsible federal state medical associations.

Funding and sponsorship

GPs are only incentivised to participate in further training by the award of CME points and the possibility of billing Disease Management Programmes (DMPs). Training obligations from GP contracts can present further incentives. However, this applies to a limited number of GPs. Depending on the quality, duration and sponsorship, the costs for GP training vary greatly and can hardly be averaged out. Sponsorship is still widespread in the GP training landscape in Germany, even if individual actors and initiatives categorically reject industry sponsorship [40].

Evaluation

CME courses are evaluated by the accrediting institutions (regional medical associations). In most cases, this is done by means of categorical questionnaires, which are filled out by the participants according to subjective aspects. Objective evaluations, which e.g., also record the learning and competence gains of the participating GPs, are hardly ever used. In addition to the evaluations of these regional medical associations, organisers also evaluate their training courses.