Results
A total of 579 doctors participated in the questionnaire survey, of whom 24 were excluded from further analyses because they were not members of a CME group. This left 555 responses as the basis for subsequent analyses.
Table 1 shows the respondents' gender, age, regional health authority, employment status and specialist status. Among the 486 respondents working in clinical practice as GPs or locums with their own patient list, the average number of patients was 1083 (minimum 203, maximum 2500). The national average for the same period was 986 (10) .
Table 1 Demographic data of respondents (N = 555) in the 2023 survey on CME-SGL
Demographic data
No. (%)
Gender1
Female
323 (58.4)
Male
230 (41.6)
Age (years)
25–39
97 (17.5)
40–59
326 (58.7)
≥ 60
132 (23.8)
Regional health authority
North
62 (11.2)
Central
68 (12.3)
South-East
305 (55.0)
West
120 (21.6)
Employment
GP
471 (84.9)
GP locum
15 (2.7)
General practice specialist in other position
21 (3.8)
Community medicine/administrative
13 (2.4)
Retired
19 (3.4)
Other
16 (2.9)
Specialist status
General practice specialist
502 (90.5 %)
Specialty registrar in general practice
47 (8.4 %)
Non-specialist in general practice
6 ((1.1)
No. of years as general practice specialist
0–5
110 (21.9)
6–10
92 (18.3)
11–20
158 (31.5)
> 20
142 (28.3)
A total of 157 of the respondents (28.3 %) were members of more than one group. These were asked to base their answers on their main group. A total of 334 (60.2 %) had experience as SGL secretaries.
On average, respondents had participated in the same CME group for 11.8 years (range 0–45). In terms of group size, 278 (50.1 %) reported that their group consisted of 2–6 participants, 247 (44.5 %) reported 7–11 participants, and 30 (5.4 %) indicated the group had 12 or more participants. Table 2 shows the reported meeting frequency, location and duration, as well as the basis for group membership. A total of 265 (47.7 %) reported that group meetings lasted 2.5–3 hours, and 407 (73.3 %) stated that the CME group met every two to three months. The most common meeting location was a medical practice (380 respondents, 68.5 %). The vast majority agreed that SGL was a setting where they could discuss their professional insecurities/sense of inadequacy: 516 (93 %) of respondents answered between 5 and 7 on the Likert scale, where 7 was 'strongly agree'. A total of 306 (55.1 %) respondents gave a score of 7.
Table 2 Reported descriptions of CME-SGL. Data from a 2023 questionnaire survey (N = 555)
Theme and response option
No. (%)
Meeting frequency
Weekly or more often/every two weeks
111 (20.0)
Monthly/every 2–3 months
407 (73.3)
Every six months/less often
37 (6.7)
Meeting location1
A participant's home
179 (32.2)
A participant's medical practice
380 (50.5)
Cafe/restaurant
79 (14.2)
Other
57 (10.3)
Meeting duration (hours)2
0.5–1
116 (21.3)
1.5–2
83 (15.2)
2.5–3
265 (48.6)
3.5–4
61 (11.2)
5–7
15 (2.8)
> 7
5 (0.9)
Basis for group membership1
GP practice has shared CME group
213 (38.4)
Continuance of supervision group
131 (23.6)
Invited to be a member
106 (19.1)
Norwegian Medical Association helped me
1 (0.002)
Started the group together
167 (30.1)
Other
12 (2.2)
We also asked respondents to rate the group's composition in terms of age, gender and background (e.g. university, country of birth) on a scale from 1 (very different) to 7 (very similar). On a combined homogeneity variable that included all three of these, the average score was 4.6.
Figure 1 provides more information about the format of meetings. A majority of 489 respondents (88.1 %) reported that they 'almost always' or 'always' looked forward to the meetings. A total of 446 (80.4 %) said that it was almost always or always possible to talk about emotionally difficult topics related to work, while 366 (65.9 %) indicated that meetings were never or almost never held during regular working hours, and 398 (71.7 %) said they never or almost never invited external speakers to their SGL meetings.
Figure 2 shows how the respondents rated the importance of CME groups (Likert scale; 1 = not important, 7 = very important). A total of 394 respondents (71 %) answered 6 or 7 regarding the group's importance for discussing challenging patients. A corresponding score of 6–7 was given by 362 (65.2 %) respondents for the importance of discussing experiences about practice management, and 340 (61.3 %) for the importance of the group as a social meeting place.
Among the respondents, 180 (32.4 %) stated that they never or almost never used externally developed courses, while 335 (60.4 %) answered 'sometimes' to this question (Figure 1). Table 3 shows the participants' emphasis on various factors when rating whether such courses might be relevant for their group. A total of 502 respondents (90.5 %) indicated that it was somewhat/very positive if the course awarded ECTS credits, and 281 (50.6 %) that it was somewhat/very positive if individual activity data could be extracted from their own medical practice (e.g. their own prescribing of various medications). A total of 259 respondents (46.7 %) stated that it was somewhat/very negative if the course required any preparation at home.
Table 3 Reported importance of various factors for the use of externally developed courses in continuing education groups in general practice. Data from a questionnaire survey in 2023 (N = 555).
Predefined factors
Somewhat/very positive, n (%)
Neutral/ unimportant, n (%)
Somewhat/n (%)
The course awards ECTS credits
502 (90.5)
49 (8.8)
4 (0.7)
The course uses clinical data from own practice
281 (50.6)
188 (33.9)
86 (15.5)
The course involves the entire medical practice
156 (28.1)
247 (44.5)
152 (27.4)
The course extends over more than one CME group
155 (27.9)
260 (46.8)
140 (25.2)
The course requires preparation at home
95 (17.1)
201 (36.2)
259 (46.7)
Most participants were satisfied with their CME group: 338 (60.9 %) were extremely satisfied and 170 (30.6 %) were very satisfied. Only 12 (2.2 %) were slightly satisfied or not satisfied at all.
There was little or no correlation between satisfaction with the CME group and demographic background variables, including age, gender and number of years as a specialist (data not shown).
Thematic analysis
Thematic analysis
We performed a template analysis (9) of the 216 free-text responses to the question about the importance of CME groups, which identified seven main themes, as detailed below. In these themes, respondents consistently emphasised the importance of SGL for fostering a sense of collegiality – something often missing from a hectic working day where they tend to work alone. Reassurance and support were also consistently emphasised as important aspects of SGL, both in emotionally and professionally difficult situations. These two themes were therefore perceived as integrated throughout the entire material.
The other seven main themes identified were:
Making the job manageable . Many expressed that SGL was very important to them, that it helped them continue their work as a GP and fostered collegiality, which was otherwise missing in their daily work.
Support in challenging situations . SGL was described as extremely important in relation to challenging situations, whether during patient consultations, in managing conflicts within their medical practice, and even in their private life.
Meeting place for colleagues . SGL was considered an important meeting place for colleagues, and many specifically expressed that it was a valuable opportunity to gain insights from other medical practices.
The importance of SGL changes as careers progress . Several respondents emphasised the value of meeting the same colleagues over many years. Over time, the main function of SGL could shift from a focus on updating clinical knowledge to a source of both professional and social support.
Freedom to structure SGL as desired . It was considered positive and important that there are no strict formal requirements for the content of SGL.
Professional benefits . SGL was considered useful for updating clinical knowledge, comparing medical practices and discussing specific clinical challenges.
It was also viewed in a positive light that SGL is mandatory, as this ensures that time is set aside for clinicians to update their clinical knowledge.
SGL is of little value . A few respondents perceived the requirement to participate in SGL as unnecessary and problematic due to time constraints both at work and in their personal lives.
A detailed coding framework (template), including main themes, subthemes and representative quotes, is provided in Table 4.
Table 4 Result of template analysis of 216 free-text responses to the question: 'Describe the importance of the CME group for you.' The table presents main themes, subthemes, integrated themes and representative quotes (9 ). Data from a questionnaire survey conducted in 2023 (N = 555).
Main theme
Subtheme
Quote
Making the job manageable
Gives breathing space
'It's been essential for my training and for continuing as a GP. Meeting colleagues regularly gives a necessary breathing space. It's extremely important to have a forum where we can vent about everything we're dealing with.'
Contributes to job satisfaction
'It probably would have been beneficial, both professionally and personally, for the group to be more diverse, but on the other hand, it's incredibly nice that we look forward to meeting up. We've become more like friends, and everyone feels completely comfortable with one another. We can bring up any topic and show vulnerability or lack of knowledge. All in all, it's really valuable to have a space that's just formal enough, yet informal enough, to meet other GPs outside the practice – because there's otherwise very little contact between GPs in our (large) municipality. I enjoy being part of my CME group. It's a loss that the doctors in the new system don't need SGL and therefore deprioritise it. It's a pity for all of us and for our sense of community.'
Important for remaining in the job
'It's also a stabilising factor in being a GP – a space to share frustrations and burdens related to the job. Having colleagues outside the practice who can offer support and encouragement feels absolutely essential for remaining in the job as a GP.'
Support in challenging situations
Provides support at work
'SGL is incredibly important for discussing clinical cases and, not least, for receiving support from colleagues who have time to listen, especially in relation to difficult patients and emotional support in challenging situations. It means a great deal. There's always an opportunity for debriefing.'
Provides support in private life
'Important for talking about difficulties at work and for helping each other when we're struggling with a personal or professional matter.'
Meeting place for colleagues
'A meeting place to talk and get support from colleagues and friends over time – something there's rarely time for in the normal working day.'
Meet people from other medical practices
'We haven't had many meetings yet, but it's nice to have a community with doctors in the same stage of establishing their practice and to get input on how to manage the day, discuss cases, and share advice on handling things at the practice. As GPs, we need a greater sense of community beyond our medical practice, which SGL can help provide.'
Leads to continuity in relationships with colleagues
'From day one, we had a strong bond, and we've maintained it ever since. We've become good friends and also stay in touch outside of the group. We share experiences about patients, running the practice, and have a space to vent to colleagues who are going through the same challenges. Without SGL, I'm convinced my quality of life would be lower.'
The importance of SGL changes as careers progress
'SGL has been absolutely essential for a "good life" as a GP over 40 years. Support, understanding and consideration from colleagues who can relate. The frequency of meetings and topics have changed over the years.'
Freedom to structure SGL as desired
'It's important that it's so unstructured that everyone has time to show up and participate without preparation. That way, it becomes a relaxed and informal morning coffee.'
Main theme
Subtheme
Quote
Professional benefits
Updating clinical knowledge
'A nice way to stay up to date, it forces me to prepare for the meeting and set aside time for a professional deep dive. We also share tips about courses and local services.'
Awards ECTS credits
'When everyday life as a GP is so busy, it's also important that you earn ECTS credits and that participation is mandatory.'
Can discuss patient cases
'A place to discuss the most difficult patients and situations.'
Practice management
'You don't receive approved ECTS credits discussing practice management. That's strange, as management is such a significant part of a GP's working day. It's about ensuring the standard of care and providing the patient with the right treatment.'
Comparing medical practices
'SGL gives us the opportunity to develop our general practice competence and to calibrate our patient care with what others are doing.'
SGL is of little value
Mandatory nature of SGL is a negative aspect
'I think the importance of SGL is over-rated as part of the specialty and should be voluntary so that those who find it beneficial can participate.'
Time constraints
'It's exhausting to have to do this on top of working yourself half to death at your job. It's frustrating that this is a requirement for continuing education.'
Integrated themes
Reassurance and support
Collegiality