In 1985 the Ministry of Health and Social Affairs recognized general practice as a specialty. The development and management of the programme was delegated to The Norwegian Medical Association. Approximately half of the general practitioners in Norway are now qualified specialists. The specialty is not a mandatory requirement for working in general practice, but there are considerable economic incentives involved (the consultation fee is increased by approximately 35%).
The five-year programme consists of:
General practice training (four years)
In order to receive authorization as a medical doctor all medical candidates in Norway have to complete one and a half years of internship. This internship consists of one year in hospital and six month as an assistant (trainee) with a district physician, usually in a rural district. Only after completing this internship may he or she enter the vocational training programme. Thus, the general practitioners have full authorization as medical doctors during their training years.
The main element of the training programme reflects the idea that training for general practice is best achieved while working in general practice.
Group-based training programme (two years)
This uniqe element is probably the most successful part of the training programme. Groups of general practitioners, working in the same geographical area, are to meet regularly every two weeks for three hour sessions.
Each group (two to ten participants) is headed by an especially appointed trainer. The Norwegian Medical Association has taken the responsibility of arranging a special education for the group leaders. However, the trainees themselves will be responsible for literature search, reading and introductory talks in the 40 meetings. The meetings cover clinical and theoretical aspects of general practice. An educational handbook presents introductory texts for preparatory reading.
Hospital training (one year)
Less emphasis is placed on hospital training than in corresponding programmes in other countries. Again, this reflects the belief that training for general practice is most effective in general practice. Hospitals have been the basis for the medical schools, but young doctors leaving the hospital to work in general practice will find that the diseases are different, the consultation time is short, and the level of technology may seem inadequate. The one year of hospital training may be divided between different clinical departments, but not less than three months in each.
Courses (400 hours)
Of the 400 hours, 300 must cover mandatory issues. There are four compulsory basic courses of 30 hours each, focusing on general practice, preventive medicine, research, and practice management, economics, and law. The rest of the obligatory courses may be chosen from a large menu of clinical topics, approved by the Medical Association. The final 100 hours may be covered by other courses (clinical or non-clinical).
Demonstration of practical skills
This is the most recent element included in the training programme. A check list has been worked out by the Medical Association. This list covers skills that should have been acquired during medical school or during the 18 months of internship, but practical skills may change over time, and regular training is considered necessary. The trainee must demonstrate his/her skill in the presence of one or more colleagues. This may be accomplished in the group-based training programme described earlier, or under the supervision of an experienced colleague.
Recertification (every five years)
There is no formal examination at the end of the programme, but the specialty is granted with an expiry date. Every five years the GP specialist must seek renewal. To qualify for recertification the specialist must have worked at least one year in general practice during the five-year period. A minimum of 200 hours of courses must have been accomplished. Furthermore, he/she must have worked at least three months in a hospital or conducted research for an equivalent period of time. Alternatively, hospital service or research may be replaced by research or another 100 hours of courses.
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