Continuing medical education: understanding general practitioners who rarely attend, a cross-sectional questionnaire study among Danish GPs.

Background: Continuing medical education (CME) is vital for patient care, society, and general practitioners' (GPs) wellbeing. Despite its benefits, some GPs attend CME infrequently. While GPs' preferences for CME are well documented, it is unclear if these preferences are shared by infrequent users. Exploring infrequent CME users' preferences and educational needs is essential to engage them effectively.

Aims of the study: To explore infrequent users' preferences for CME formats and their attitudes towards mandatory CME compared to their CME attending GP colleagues.

Methods: A cross-sectional questionnaire study was conducted among all 3,257 GPs in Denmark. Descriptive statistics and logistic regression analyses were used.

Results: Responders were categorized into four CME user types: frequent (42%), partial (44%), infrequent (14%), and "do not know" (< 1%). All responders highly valued teachers and course leaders with insight into general practice. Overall, interactive learning activities and formats directly applicable to clinical practice were preferred, while online education, self-study, fact-based lectures, and sponsored meetings ranked lower. Infrequent users were more positive than frequent users towards reading on their own and fact-based lectures without participant involvement and short travel time. They were less positive about time-consuming learning such as week-long courses and courses abroad. Among infrequent users, 72% were principally opposed to mandatory CME setups, whereas a much smaller proportion opposed the current extent of mandatory CME in Denmark. This suggests a difference between practical acceptance and principled opposition. Despite infrequent users' reluctance towards participant involvement, they were open to small group learning and in-practice formats.

Conclusion: Teachers and course leaders with profound insight in general practice and patient-focused content seem to be an unquestionable requirement for successful CME. Infrequent users' reluctance towards participant involvement, but openness to small group learning and in-practice formats should be used strategically. Offering a variety of accessible, smaller-scale courses supports autonomy and diversity. Mandatory CME is not seen exclusively negatively and can be accepted if perceived relevant or as a valuable break or educational guarantee. However, it must be balanced with voluntary options to avoid causing demotivation.