**Background:** Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are major causes of chronic liver disease, with prevalence exceeding 25% in European adults and rates over 70% among patients with obesity or type 2 diabetes. Primary care providers (PCPs) are well-positioned for prevention, early detection, and long-term management, yet studies show screening rates below 46%, poor guideline familiarity, and low confidence. In 2021, a European collaborative team developed a continuing medical education (CME) program on NAFLD/NASH tailored to primary care. This article reports the development methodology and results of a feasibility study in Greece.
**Methods:** An expert advisory group (specialists and GPs from Greece, Spain, and the Netherlands) guided CME design using the Theory of Planned Behavior framework. The CME comprised four training modules with problem-based learning using clinical case studies. Feasibility testing used a before-and-after design with convenience sampling of 50 GPs in Crete, Greece (28 participated; 58% response rate). Participants completed online surveys pre-training, immediately post-training, and at 1-month follow-up. Outcome measures included satisfaction (5-point Likert scale), confidence (8 items, 1–5 scale), knowledge (7 multiple-choice questions), attitudes and clinical norms, and self-reported clinical practices. Statistical analysis used McNemar's tests, marginal homogeneity tests, and Wilcoxon signed-rank tests (significance level 0.05).
**Key Results:** Among 28 participating GPs (42.9% male; mean 18.3 years practice; 75% had no prior NAFLD CME), satisfaction was high: 96.3% reported being extremely or very satisfied overall. For specific components, 96.3% were extremely/very satisfied with content and presentation quality, 100% with case studies, and 85.2% with duration. 95% felt the training was free of commercial bias. Baseline confidence was low-to-moderate (mean ~3/5 across domains). Statistically significant increases in confidence were observed in all eight domains post-training (p<0.05 to p<0.001), sustained at 1-month follow-up (p<0.001). Knowledge effects were mixed—positive changes in 3 of 7 items. Attitude and clinical norm changes were not statistically significant. At follow-up, 64.3% of GPs reported the CME changed their practices to a great extent, and the proportion screening patients with obesity/diabetes rose from 64.3% to 78.6% (p=0.250). A significant shift occurred in the proportion of high-risk patients screened (p=0.035).
**Clinical Implications:** This CME addresses an identified gap in NAFLD/NASH training for European PCPs. The high satisfaction and significant confidence gains suggest that a brief, expert-designed, language-adapted e-learning intervention can be feasible and acceptable. However, mixed knowledge results indicate that additional focus on key areas (e.g., non-invasive testing like FIB-4) is needed. The authors note that training alone is likely insufficient and should be complemented by automated screening algorithms, collaborative care models, and practice incentives. The CME is available open-access in English, Greek, Spanish, and Dutch on the ESPCG platform. Limitations include small sample size, single-country setting, significant loss to follow-up (50% at 1 month), and reliance on self-reported data.