Some countries have specific requirements for first time approval as a medical examiner. They may also have specific requirements for in-service approved doctors, like regular attendance at meetings, or individual audits from the maritime authority. Only a few national maritime authorities approved doctors outside their own borders. The best known are the UK, Germany, Netherlands and Norway.

The requirements for approval varies between countries. In Northern Europe, a growing, informal cooperation between seafaring countries has grown, which leads us to the NEMAM[1] Group mentioned below.

Medical examiners have the right and duty to carry out an assessment against standards and criteria, which means that they are allowed a certain amount of discretion. How do we ensure that this is carried out properly? When individual doctors mostly are following their gut feeling, the need for harmonisation of their assessments is obvious.

How do we harmonise doctors’ assessment and decisions against a given set of standards and criteria? The answer is basic training and refresher training, exercises, discussions, quality circles, quality assurance and audits. We will have a look at these aspects below.

C.8.1.1 NEMAM Group curriculum

The NEMAM Group got its name in November 2018, after having existed as an informal cooperation between the medical advisers of the maritime authorities in several Northern European countries.

The ‘NEMAM Group’ stands for Northern European Maritime Authorities Medical Group. It is an informal group that is open to attendance by more countries than the present 10. Per 2019, the group consists of Belgium, Denmark, Faroe Islands, Finland, Germany, Luxembourg, Netherlands, Norway, Sweden and the UK. The initiative came from Norway, and the first meeting was between Norway, UK, Netherlands, Germany and Denmark. Both Germany and Denmark left the group, but joined again later. The first agreement between the countries Norway, Netherlands and UK, was a curriculum for basic training of approved doctors, including a description of skills and knowledge necessary for approval by the maritime authorities in the different countries.

Some countries require this training prior to approval, others within the first year after approval, but the curriculum of the “Basic Course for Medical Examiners, On behalf of the Maritime Administrations of Denmark, Germany, Netherlands, Norway and UK” is a description of the expected skills and knowledge of the approved doctors, regardless of how their competencies are achieved.

The learning outcomes are shown in the frame[2].  


On completion of this course, the participants shall

  • be able to conduct medical examinations of seafarers in accordance with laws, regulations and guidelines, which set the requirements for such examinations on behalf of the British, Dutch, German and Norwegian flags.
  • be able to assess the safety risk that relates to the seafarer’s medical condition in general, to his or her regular and emergency duties, within a time perspective corresponding to the validity period of the medical certificate.

be able to individualize the safety risk assessment relating to workers with medical conditions, and the consequences this may have for the individual him/herself, the safe operation of the ship and to other crewmembers.

  • understand the limitations and challenges regarding medical treatment of ill and injured seafarers whilst at sea.
  • understand the possibilities and limitations for medical care for workers on board ships whilst at sea, including knowledge of available on board medical resources.
  • understand the possibilities and limitations for medical assistance to workers on board ships, including medical evacuation and evaluation of the specific dangers related to medical evacuation
  • understand the characteristics of working places on board ships, and the different physical and mental demands which relate to different types of work on board ships
  • be able to conduct medical examination in accordance with statutory requirements, medical best practice, and proper case consideration
  • understand the different roles of doctors in different positions, and be aware of his/her own role whilst conducting medical examination of seafarers
  • be able to conduct medical examinations with a clear understanding of confidentiality, gathering of information and communication
  • understand the consequences of a declaration of unfitness in relation to the statutory regulations, and the “loss of licence insurance”
  • be able to assist the seafarer in cases of complaints and applications for exemption, and prepare a proper case for the appellate bodies


C.8.1.2 The Norwegian basic course for seafarers’ doctors

In Norway, this is organised as a 3-day course of attendance, preceded by preparatory homework and a pre-course test. Refresher training is due every 5 years and is organised as a course of 2 days attendance, also preceded by some preparatory homework and a pre-course test. Both the basic and the refresher courses concludes with a course test where the participant has to answer 80 % of the questions correctly to pass.


[1] Northern European Maritime Authorities Medical Group, an informal group of medical advisers of the European maritime authorities.

[2] Basic Course for Medical Examiners On behalf of the Maritime Administrations of  Denmark, Germany, Netherlands, Norway and UK, unpublished