Background E-learning is a growing phenomenon which provides a unique opportunity to address the challenges in continuing medical education (CME). The China-Gates Foundation Tuberculosis (TB) Control Program implemented online training for TB health workers in three provinces of China. We aim to evaluate the implementation of E-learning CME programs, analyse the barriers and facilitators during the implementation process, and to provide policy recommendations. Methods Routine monitoring data

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... e collected through the project office from December 2017 to June 2019. In-depth interviews, focus group discussion with project management personnel, teachers, and trainees (n = 78), and staff survey (baseline n = 555, final n = 757) were conducted in selected pilot areas at the provincial, municipal, and county/district levels in the three project provinces (Zhejiang, Jilin, and Ningxia). Descriptive analysis of quantitative data summarized the participation, registration, and certification rates for training activities. Thematic approach was used for qualitative data analysis. Results By the end of June 2019, the national and provincial remote training platforms had organized 98 synchronous learning activities, with an average of 173.2 people [standard deviation (SD) = 49.8] per online training session, 163.3 people (SD = 41.2) per online case discussion. In the pilot area, 64.5% of TB health workforce registered the asynchronous learning platform, and 50.1% obtained their professional certifications. Participants agreed that E-learning CME was more economical, has better content as well as more flexible work schedules. However, the project still faced challenges in terms of unmet learning needs, disorganized governance, insufficient hardware and software, unsupported environment, and lack of incentive mechanisms. Conclusions Our results suggested that it's feasible to conduct large scale E-learning CME activities in the three project provinces of China. Training content and format are key facilitators of the program implementation, while the matching of training supply and demand, organizational coordination, internet technology, motivations, and sustainability are key barriers.