How self-regulated learning influences undergraduate medical students to conduct student-centred learning: a scoping review protocol.

INTRODUCTION: Self-regulated learning is one of the influencing factors in successful learning. There is a need to understand the factors influencing self-regulated learning in undergraduate medical students in implementing a student-centred learning curriculum. This scoping review aims to systematically identify and map undergraduate medical students' self-regulated learning during student-centred learning implementation and to learn the tools used to measure it. METHODS AND ANALYSIS: The scoping review will use Arksey and O'Malley's proposed five-stage framework guideline. A search for published literature between 2012 and 2022 in the five electronic databases of EBSCOHost, Science Direct, Scopus, ProQuest and PubMed will be conducted using keywords to identify relevant studies. Articles will be limited to the English language. Mendeley software will eliminate duplicates, and results will be exported into abstracts for two stages of the screening process: title and abstract reviews and full-text reviews. The selection process of eligible literature will be reported using the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist recommendations. Studies using qualitative and quantitative data from all world regions will be considered. To be included, studies should examine medical students' self-regulated learning in a student-centred learning approach curriculum. A data chart will capture relevant information from all the included studies. As a scoping review, no assessment of the studies' quality and risk of bias will be made. Results will be presented in tabular form and a narrative report. ETHICS AND DISSEMINATION: No Ethics Committee or Institutional Board approval is required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and professional networks.

What Are the Various Comprehensive Treatment Models to Improve Self-Efficacy and Self-Management in Adolescents with Diabetes Mellitus? A Scoping Review.

Background: This review aimed to synthesize intervention models involving the role of adolescent and family support as part of comprehensive care to improve self-efficacy and self-management among adolescents with Diabetes Mellitus (DM). Methods: A review was conducted to conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards. We searched PubMed, Research Gate, Science Direct, Cochrane Library databases, and grey literature. We included articles exploring family intervention models on improving self-efficacy and self-management among adolescents with DM, published from January 1, 2009, to June 30, 2022, and in English. Articles were declared eligible, reviewed critically, and then synthesized narratively. Results: We identified 487 abstracts and title records from the initial search and excluded 409 irrelevant studies. Sixty-six full-text articles were screened, and nine were included in the synthesis. Five articles presented findings from using models focusing on child and adolescent intervention, while in the remaining four articles, the intervention models involved adolescents and their caregivers or parents. Only two models provide comprehensive care that requires collaboration among healthcare providers, patients, and families. Adolescent self-efficacy and self-management schemes as intermediary variables are closely related to everything that can influence health behavior, metabolic control, and quality of life for adolescents, which requires support from a multidisciplinary collaborative team. Conclusion: Excellent comprehensive care team collaboration involving family support is essential to increase the self-efficacy and self-management of adolescents with DM.

The interactional communication of feedback in clinical education: A focused ethnographic study in a hierarchical and collectivist culture.

Background: The definition of feedback in clinical education has shifted from information delivery to student-teacher dialogue. However, based on Hofstede's theory, countries with large power distance or a robust social hierarchy and collectivistic cultural dimensions can reduce the feedback dialogue to a minimum. Indonesia is classified in this group, with some Asian, African, Mediterranean, and Latin American countries. This study explores the interactional communication of feedback during clinical education in a hierarchical and collectivistic context. Methods: The focused ethnographic approach was applied to the clinical rotation program in an Indonesian teaching hospital. Data sources included observations of feedback episodes during workplace-based assessments followed by interviews with clinical supervisors and students. The data were compiled within 16 weeks of observation in 7 groups of clinical departments, consisting of 28 field notes, audiotaped interviews including nine focus group discussions of students (N = 42), and seven in-depth interviews with clinical supervisors. Data were analyzed through transcription, coding, categorization, and thematic analysis using the symbolic interactionist perspective. Results: We identified four themes representing actual interactional communication and its 'meaning' or interpretation. The interactional communication in feedback is described in the first and second themes, such as 1) Students play the subordinate roles in a feedback dialogue; 2) The feedback content is focused on explanation and students' limitations. The third and fourth themes represent the clinical supervisors' and students' interpretation of their feedback experience, such as 3) Clinical supervisors' perspectives are mostly on dissatisfaction and teaching authority; 4) Students' acceptance of reality and negative affection. Conclusions: This study shows that the social gap between students and clinical supervisors in Indonesia, and other countries in the same cultural classification, potentially causes communication barriers in the feedback dialogue. The adaptation of 'feedback as a dialogue' requires further effort and research to develop communication strategies in feedback that consider the national culture and context.

Challenges and opportunities in cultivating medical students' competencies: Participatory action research from a hierarchical cultural setting.

BACKGROUNDS: Research concerning student-centered learning (SCL) recommends a comprehensive assessment of medical students' competencies including their personal and professional characters. Accordingly, nurturing future doctors should be in a continuous mentorship program. However, in a hierarchical culture, communication is one-way with limited feedback and reflection. We aimed to explore challenges and opportunities for SCL implementation in medical schools in this cultural setting necessary for a globally interdependent world. METHODS: Two cycles of participatory action research (PAR) were conducted, involving medical students and teachers in Indonesia. A national conference on SCL principles was conducted between the cycles, also the SCL modules were developed for each institution and feedback was shared. Twelve focus group discussions were conducted (before and after the module development), with 37 medical teachers and 48 medical students from 7 faculties of medicine across Indonesia at various levels accreditation. Following verbatim transcriptions, a thematic analysis was conducted. RESULTS AND DISCUSSIONS: In cycle 1 PAR, some challenges in implementing SCL were identified: lack of constructive feedback, overloaded content, summative-based assessment, hierarchical culture environment, and teachers' dilemma of committed time between patient-care and education. In cycle 2, several opportunities to approach the SCL were proposed: a faculty development program on mentorship, students' reflection guides and training, a more longitudinal assessment system, also a more supportive government policy on the human resources system. CONCLUSIONS: The main challenge of fostering student-centered learning revealed in this study was a teacher-centered learning tendency in the medical curriculum. The weighting towards summative assessment and the national educational policy drive the curriculum like a 'domino effect', away from the expected student-centered learning principles. However, using a participative method, students and teachers could identify opportunities and articulate their educational needs, i.e., a partnership-mentorship program, as a significant step toward student-centered learning in this cultural context.

The importance of developing meaningfulness and manageability for resilience in rural doctors.

INTRODUCTION: Retention of rural doctors is a problem in many countries. A previous study has identified resilience as a factor associated with longer retention. However, this needs a deeper study to understand what local and personal factors are at play. Studies suggest resilience can be developed during training. We propose that a better understanding of factors associated with resilience might assist in training students for rural practice and increase retention. AIM: This study aimed to understand the differences in resilience development between the more and the less resilient rural doctors. A secondary purpose was to identify how to assist this developmental process through health professional education. METHODS: This study employed a mixed-method design and was part of a more extensive study aiming to develop rural doctors' resilience in a low-resource setting. A prior survey assessed rural doctors' resilience levels. This study sampled high-level and low-level resilience participants to be interviewed. A total of 22 rural doctors participated in the individual semi-structured interviews. The interviews were analyzed qualitatively based on Richardson's Resilience Model and the six resilience dimensions looking for factors that explained high or low resilience. RESULTS: Two important themes emerged during the qualitative analysis: 'meaningfulness' and 'manageability.' The different responses of high and low-resilient participants can be explained through cases. CONCLUSIONS: The participants' perceived meaningfulness and manageability of the stressor determine the responses. We suggest that teachers may better construct students' resilience by focussing on assisting them in finding meaning and developing a sense of manageability.

The Practice of Feedback in Health Professions Education in the Hierarchical and Collectivistic Culture: a Scoping Review.

The global trend in student assessment is moving towards outcome-based assessment that requires multiple systematic data points and continuous feedback. However, in hierarchical and collectivistic cultures, one-way communication is practised more often, leading to less dialogical feedback. This scoping review explored feedback practice in Asian educational setting. Based on the 17 articles selected, the findings were categorised into four themes, i.e. inhibiting or facilitating factors of feedback, influences of cultural factors on feedback, discrepancies between students' and teachers' perceptions of feedback and impact of feedback. Hierarchical and collectivist cultural aspects, such as preference for group feedback, are pertinent to feedback practice, which likely influence the readiness for programmatic assessment.

Developing Personal Resilience Questionnaire for rural doctors: an indigenous approach study in Indonesia.

BACKGROUND: Resilience is recognized as a critical component of well-being and is an essential factor in coping with stress. There are issues of using a standardized resilience scale developed for one cultural population to be used in the different cultural populations. This study aimed to create a specific measurement scale for measuring doctors' resilience levels in the rural Indonesian context. METHOD: A total of 527 rural doctors and health professional educators joined this study (37 and 490 participants in the pilot studies and the survey, respectively). An indigenous psychological approach was implemented in linguistic and cultural adaptation and validation of an existing instrument into the local Indonesian rural health context. A combined method of back-translation, committee approach, communication with the original author, and exploratory qualitative study in the local context was conducted. The indigenous psychological approach was implemented in exploring the local context and writing additional local items. RESULT: The final questionnaire consisted of six dimensions and 30 items with good internal consistency (Cronbach's α ranged 0.809-0.960 for each dimension). Ten locally developed items were added to the final questionnaire as a result of the indigenous psychological approach. CONCLUSION: An indigenous psychological approach may enrich the linguistic and cultural adaptation and validation process of an existing scale.

Empowering adolescents as peer-educators for early prevention of non-communicable diseases: Through existing 'POSBINDU' program in Indonesia.

BACKGROUND: Human lifestyles, including sedentary activities, obesity, and smoking, are associated with a high risk of non-communicable diseases that are a leading cause of death globally. Accordingly, health promotion should be done as early as possible in the adolescent period. AIMS: This study explores the efficacy of a peer-educator program in promoting the healthy habits of adolescents, via an existing Indonesian community initiative program called 'POSBINDU' (Integrated Counseling Post), led by the general practitioners. METHODS: Twenty-week 'experiential learning' approach with mixed-method was designed to: 1) Train 10 GP trainers, 2) Recruit and observe the 10 group-1 and 50 group-2 peer-educators in a high school; 3) Develop modules on health lifestyles by the GPS and peer-educators, and 4) Implement the POSBINDU program at the high school. RESULTS: Both GPs and students' perceptions significantly increased before to after the intervention (p > 0.05). The participants also expressed they experienced increased comprehension of NCDs and the importance of healthy habits. CONCLUSIONS: The existing POSBINDU community's initiative program can potentially be improved by appropriate interventions to empower school students towards better healthy habits to prevent the early progression of NCDs.

Indonesian General Practitioners' Experience of Practicing in Primary Care under the Implementation of Universal Health Coverage Scheme (JKN).

INTRODUCTION: The Indonesian government has been implementing Jaminan Kesehatan Nasional (JKN) as the national universal coverage scheme to help Indonesian citizens affording medical care since 2014. However, after a few years of its implementation, a very limited study has been conducted to explore general practitioners' (GPs) views and experiences of practicing in primary care under JKN implementation. METHODS: The study applied semi-structured interviews with GPs from January to February 2016, guided by a phenomenology approach in Yogyakarta province, Indonesia. The GPs were recruited using a maximum variation sample design. The interviews were recorded and transcribed, and the data were analyzed thematically. RESULT: A total of 19 GPs were interviewed. Three major themes emerged, namely: powerlessness, clinical resources, and administration. Transition to the JKN system has improved patient access to primary care without significant economic barrier, however, GP participants experienced a sense of powerless practice during JKN implementation. They also commented on limited clinical resources and claimed that JKN administration was complicated and burdened their practice. CONCLUSION: This study identifies various perspectives from GPs practicing in primary care under JKN implementation. The JKN improves access to primary care practice, but there are limited supports for GPs to practice optimally and maintain their relationships with patients. Extensive improvements are needed to upgrade the GP practice in primary care.

Predicting Factors on Modeling Health Behavior: A Systematic Review.

Objectives: In this study, we summarize current evidence on learning health behaviors through modeling, thereby offering greater insight into the predictors of modeling's effectiveness on health behavior change. Methods: We searched 5 electronic bases (PubMed, ProQuest New Platform, EBSCOHost, ERIC, and ScienceDirect) drawing on articles from January 1986 to April 2018. In addition, we performed follow-up searches of unique citations from identified articles. Results: Overall, our search identified 3339 articles. Based on inclusion and exclusion criteria, we reviewed 20 qualifying articles across 4 conditions of role modeling: attention, retention, motor reproduction, and motivation. Characteristics of role models and observers, use of technology to promote the modeling of health behavior, and use of peers as role models emerged as predictive factors related to attention; types of information and adherence to a specific timeframe were related to retention. Opportunity to practice a modeled health behavior and a specific timeframe to perform what was observed were key elements for motor reproduction. Support by significant others, self-efficacy, self-regulation, and policy incentives were predictive of sustained motivation. Conclusions: This review highlights several predictive factors in each situation in learning healthy behavior through role modeling. Identification and application of these factors may increase health behavior adoption.

Improving Nursing Students' Medication Safety Knowledge and Skills on Using the 4C/ID Learning Model.

INTRODUCTION: Learning medication-safety has become a focus in many countries to improve medication-safety competencies in nursing students. Research on instructional design for medication-safety is still limited, especially about the use of the Four Components Instructional Design (4C/ID) model. This study aimed to compare the knowledge and skills in medication safety of nursing students after the medication-safety training using four components of instructional design known as 4C/ID. METHODS: This was a posttest-only quasi-experimental study using an intervention and control group. The participants were the third-semester students of a nursing school at Yogyakarta, Indonesia (intervention: n=55, control: n=40). The intervention group was trained for five weeks using the 4C/ID approach with interactive lectures, small group discussions, reflections, and skills simulation sessions. An observational skills evaluation and Multiple-Choice Questionnaire were administered in the last week after the training completed. Independent sample t-test and Mann Whitney tests were used to analyze the mean differences of knowledge and skills in giving oral medicine and drug injections between the two groups. RESULTS: The majority of respondents were female (74.1%), aged 19-20 years (77.8%), with GPA >3 (87.37%) and, the majority had never received instruction about patient safety (69%). There were significant mean differences in overall knowledge (p<0.05) and also in the skills of oral drug and intramuscular drug administration (p<0.05) between the intervention and control groups. CONCLUSION: Training in medication-safety using the 4C/ID approach could improve the medication-safety knowledge and skills of the nursing students based on simple to complex learning.

Factors influencing healthy role models in medical school to conduct healthy behavior: a qualitative study.

OBJECTIVES: This study aimed to identify the factors that support or inhibit medical teachers as healthy role models in medical school to conduct healthy behavior. METHODS: This qualitative study involved semi-structured in-depth interviews with medical teachers categorized as healthy role models in a medical school from a previous survey. Ten medical teachers were selected using purposive sampling. Three medical teachers were interviewed by direct meetings, and the remaining were phone interviewed, with one interview facilitated by chat using WhatsApp. Transcribed interviews were coded openly. Themes were finalized through discussion and debate to reach a consensus. RESULTS: Two themes were identified: perceived facilitators and perceived barriers, which were classified into four categories and 13 subcategories: intrinsic facilitators (motivation, conscious awareness, having physical limitations, knowledge, and economic reasons); extrinsic facilitators (the impact on doing a particular job, feedback, time, and environment); intrinsic barriers (the lack of self-motivation and having physical limitations); and extrinsic barriers (the burden of responsibilities for being medical teachers and environment). CONCLUSIONS: Factors that support and inhibit medical teachers as healthy role models in medical school are influenced by intrinsic and extrinsic factors. This result could be used by medical schools to design appropriate interventions to help medical teachers as healthy role models in conducting healthy behavior. More studies are needed to explore other factors that influence medical teachers to conduct healthy behavior. During the COVID-19 pandemic, healthy role models in medical schools are vitally important and significantly contribute to the overall health of a nation.

Defining a "Healthy Role-Model" for Medical Schools: Learning Components That Count.

INTRODUCTION: Producing healthy physicians who act as a "healthy role-model" in their environment must be one of the concerns of medical schools today in response to the global movement of "health-promoting university" by the WHO (1995). However, no publications explained the "healthy role-model" in medical school. This study aimed to fill this gap by exploring the definition and characteristics of a "healthy role-model" for medical teachers. METHODS: We used a grounded theory approach with in-depth interviews and e-mail communications to 48 medical teachers from various backgrounds of "health professions education," "health education and behavior"/'health education and promoter,' "general practitioners/family medicine," "adolescent health," "internal medicine," and "cardiology-vascular medicine." The medical teachers were from Indonesia, one other developing country (Bangladesh), and five developed countries (United States of America, Canada, Netherlands, Australia, and United Kingdom). We also invited 19 medical students from Indonesia for three focus group discussions. RESULTS: We identified four categories to define a "healthy role-model" for medical schools as persons who are seen: 1) "physically," "socially," "mentally", and "spiritually" healthy; 2) internalized healthy behaviors; 3) willing to promote healthy lifestyles; and, 4) a life-long learner. In each category, there are several characteristics discussed. CONCLUSION: Our study provides some insights to define a "healthy role-model" of medical teachers by using the characteristics of healthy people and adult learners. The first category describes the characteristics of healthy people, but cultural issues influence the perspectives of medical teachers to define a "healthy role-model" for medical schools.

Personal resilience and rural doctors retention: a study in Indonesia.

INTRODUCTION: Retaining the health workforce in rural areas is a global problem. Job dissatisfaction or work-related distress are among the factors that drive doctors to leave rural places. Resilience has been recognised as a key component of wellbeing and is associated with better satisfaction with life. Building personal resilience has the benefits of lowering vulnerability to work-related adversity. This study examined the association between rural doctors' personal resilience and the duration of rural practice. METHODS: This cross-sectional study was set in a rural province in Indonesia. A total sampling procedure was implemented. A total of 528 participants responded to an online survey. The survey tool measured six dimensions of a resilience profile (determination, endurance, adaptability, recuperability, comfort zone and life calling) and collected personal data such as date of birth, practice location and duration of rural practice experience. These participants were classified into four groups: intern, general (GP) with 10 years experience. The data were analysed quantitatively using Oneway analysis of variance (ANOVA). RESULTS: Doctors with longer durations of rural experience showed higher resilience levels in four of the dimensions of personal resilience: endurance, adaptability, recuperabilit­y and comfort zone. Among those four dimensions, endurance and comfort zone showed significant differences between groups with >10 years of difference in rural experience (p<0.05). The other two dimensions, determination and life calling, showed fluctuations across groups with different rural durations. CONCLUSION: This study provides a preliminary result for understanding the relationship between personal resilience and rural doctor retention. It suggests that resilience is partly associated with rural doctor retention. Further studies are needed to examine the causal relationship between resilience and retention.

A partnership-oriented and culturally-sensitive communication style of doctors can impact the health outcomes of patients with chronic illnesses in Indonesia.

OBJECTIVES: A partnership-oriented communication style is globally recommended for medical practice. A culturally-sensitive doctor-patient communication guideline is also needed for Southeast Asia. The 'Greet-Invite-Discuss' guideline was established and tested with primary care doctors and their patients in Indonesia. METHODS: In this mixed-methods study, doctors were trained according to the 'Greet-Invite-Discuss' guideline, while patients received standard treatment. Two groups of fifteen doctors were assigned to have consultations with 45 patients with hypertension or 51 patients with type-2 diabetes mellitus. Doctors' self-assessment and patients' perceptions and their clinical outcomes were longitudinally measured. Six focus group discussions were conducted to explore doctors' and patients' experiences. RESULTS: Doctors' self-assessments and patients' perceptions of doctors' communication skills increased significantly (p < 0.05). Moreover, patients' blood pressure or fasting blood glucose levels decreased significantly (p < 0.05), except the two-hour blood glucose levels (NS). Qualitatively, doctors demonstrated more partnership and culturally-sensitive communication, and patients expressed more satisfaction, increased comprehension and self-management, of their chronic illnesses. CONCLUSIONS: The 'Greet-Invite-Discuss' guideline was useful for primary care doctors for a more partnership-oriented and culturally-sensitive communication with patients in chronic care management. PRACTICE IMPLICATIONS: Using a partnership-oriented and culturally-sensitive communication guideline, doctors can improve their communication skills with their patients towards optimum health outcomes.

Why do nursing students make medication errors? A qualitative study in Indonesia.

OBJECTIVES: This study aimed to explore Indonesian nursing students' perceptions of the types and causes of medication errors in clinical rotations. METHODS: This descriptive qualitative study was conducted with 26 nursing students who had completed their final clinical rotations. Data were collected through four focus group discussions and analysed by Colaizzi's method. RESULTS: Three themes were obtained from the data analysis: important role played by nurses in medication safety, types of medication errors (near misses) committed by nursing students, and the causes of medication errors during clinical rotations. CONCLUSION: Nurses play a vital role in dispensing medication and ensuring patient safety, but near misses are still reported during clinical rotations. Lack of knowledge, skills, proper supervision, and appropriate role models during clinical rotations lead to medication errors by nursing students. Appropriate role models and adequate supervision in the clinical education stage are necessary to ensure the achievement of medication safety competencies.

Community-based educational design for undergraduate medical education: a grounded theory study.

BACKGROUND: Community-based education (CBE) is strategically important to provide contextual learning for medical students. CBE is a priority for countries striving for better primary health care. However, the CBE literature provides little curriculum guidance to enhance undergraduate medical education with the primary health care context. We aim to develop a CBE framework for undergraduate medical education (from macro, meso, and micro curriculum levels) to engage students and teachers with better, more meaningful learning, within primary health care settings. METHODS: We used a grounded theory methodology by interviewing eight medical educationalists and ten CBE teachers, followed with the coding process by sensitizing the concepts of 'medical education' and 'primary care', to explore any new concepts. The primary data originated from a developing country where the paradigm of high-quality primary health care is mostly unfamiliar. Three senior researchers from international associations of general practices from different countries provided validation to the results. RESULTS: We identified a new framework for a community-based educational program. The micro-curriculum should offer opportunities for small group activities, ranging from simple to complex learning, emphasizing clinical skills, leadership, and teamwork to improve self-directed and collaborative practice. Sufficient role models and constructive feedback within primary care contexts are robust facilitators. For the meso-curriculum, comprehensive coordination on teacher-training and CBE program is needed. To ensure the sustainability of the program, faculty leaders and managers should include the macro-curriculum with a national postgraduate general practice curriculum and provide strong commitment. CONCLUSIONS: We designed a 'CBE-tree' model for the undergraduate medical curriculum. By using the CBE framework developed in this study, students and teachers may better comprehend the essential of primary health care.

Interprofessional communication in a socio-hierarchical culture: development of the TRI-O guide.

OBJECTIVES: Interprofessional education (IPE) and collaborative practice are essential for patient safety. Effective teamwork starting with partnership-based communications should be introduced early in the educational process. Many societies in the world hold socio-hierarchical culture with a wide power distance, which makes collaboration among health professionals challenging. Since an appropriate communication framework for this context is not yet available, this study filled that gap by developing a guide for interprofessional communication, which is best suited to the socio-hierarchical and socio-cultural contexts. MATERIALS AND METHODS: The draft of the guide was constructed based on previous studies of communication in health care in a socio-hierarchical context, referred to international IPE literature, and refined by focus group discussions among various health professionals. Nominal group technique, also comments from national and international experts of communication skills in health care, was used to validate the guide. A pilot study with a pre-posttest design was conducted with 53 first- and 107 fourth-year undergraduate medical, nursing, and health nutrition students. RESULTS: We developed the "TRI-O" guide of interprofessional communication skills, emphasizing "open for collaboration, open for information, open for discussion", and found that the application of the guide during training was feasible and positively influenced students' perceptions. CONCLUSION: The findings suggest that the TRI-O guide is beneficial to help students initiate partnership-based communication and mutual collaboration among health professionals in the socio-hierarchical and socio-cultural context.

The Indonesian general practitioners' perspectives on formal postgraduate training in primary care.

BACKGROUND: To be recognized as a primary care physician (PCP), an Indonesian general practitioner (GP) has to follow a formal postgraduate training in primary care. However, 4 years since the regulation was published, the progress of the training is slow. There is a need to deeply investigate the doctors' perspectives, particularly to explore factors associated with their willingness to follow this training. AIM: This study aims to explore the GPs' views and perspectives related to the formal postgraduate training in primary care that may influence their enrolment in PCP program. METHODS: We conducted semi-structured interviews with a topic guide. The study took place in Yogyakarta from January to December 2016. The participants were GPs practicing in Yogyakarta primary care clinics who were recruited using purposive-maximum variation sample design. The interviews were audio-recorded and transcribed. The data were analysed using interpretative phenomenological analysis approach. RESULTS: Nineteen GPs participants were involved in this study. Three major themes were identified, namely unfamiliarity, resistance, and positivism. Almost all the GP participants were unfamiliar with the primary care training program. They were also pessimistic if the training could change the health service in the country while it lacked resources and infrastructures. However, exposure to the training brought positive insights that it could improve the doctors' knowledge and skills in primary care practice. DISCUSSION: The government intention to establish PCP training is currently on the right tract. However, information dissemination and more supports in primary care are also essential.