Table 2 Themes and illustrative quotes for the context domain^a

Lack of resources

It’s still far from our ability to apply these technologies in our current situation. We will need IT technicians, good internet connection, and more computers. Also, regarding high fidelity simulators, there are some maintenance problems. (Fellow E, MOH, Medicine)

Most of the teachers who come to teach at UHS, they have their own private clinics to make more money. Most of the time, they do not want to attend (a workshop or fellowship) unless any incentives are given. However, we cannot ignore them, because we really need those people. We don’t have other resources. (Fellow D, University, Nursing)

Cultural background

Obedience to hierarchy

Promotion, no… But I might be involved in educational work. It depends on the decision of the superiors. But, they did not tell me and usually never tell us before (the decision is made). (Fellow H, MOH, Medicine)

I have authority and I can call my subordinates to my office and tell them ‘let’s do this’. I can arrange (projects). (Fellow C, University, Nursing)

Respect for seniority

So, if I join the training, the trainees will be my teachers who taught me in my university years, because I graduated that university as well. So, some of them would say, “You were my student. How can you come teach me how to teach? I taught you well until you become like today”. That’s what concerns me the most. (Fellow A, University, Pharmacy)

Educational environment

Lack of consensus among faculty members in workplace

Terminology like “outcome-based curriculum” is already known, but we don’t actually have agreement on what it is. Different faculty members have different conception or understanding regarding terminologies and it delays the process (Fellow B, University, Medicine)

Dependency on personal commitment

There is no institutional encouragement in applying new teaching methods. Whether you do it or not, there is no difference including recognition from dean or colleagues. However, students like it (the changes) and I could feel it. (Fellow D, University, Nursing)

I plan to send a report in person to the rector and dean which covers brief explanation of important points. I hope this may increase the chance of application (of the knowledge gained). I myself always put the collective interest first. Whenever the school needs me, I will gladly share my experience. (Fellow F, University, Pharmacy)