<![CDATA[Background Physician competency in breastfeeding counseling is crucial for improving suboptimal breastfeeding rates in Indonesia, where exclusive breastfeeding coverage (67.96% in 2023) remains below the national target of 80%. The Indonesian Breastfeeding Course for Clinicians (IBFCC) is a structured continuing medical education (CME) program developed by Satuan Tugas Air Susu Ibu Ikatan Dokter Anak Indonesia/Satgas ASI-IDAI (Breastfeeding Task Force of the Indonesian Pediatrics Society/IPS), yet its effectiveness has not been formally evaluated. Objective To evaluate the effectiveness of the IBFCC in improving physician breastfeeding knowledge across multiple centers and to characterize factors associated with knowledge improvement. Methods A multicenter, single-group, paired pre-post intervention study was conducted between 2022 and 2025 across 17 batches delivered at 13 training sites, comprising 11 IPS regional branches in 11 Indonesian provinces and 2 hospital-based sites in Jakarta. Knowledge was assessed using a 15-item validated questionnaire administered immediately before and after training. The Wilcoxon signed-rank test served as the primary analysis, with a paired t-test reported for comparability. Effect sizes were expressed as Cohen’s d and Wilcoxon r. Passing rates (≥60%) were compared using the McNemar test. Factors significantly associated with knowledge improvement was age. Results Of 1,176 enrollees, 1,106 (94.0%) with complete paired data constituted the analytic sample. The mean pre-test score was 40.2 (SD 11.0)% and the mean post-test score was 71.0 (SD 12.5)%, a mean improvement of 30.8 percentage points (95%CI 29.9 to 31.7; paired t-test t=66.99, df=1,105, P<0.001; Wilcoxon signed-rank Z=28.40, P<0.001). The effect size was very large (Cohen’s d=2.01; 95%CI 1.91 to 2.12; Wilcoxon r=0.85) and the mean normalised gain was 0.50 (SD 0.22). The largest item-level gains were for tongue-tie-related nipple pain (+90.2%), early initiation of breastfeeding (+73.7%) and signs of effective latch and milk transfer (+69.3%); three items did not improve. Improvement did not differ between pediatricians and general physicians (30.9 vs. 30.1 percentage points; P=0.39), but increased with age group, from 20.0 percentage points in participants aged ≤35 years to 38.4 in those aged >55 years (P<0.001). Conclusion The IBFCC produces substantial improvements in physician breastfeeding knowledge that are consistent across professional affiliations. Smaller gains among younger physicians indicate a need for targeted reinforcement and monitoring of delivery fidelity. These findings support nationwide scale-up as a mandated CME program for physicians involved in maternal and child health.]]>
