Purpose: India has rolled out competency based medical education (CBME) in 2019. Foundation course is a bridge element along with many other new components of the curriculum. The effect of national policy change are felt by all levels of the organizational hierarchy and stake holders. Within medical education, literature is sparse on how the levels of the educational systems interact to effect change. In this context, it is important for educators and researchers to understand the challenges faced by reflecting on their experiences in wide-scale policy changes. Methods: We developed an anonymous online survey to elicit program coordinators (PCs) opinions and experiences with implementation of the foundation course in their institute. It was a mixed method study. Descriptive analysis was performed on the quantitative data; thematic analysis was performed on the qualitative comments; and mixed-methods analysis was completed with triangulation of data Results: A total of 65 PCs responded to our survey. Quantitative analysis revealed that 62.7% of respondents did not feel involved in decision-making regarding policy changes, 35 % of respondents did not feel prepared to implement the foundation course. PCs were divided on the reasonableness of foundation course components and its objectives. Qualitative analyses produced four themes: Communication, Resources, Expectations of Outcomes, and Buy-In, as well as nine sub themes.  Mixed methods analysis noted a high level of convergence across content, with four areas of divergence. The analysis also highlighted areas of expansion where the qualitative and quantitative strands provided additive insights to each other. Conclusions: The PCs reported unique and wide variety of challenges in implementation of Foundation Course. This national mixed-methods study provides insights on the nature and process of large-scale policy change from the perspective of those charged with operationalizing. The combined approach yielded robust insights applicable to CBME implementation.