Facilitators’ perspectives on a pre-matriculation program in basic biomedical sciences for medical students: a qualitative study

Facilitators’ perspectives on a pre-matriculation program in basic biomedical sciences for medical students: a qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Facilitators’ perspectives on a pre-matriculation program in basic biomedical sciences for medical students: a qualitative study Yani Istadi, Rinawati Rinawati, Endang Lestari, Dina Fatmawati This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8378558/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Pre-matriculation programs in basic biomedical sciences are commonly used to help new medical students transition into medical school, especially when students come from varied educational background.. Little is known about facilitators’ perspectives, even though they play a key role in designing and delivering these programs. This study aimed to explore facilitators’ views on the effectiveness, challenges, and future improvement of a basic biomedical sciences pre-matriculation program Methods A qualitative exploratory study was conducted using a focus group discussion involving ten biomedical science facilitators (anatomy, physiology, biochemistry, histology, and chemistry) at a private medical faculty in Indonesia. Participants were purposively sampled to represent diverse disciplines and teaching experience. Data were audio-recorded, transcribed verbatim, translated into English, and analyzed using thematic analysis following Braun and Clarke’s framework. Results Four main themes were identified. First, facilitators had different views on the program’s effectiveness. Some saw it as an important bridge that supports students’ academic and mental readiness, while others questioned its impact due to inconsistent delivery and lack of systematic evaluation. Second, students showed weak understanding of key biomedical subjects, often relying on memorization rather than understanding concepts. Third, challenges in implementation included low student motivation, weak literacy and learning culture, generational and cultural gaps, curriculum overload, and limited pedagogical support. Fourth, facilitators proposed recommendations for improvement, emphasizing a shift toward learning skills, stronger integration of basic and clinical sciences, structured evaluation, faculty development, and institutional support. Conclusions Facilitators viewed the pre-matriculation program as valuable but identified ongoing challenges. Addressing these through targeted program redesign may enhance program effectiveness. These findings highlight the importance of learner-centered design, integrated teaching approaches, and systematic evaluation in pre-matriculation programs. Further research involving diverse participant groups and longitudinal evaluation of student outcomes is needed to assess program effectiveness and sustainability. Trial Registration Not applicable Pre-matriculation basic biomedical sciences medical education faculty perspectives qualitative study Background A strong foundation in basic biomedical sciences is critical for preparing medical students to meet the academic and professional challenges of their future careers. Subject of basic biomedical sciences such as anatomy, physiology, biochemistry, histology, chemistry, provide the conceptual basis upon which clinical reasoning and medical practice are built ( 1 ). Without this foundation, students may struggle to integrate clinical knowledge and develop professional competence. However, new medical students often enter with diverse educational backgrounds, resulting in variable readiness to understand fundamental biomedical concepts ( 2 , 3 ). The transition from secondary to higher education is therefore a critical period that can influence academic confidence, performance, and even mental health ( 4 ). Students with weaker preparation may face greater difficulties adapting, which in turn can lead to lower academic outcomes and increased stress. To address these challenges, many institutions have implemented pre-matriculation or bridging programs designed to prepare students for the demands of medical school ( 5 ). These programs aim to equalize knowledge gaps, strengthen study skills, and enhance confidence among incoming students. While such programs are widely practiced internationally, their implementation varies considerably across institutions, and there is little consensus on standardized design or evaluation. A survey of 170 U.S. medical schools found that most pre-matriculation programs were introduced more as a tradition than as an evidence-based practice, with limited rigorous evaluation of their effectiveness ( 6 ). In the Indonesian context, pre-matriculation programs in basic biomedical sciences have been implemented as an institutional strategy to support new students. A previous study at a Public Faculty of Medicine in Indonesia explored students’ perspectives on the effectiveness of a biomedical pre-matriculation program, reporting positive impacts on confidence and early adaptation. Nevertheless, few studies have examined the program from the faculty perspective, despite facilitators playing a crucial role in design, content delivery, and student engagement. This study addressed that gap by exploring facilitators’ perspectives on the effectiveness, challenges, strategies, and opportunities in delivering such program. Insights from facilitators are essential for designing programs that are not only supportive for students but also feasible and effective for faculty to implement. Methods Study design We conducted a qualitative exploratory study using focus group discussions (FGD) to capture basic biomedical facilitators’ perspectives on the pre-matriculation program. A qualitative design was chosen to allow in-depth exploration of perspective, experiences, challenges, and suggestions in a naturalistic and dialogic setting, which aligns with the study’s aim to generate insights rather than measure outcomes (7). Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine, Universitas Islam Sultan Agung (No. 178/II/2024/Komisi Bioetik). All participants provided informed consent prior to participation. Setting The study was conducted at the Faculty of Medicine, Sultan Agung University, Indonesia. Since 2023, this institution has implemented a pre-matriculation program in basic biomedical sciences (anatomy, physiology, biochemistry, histology, chemistry) to prepare new medical students for transition from secondary school to university-level learning. The program typically runs for two weeks prior to the start of the early modules in the first semester. Participants and sampling Participants were biomedical science facilitators directly involved in designing and/or teaching the pre-matriculation modules. Disciplines represented included anatomy, biochemistry, physiology, histology, chemistry. Inclusion criteria were: (1) serving as a lecturer or facilitator in the pre-matriculation program during the last two academic years. A purposive sampling strategy was applied to ensure diversity across biomedical disciplines (8). A total of 10 facilitators participated, representing both junior and senior faculty, with teaching experience ranging from 5 to 20 years. Data collection An FGD was conducted in September, 2025. The guide of the FGD guide was developed by the research team specifically for this study and has not been published elsewhere (Supplementary File 1). It was developed based on literature on pre-matriculation and explored: experiences in teaching pre-matriculation biomedical sciences, perceived challenges related to students’ preparedness, motivation, and learning habits, pedagogical and curricular issues, recommendations for improvement. FGDs were conducted in Indonesian Language by a trained moderator with a note-taker. the session lasted approximately 100 minutes. Discussions were audio-recorded, transcribed verbatim, translated into English, and anonymized. Data analysis Data were analyzed using thematic analysis following Braun and Clarke’s six-step framework (9). Transcriptor software was used to facilitate data transcription (10). Coding was conducted independently by two researchers, with discrepancies resolved through discussion until consensus was reached. The example of the coding process is presented in table 1 Table 1. An Example of the qualitative coding process from meaning units to sub-categories Topics Meaning Units Condensed Meaning Units Codes Sub-categories How do facilitators perceive the overall value of the pre-matriculation program? “Without pre-matriculation, students would be even less prepared. It is still important to bridge those whose foundations are weak.” (F9) Pre-matriculation is needed to support students with weak academic foundations Program necessity; Bridging weak foundations Positive perception of program value “Pre-matriculation is like a warm-up so they won’t be shocked when they start their first module.” (F3) Program prepares students mentally and academically for transition Transition support; Early academic orientation Positive perception of program value “The benefit is not only academic but also mental. They become more confident in the first few weeks of medical school.” (F2) Program increases students’ confidence and psychological readiness Confidence building; Psychological preparation Positive perception of program value What challenges or doubts do facilitators express about the program’s impact? “We put in a lot of effort, but the results are minimal. Students’ abilities remain the same.” (F8) High effort but limited observable improvement Limited effectiveness; Minimal learning gains Negative perception of effectiveness “The format keeps changing—sometimes online, sometimes face-to-face—so it’s hard to judge whether it really works.” (F5) Inconsistent delivery makes effectiveness difficult to assess Inconsistent implementation; Evaluation difficulty Implementation-related concerns “I have never seen clear evidence of improvement, so it’s difficult to say the program is truly effective.” (F10) Lack of measurable evidence of program impact Lack of monitoring; No objective evaluation Evaluation gap What is the facilitators’ overall stance on maintaining the program? “It’s not perfect, but removing it would mean losing a space to prepare students gradually.” (F4) Program is flawed but still needed as a transitional space Need for improvement; Retain program Shared consensus on program necessity How do facilitators perceive the overall value of the pre-matriculation program? “Without pre-matriculation, students would be even less prepared. It is still important to bridge those whose foundations are weak.” (F9) Pre-matriculation is needed to support students with weak academic foundations Program necessity; Bridging weak foundations Positive perception of program value Results Participant characteristics Ten facilitators from 5 biomedical disciplines (anatomy, physiology, biochemistry, histology, chemistry) participated in the focus group discussions. Their teaching experience ranged from fewer than five years to more than two decades, and most had been involved in the pre-matriculation program since its inception (table 2).Thematic analysis produced five overarching themes: 1) reflecting how facilitators perceived the effectiveness; 2) weekly mastered biomedical content; 3) the challenges of delivering biomedical sciences within a short preparatory course and 4) recommendation for program refinement and sustainability. Table 3 shows the data analytic framework of the study. Table 2. Characteristics of facilitators participating in the pre-matriculation program Characteristic n % Discipline Anatomy 2 20 Physiology 2 20 Biochemistry 2 20 Histology 2 20 Chemistry 1 10 Gender Female 6 60 Male 4 40 Years of teaching experience 10 years 3 30 Involvement in pre-matriculation program Since initiation 10 100 Characteristic n % Discipline Anatomy 2 20 Physiology 2 20 Biochemistry 2 20 Histology 2 20 Chemistry 1 10 Gender Female 6 60 Male 4 40 Different Perceptions of Program Facilitators had different opinions about the value and impact of the pre-matriculation program. Some saw it as an important bridge to help new medical students adjust to academic and personal challenges. Others, however, questioned how effective or sustainable the program really was. These differences showed that there was still uncertainty about whether the program’s design and results matched its main purpose. Several facilitators believed the program was essential, especially for students from non-science or weaker academic backgrounds. They felt it helped students prepare mentally and academically before entering the main curriculum. “ Without pre-matriculation, students would be even less prepared. It is still important to bridge those whose foundations are weak.” (Facilitator 9) “Pre-matriculation is like a warm-up so they won’t be shocked when they start their first module.” (Facilitator 3) “ The benefit is not only academic but also mental. They become more confident in the first few weeks of medical school.” (Facilitator 2) These facilitators viewed the program as a way to reduce differences among students with varied educational backgrounds. They believed it helped students build confidence, understand learning expectations, and start forming effective study habits before facing regular coursework. In contrast, other facilitators were less positive. They felt that the results did not match the effort and time invested by faculty. Although students attended classes and completed activities, they saw little improvement in students’ academic readiness. The lack of a consistent format, sometimes online and sometimes face-to-face, also made it hard to measure progress. “We put in a lot of effort, but the results are minimal. Students’ abilities remain the same.” (Facilitator 8) “The format keeps changing—sometimes online, sometimes face-to-face—so it’s hard to judge whether it really works.” (Facilitator 5) “I have never seen clear evidence of improvement, so it’s difficult to say the program is truly effective.” (Facilitator 10) These facilitators also pointed out that the program lacked systematic evaluation. Success was usually based on personal impressions rather than data, such as student grades or later performance. Despite their different opinions, all facilitators agreed that the pre-matriculation program served an important purpose: helping students adjust to the demands of medical school. They believed that even if the program was not perfect, it should be improved not removed. “It’s not perfect, but removing it would mean losing a space to prepare students gradually.” (Facilitator 4) Weakly Mastered Biomedical Content Facilitators consistently pointed out that students had the greatest difficulty mastering three core biomedical disciplines (biochemistry, physiology, and anatomy ) . These subjects were described as essential for understanding medicine but also the most conceptually demanding. As a result, they revealed clear gaps in students’ ability to reason scientifically and integrate basic concepts. “Students struggle the most in biochemistry; they memorize reactions but don’t understand what they mean.” (Facilitator 7) “Physiology is difficult because it requires logical thinking, not just memorization.” (Facilitator 2) “Anatomy is memorized without understanding its relation to physiology or clinical relevance.” (Facilitator 1) Facilitators agreed that these difficulties stemmed mainly from students’ long-standing learning habits. Many were accustomed to rote learning focusing on remembering facts for exams rather than understanding the underlying principles or mechanisms. “They’re used to memorizing for exams, not understanding processes. When you ask ‘why,’ they get confused.” (Facilitator 6) This surface-learning approach made it hard for students to grasp how different biomedical concepts were connected. Instructors often found that students could recall isolated details but struggled to apply or explain them logically. In addition to learning habits, differences in academic background contributed to uneven readiness among students. Those from non-science or religious-based high schools entered the program with limited exposure to chemistry, physics, or biology, making biomedical topics especially challenging. “Some come from social science or religious schools; their science background isn’t the same.” (Facilitator 10) Even among students from science tracks, facilitators observed that their knowledge was fragmented across disciplines. Students could often recall anatomical structures but failed to relate them to physiological functions or biochemical mechanisms. “They know the organs in anatomy but not their functions in physiology or reactions in biochemistry.” (Facilitator 8) Facilitators viewed this lack of integration as one of the biggest barriers to higher-level reasoning in medical studies. Without understanding how systems connect, students struggled to see the relevance of basic sciences to clinical problem-solving. “When asked to explain the link between anatomy and pathophysiology, they go silent. Their concepts are not connected.” (Facilitator 7) The short duration and heavy content of the pre-matriculation program further limited students’ ability to build these connections. The rapid pace encouraged superficial learning, with students rushing to complete topics rather than engage deeply with them. “The time is too short and the content too dense, so students just rush to finish instead of truly understanding.” (Facilitator 3) Overall, facilitators believed that although the program successfully introduced students to basic biomedical sciences, it did not allow enough time or depth for meaningful understanding. They stressed the need for more integrated, case-based, and contextualized teaching approaches that could help students connect basic knowledge to its clinical relevance Challenges Student motivation and engagement Facilitators overwhelmingly described low intrinsic motivation among students. Many joined medical faculty because of family influence, particularly when parents were physicians or owned clinics, rather than out of personal interest. This resulted in superficial participation, with students attending sessions to “comply” rather than to learn. One facilitator explained: “Their desire to learn was very minimal … many only joined the program because their parents already have a clinic.” (Biochemistry facilitator). Low motivation often manifested as lack of accountabilityarriving late, skipping sessions, or disengaging during class. Without consequences for absenteeism, facilitators felt it was difficult to foster a sense of seriousness. “Some arrived late or did not attend at all, because there were no clear consequences.” (Anatomy facilitator). These patterns of disengagement suggested to facilitators that unless the program incorporated mechanisms to build intrinsic motivation—through relevance, mentorship, or assessment—students would continue to treat pre-matriculation as optional or low-stakes. Literacy and learning culture Another challenge was the weak literacy skills and fragile study culture of students. Facilitators observed that many had never finished reading a textbook in their academic lives, reflecting both inadequate preparation in high school and the dominance of shortcut-based learning. “I asked them, have you ever in your life finished reading a whole book? They said: never.” (Physiology facilitator). Instead of developing habits of critical reading, students relied on lecture slides, seniors’ notes, or condensed summaries. With the rise of digital tools, they increasingly turned to AI-generated content. While this provided quick answers, facilitators worried it discouraged critical evaluation and fostered a “surface learning” mindset. “They rely on AI-generated answers without knowing how to validate the correctness.” (Histology facilitator). This reliance on shortcuts, coupled with low reading stamina, undermined the very purpose of pre-matriculation: to cultivate readiness for the heavy reading, comprehension, and synthesis required in medical school. Facilitators felt that without explicit literacy support—such as structured reading tasks or guided study skills—the program risked reinforcing poor habits rather than correcting them. Conceptual understanding and clinical linkage Facilitators expressed concern that students approached biomedical sciences primarily through memorization rather than conceptual understanding. This was particularly evident in anatomy and physiology, where students memorized terms or processes without grasping their functional relationships. “Anatomy was only memorized, without understanding its correlation with physiology and clinical relevance.” (Anatomy facilitator). Similarly, in biochemistry, students often failed to see the value of learning abstract pathways, asking why such content mattered for their future careers. “They struggled to link basic concepts, such as biochemical reactions, with clinical applications.” ( “Mereka kesulitan mengaitkan konsep dasar, seperti reaksi biokimia, dengan aplikasi klinis.” , Biochemistry facilitator). Facilitators believed this disconnect reflected both students’ immature epistemological beliefs or knowledge as facts to memorize and curricular design that emphasized content coverage over clinical contextualization. They argued that unless the program explicitly demonstrated how biomedical sciences underpin clinical reasoning, students would continue to see them as irrelevant hurdles rather than as foundations of medical practice. Generational and cultural gaps A striking theme was the generational gap between facilitators and students. Many facilitators described today’s learners as “digital natives” who display short attention spans, become easily distracted, and expect rapid, visually engaging content delivery. “Their attention is lost quickly; during long lectures they immediately lose focus.” (Physiology facilitator). This digital fluency did not translate into intellectual curiosity. Instead, facilitators felt that students demonstrated low curiosity and critical thinking, often giving shallow, AI-like responses to probing questions. “Their curiosity is low … when asked, their answers are short, like AI.” (Histology facilitator). Beyond generational learning styles, facilitators also pointed to a cultural gap in academic discipline. Students were perceived as permissive, reluctant to commit to self-directed study, and unaccustomed to rigorous academic norms. “There is an academic culture gap … they are too permissive and difficult to engage in building an independent learning culture” . (Physics facilitator). These generational and cultural gaps required facilitators to rethink pedagogy. However, many admitted they felt ill-equipped to design learning experiences tailored to students with such different expectations and habits. Pedagogical and curricular challenges At the program level, facilitators identified content overload as a significant challenge. The pre-matriculation course attempted to cover a broad range of biomedical content in a condensed timeframe, which overwhelmed students and discouraged deep engagement. “The content is too heavy … reading textbooks feels boring, so innovative strategies are needed.” (Biochemistry facilitator). Facilitators advocated for greater integration of biomedical sciences with clinical context. By connecting abstract concepts to case-based or problem-based learning, they believed students could better appreciate the value of biomedical sciences in medical practice. “We need a teaching model that connects basic concepts with clinical cases so students can see the benefit.” (Physiology facilitator). They also highlighted the need for pedagogical innovation. Traditional lectures, even if well-prepared, were poorly suited for students with limited attention spans. Facilitators suggested incorporating active learning methods, small-group discussions, and interactive technologies. However, they acknowledged institutional constraints, including limited training in educational methods and rigid curricular structures. Recommendations for a More Effective Program Despite these challenges, facilitators agreed that the pre-matriculation program should be retained but redesigned to better achieve its goals. They advocated shifting the program’s focus from content transmission toward cultivating self-directed learning skills. “Don’t just fill them with material—teach them how to learn.” (Facilitator 4) “The focus shouldn’t be on how much we teach, but how well they can learn independently.” (Facilitator 8) They also emphasized the need for structured evaluation through pre- and post-tests to assess progress objectively. “We need pre-tests and post-tests to clearly see whether students improve.” ( Facilitator 10) Facilitators recommended linking basic sciences to clinical cases to enhance relevance and engagement. “If we relate the topics to clinical cases, students become more interested and understand why basic science matters.” (Facilitator 7) Finally, they underscored the importance of faculty development and institutional support to ensure quality and consistency. “Tutors also need training so that teaching methods and commitment are aligned.” (Facilitator5) “If the institution wants good results, it must provide time, facilities, and training.” (Facilitator 2) Collectively, these recommendations reflected a shared aspiration to transform the pre-matriculation program into an integrated, evidence-informed, and learner-cantered foundation for medical study. Discussion This study explored facilitators’ experiences in implementing a pre-matriculation program in basic biomedical sciences for medical students. Five key themes emerged: (1) low student motivation and engagement, (2) weak academic literacy and reliance on shortcuts, (3) limited conceptual understanding and difficulty linking basic sciences to clinical practice, (4) generational and cultural gaps between students and facilitators, and (5) curricular and pedagogical challenges, including content overload and lack of integration. Our findings reinforce concerns raised in previous research that medical students often enter with heterogeneous academic backgrounds, leading to varying levels of preparedness in basic sciences (1–3). Low motivation and external pressure to pursue medicine, as reported by facilitators, align with studies showing that students’ intrinsic motivation is critical for academic performance and professional identity formation (11,12,13). Weak literacy and reading habits were a recurring theme. Facilitators noted that students rarely complete textbooks and often depend on AI or summaries. This resonates with evidence that poor academic literacy and surface learning strategies can undermine critical thinking in medical education (14,15). The generational shift towards digital learning may exacerbate this issue, requiring innovative approaches to foster deep learning (16). The challenge of rote memorization without integration into clinical relevance echoes long-standing debates about the basic sciences’ place in medical curricula. Harden argued for integration across preclinical and clinical phases to enhance knowledge transfer (17). Generational gaps and cultural mismatches between faculty and students were also evident. Short attention spans, reliance on gadgets, and limited curiosity mirror findings in studies of “Generation Z” learners (18,19). Faculty development is thus essential to bridge expectations and adapt pedagogy. Finally, the lack of standardization in pre-matriculation programs is consistent with reports that such interventions are often designed based on tradition rather than evidence (6). While prior research has primarily examined students’ perspectives, our study contributes novel insights from facilitators, underscoring the need to evaluate these programs from multiple stakeholder viewpoints. Practical implications The insights from facilitators highlight several strategies to enhance the effectiveness of pre-matriculation programs (Table 2). First, structured efforts to foster intrinsic motivation and accountability are needed to ensure active participation. Second, targeted support in academic literacy, particularly reading comprehension and critical appraisal of digital and AI-generated information—may reduce reliance on superficial learning strategies. Third, embedding case-based and problem-based learning, with early clinical integration, can improve conceptual understanding and relevance. Fourth, faculty development initiatives are essential to adapt pedagogical approaches to the preferences of Generation Z learners, including the use of technology-enhanced and interactive methods. Finally, curricular redesign to streamline content and improve integration with the first-year medical curriculum may help reduce overload and increase perceived value. Together, these recommendations provide a roadmap for institutions seeking to strengthen pre-matriculation as a meaningful bridge into medical education. Strengths and limitations This study offers novel insights into how biomedical sciences facilitators perceive the value and challenges of pre-matriculation programs designed to support students’ transition into medical school. Its strength lies in addressing an under-explored area within medical education and drawing on perspectives from facilitators representing multiple biomedical disciplines who have been involved since the program’s initiation. The use of focus group discussions provided a rich platform for interactive reflection and for capturing shared experiences across departments. However, the study’s scope was limited to one institution and focused solely on facilitators’ perceptions, which may not fully represent the views of students, administrators, or clinical educators. In addition, as a qualitative inquiry, the findings are context-specific and not intended for generalization. Conclusion This study provides insight into facilitators’ perspectives on a basic biomedical sciences pre-matriculation program designed to support students’ transition into medical school. Facilitators generally perceived the program as a useful bridging mechanism. However, its perceived impact was limited by ongoing challenges, including low student motivation, weak academic literacy, fragmented conceptual understanding across biomedical disciplines, and inconsistencies in curriculum structure and delivery. Despite its limitations, facilitators agreed that the program fulfills an important transitional role and should be improved rather than discontinued. The findings indicate that pre-matriculation programs are most likely to be effective when they are learner-centered, conceptually integrated, and supported by systematic evaluation and faculty development. Further research involving diverse participant groups, including students and institutional stakeholders, as well as longitudinal evaluation of academic progression and early clinical performance, is needed to more comprehensively assess program effectiveness and sustainability. Declarations Acknowledgements The authors sincerely thank the biomedical science facilitators at the Faculty of Medicine, Sultan Agung Islamic University, for their valuable insights and participation in this study. We also acknowledge the support of the Department of Medical Education, Faculty of Medicine, Sultan Agung Islamic University for facilitating data collection and discussions. Funding This work was supported by a research grant from the Indonesian Ministry of Higher Education, Science Technology in 2025 (No. 127/C3/DT.04.00/PL/2025). Trial Registration Not applicable Availability of data and materials The datasets (interview transcripts and coded data) generated and analyzed during the current study are not publicly available due to confidentiality agreements with participants but are available from the corresponding author on reasonable request. Authors’ contributions YI, EL, and RR, DF conceptualized the study and designed the methodology. Data collection and transcription were conducted by RR and DF. RR performed data analysis with input from YI and EL. All authors contributed to the interpretation of findings. The manuscript was drafted by RR and critically revised for intellectual content by YI and EL. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Ethics approval Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine (No. 514/XI/2025/Komisi Bioetik), Universitas Islam Sultan Agung. Consent for publication: Not applicable. Authors’ information 1 Department of Medical Education, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia 2 Undergraduate Program in Medicine, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia References Schmidt HG, Cohen-Schotanus J, Arends LR. Impact of problem-based, active learning on graduation rates for 10 generations of Dutch medical students. Med Educ. 2009;43(3):211–8. Stegers-Jager KM, Cohen-Schotanus J, Themmen AP. Motivation, learning strategies, participation and medical school performance. Med Educ. 2012;46(7):678–88. Wijnen-Meijer M, Ten Cate OT, van der Schaaf M, Borleffs JC. Vertical integration in medical school: effect on the transition to postgraduate training. Med Educ. 2010;44(3):272–9. Kaufman DM, Mann KV. Teaching and learning in medical education: how theory can inform practice. In: Swanwick T, editor. Understanding Medical Education. 2nd ed. Wiley-Blackwell; 2014. White CB, Dey EL, Fantone JC. Analysis of factors that predict clinical performance in medical school. Adv Health Sci Educ. 2009;14(4):455–64. Boyse TD, et al. Pre-matriculation programs in U.S. medical schools: prevalence, structure, and outcomes. Acad Med. 2018;93(11):1640–8. Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4th ed. Thousand Oaks: Sage; 2018. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533–44. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: Sage; 1985. Kusurkar RA, Croiset G, Mann KV, Custers E, ten Cate O. Have motivation theories guided the development and reform of medical education curricula? A review. Acad Med. 2012;87(6):735–43. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78. Wingate U. A framework for transition: supporting ‘learning to learn’ in higher education. High Educ Q. 2007;61(3):391–405. Prince M. Does active learning work? A review of the research. J Eng Educ. 2004;93(3):223–31. Sandars J, Morrison C. What is the Net Generation? The challenge for future medical education. Med Teach. 2007;29(2–3):85–8. Harden RM. The integration ladder: a tool for curriculum planning and evaluation. Med Educ. 2000;34(7):551–7. Twenge JM. iGen: Why today’s super-connected kids are growing up less rebellious, more tolerant, less happy—and completely unprepared for adulthood. Atria Books; 2017. García-Morales VJ, Garrido-Moreno A, Martín-Rojas R. The transformation of higher education after the COVID disruption: Emerging challenges in an era of digitalisation. Innov Educ Teach Int. 2021;58(5):1–13. Table 3 Table 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.VerbatimTranscriptofFacultyFocusGroupDiscussiononMedicalMatriculationtranslated.docx Table3.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 25 Feb, 2026 Reviews received at journal 11 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers invited by journal 12 Jan, 2026 Editor assigned by journal 06 Jan, 2026 Editor invited by journal 06 Jan, 2026 Submission checks completed at journal 02 Jan, 2026 First submitted to journal 02 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8378558","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":573633758,"identity":"aa5651d9-d485-4084-b009-6e7522ebc467","order_by":0,"name":"Yani Istadi","email":"","orcid":"","institution":"Universitas islam Sultan Agung","correspondingAuthor":false,"prefix":"","firstName":"Yani","middleName":"","lastName":"Istadi","suffix":""},{"id":573633761,"identity":"1d8aa0e4-cdf4-463e-9f37-c6bab5512e9d","order_by":1,"name":"Rinawati Rinawati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACZgjFww8kDgCxDIRvwExIiwGPZANECw9hLVAVDAYHoNah2o4FmLfzHvzMU/NHxvhG7sGDP/4c5uFvYH74gaHAGqcWmcN8ydI8xwx4zG7kJRzmbTvMI3GAzViCwSAdpxYJZh4D6Rw2kJYcg8OMDYd5gD4yA7r0MD4txr9z/hnwGM/IMQA7TP4A+zdCWsykc9sMeAwkcgwO8LAd5gGSBG0xs/7bZ8wjceaNAdAv6TyGh3mKJRLw+YX/jPHNGd/k7Pnbc4w//vhjLSd3vH3jhw9/cIcYFgCKkQRSNIyCUTAKRsEowAAAgLpHxe54U9UAAAAASUVORK5CYII=","orcid":"","institution":"Universitas Islam Sultan Agung","correspondingAuthor":true,"prefix":"","firstName":"Rinawati","middleName":"","lastName":"Rinawati","suffix":""},{"id":573633762,"identity":"62c11302-229d-4764-bcc2-86c617a230fb","order_by":2,"name":"Endang Lestari","email":"","orcid":"","institution":"Universitas islam Sultan Agung","correspondingAuthor":false,"prefix":"","firstName":"Endang","middleName":"","lastName":"Lestari","suffix":""},{"id":573633765,"identity":"ce5b5621-6642-41d5-8c37-7f9143baf80c","order_by":3,"name":"Dina Fatmawati","email":"","orcid":"","institution":"Universitas Islam Sultan Agung","correspondingAuthor":false,"prefix":"","firstName":"Dina","middleName":"","lastName":"Fatmawati","suffix":""}],"badges":[],"createdAt":"2025-12-16 17:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8378558/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8378558/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100218465,"identity":"587c821b-9b92-4d60-b4b0-16102fcc2d74","added_by":"auto","created_at":"2026-01-14 09:06:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":52884,"visible":true,"origin":"","legend":"","description":"","filename":"3ndRevisionPreMatriculationProgramBMCMedicalEducation1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/c937e6a8dde2acfa1a7dbe36.docx"},{"id":100218466,"identity":"914d9e2e-07d3-4210-aa61-44898523f039","added_by":"auto","created_at":"2026-01-14 09:07:00","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7135,"visible":true,"origin":"","legend":"","description":"","filename":"0d8ade9cde4a46c1b0121e916e2a994f.json","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/6cc44088afc6d2a9ba157fcc.json"},{"id":100218469,"identity":"9128b37f-0d71-4b2e-a85c-d33d6e92fecf","added_by":"auto","created_at":"2026-01-14 09:07:00","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":29111,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.VerbatimTranscriptofFacultyFocusGroupDiscussiononMedicalMatriculationtranslated.docx","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/76c45a4f0e80c94ef0c82879.docx"},{"id":100218474,"identity":"e1c40c29-ced4-492f-9d5b-4869f7b0e1b3","added_by":"auto","created_at":"2026-01-14 09:07:00","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98794,"visible":true,"origin":"","legend":"","description":"","filename":"0d8ade9cde4a46c1b0121e916e2a994f1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/a8b4efe931216a3c23a36f78.xml"},{"id":100218470,"identity":"632b603f-b14c-45b7-b9ac-8525bdd5cbc0","added_by":"auto","created_at":"2026-01-14 09:07:00","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93703,"visible":true,"origin":"","legend":"","description":"","filename":"0d8ade9cde4a46c1b0121e916e2a994f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/3aa10e85ef1c78abaad55282.xml"},{"id":100218471,"identity":"d62fd205-29cb-406f-b88a-9c1aa505444c","added_by":"auto","created_at":"2026-01-14 09:07:00","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":107728,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/7e589b1b83a5a2e2331c7f02.html"},{"id":100383117,"identity":"9db43f27-6197-4955-8dba-6c137b99789f","added_by":"auto","created_at":"2026-01-16 10:46:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":869483,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/72f0e335-0d41-4019-97e2-7a6875065d16.pdf"},{"id":100370331,"identity":"a35a0996-eeea-4ba3-ae7a-4d19ec8d0280","added_by":"auto","created_at":"2026-01-16 08:05:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29111,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.VerbatimTranscriptofFacultyFocusGroupDiscussiononMedicalMatriculationtranslated.docx","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/01fe32b7892cddfd62923d0d.docx"},{"id":100370434,"identity":"047377bc-5d8a-427c-9cc8-b01168d81e52","added_by":"auto","created_at":"2026-01-16 08:05:48","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20583,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8378558/v1/708612ffce4cd48423e2ca52.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Facilitators’ perspectives on a pre-matriculation program in basic biomedical sciences for medical students: a qualitative study","fulltext":[{"header":"Background","content":"\u003cp\u003eA strong foundation in basic biomedical sciences is critical for preparing medical students to meet the academic and professional challenges of their future careers. Subject of basic biomedical sciences such as anatomy, physiology, biochemistry, histology, chemistry, provide the conceptual basis upon which clinical reasoning and medical practice are built (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Without this foundation, students may struggle to integrate clinical knowledge and develop professional competence.\u003c/p\u003e \u003cp\u003eHowever, new medical students often enter with diverse educational backgrounds, resulting in variable readiness to understand fundamental biomedical concepts (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The transition from secondary to higher education is therefore a critical period that can influence academic confidence, performance, and even mental health (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Students with weaker preparation may face greater difficulties adapting, which in turn can lead to lower academic outcomes and increased stress.\u003c/p\u003e \u003cp\u003eTo address these challenges, many institutions have implemented pre-matriculation or bridging programs designed to prepare students for the demands of medical school (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These programs aim to equalize knowledge gaps, strengthen study skills, and enhance confidence among incoming students. While such programs are widely practiced internationally, their implementation varies considerably across institutions, and there is little consensus on standardized design or evaluation. A survey of 170 U.S. medical schools found that most pre-matriculation programs were introduced more as a tradition than as an evidence-based practice, with limited rigorous evaluation of their effectiveness (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the Indonesian context, pre-matriculation programs in basic biomedical sciences have been implemented as an institutional strategy to support new students. A previous study at a Public Faculty of Medicine in Indonesia explored students\u0026rsquo; perspectives on the effectiveness of a biomedical pre-matriculation program, reporting positive impacts on confidence and early adaptation. Nevertheless, few studies have examined the program from the faculty perspective, despite facilitators playing a crucial role in design, content delivery, and student engagement.\u003c/p\u003e \u003cp\u003eThis study addressed that gap by exploring facilitators\u0026rsquo; perspectives on the effectiveness, challenges, strategies, and opportunities in delivering such program. Insights from facilitators are essential for designing programs that are not only supportive for students but also feasible and effective for faculty to implement.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a qualitative exploratory study using focus group discussions (FGD) to capture basic biomedical facilitators\u0026rsquo; perspectives on the pre-matriculation program. A qualitative design was chosen to allow in-depth exploration of perspective, experiences, challenges, and suggestions in a naturalistic and dialogic setting, which aligns with the study\u0026rsquo;s aim to generate insights rather than measure outcomes (7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine, Universitas Islam Sultan Agung (No. 178/II/2024/Komisi Bioetik). All participants provided informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted at the Faculty of Medicine, Sultan Agung University, Indonesia. Since 2023, this institution has implemented a pre-matriculation program in basic biomedical sciences (anatomy, physiology, biochemistry, histology, chemistry) to prepare new medical students for transition from secondary school to university-level learning. The program typically runs for two weeks prior to the start of the early modules in the first semester.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were biomedical science facilitators directly involved in designing and/or teaching the pre-matriculation modules. Disciplines represented included anatomy, biochemistry, physiology, histology, chemistry. Inclusion criteria were: (1) serving as a lecturer or facilitator in the pre-matriculation program during the last two academic years.\u003c/p\u003e\n\u003cp\u003eA purposive sampling strategy was applied to ensure diversity across biomedical disciplines (8). A total of 10 facilitators participated, representing both junior and senior faculty, with teaching experience ranging from 5 to 20 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn FGD was conducted in September, 2025. The guide of the FGD guide was developed by the research team specifically for this study and has not been published elsewhere (Supplementary File 1). It was developed based on literature on pre-matriculation and explored: experiences in teaching pre-matriculation biomedical sciences, perceived challenges related to students\u0026rsquo; preparedness, motivation, and learning habits, pedagogical and curricular issues, recommendations for improvement.\u003c/p\u003e\n\u003cp\u003eFGDs were conducted in Indonesian Language by a trained moderator with a note-taker. the session lasted approximately 100 minutes. Discussions were audio-recorded, transcribed verbatim, translated into English, and anonymized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using thematic analysis following Braun and Clarke\u0026rsquo;s six-step framework (9). Transcriptor software was used to facilitate data transcription (10). Coding was conducted independently by two researchers, with discrepancies resolved through discussion until consensus was reached. The example of the coding process is presented in table 1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. An Example of the qualitative coding process from meaning units to sub-categories\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTopics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeaning Units\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondensed Meaning Units\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCodes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eHow do facilitators perceive the overall value of the pre-matriculation program?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;Without pre-matriculation, students would be even less prepared. It is still important to bridge those whose foundations are weak.\u0026rdquo; (F9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003ePre-matriculation is needed to support students with weak academic foundations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eProgram necessity; Bridging weak foundations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003ePositive perception of program value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;Pre-matriculation is like a warm-up so they won\u0026rsquo;t be shocked when they start their first module.\u0026rdquo; (F3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eProgram prepares students mentally and academically for transition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eTransition support; Early academic orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003ePositive perception of program value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;The benefit is not only academic but also mental. They become more confident in the first few weeks of medical school.\u0026rdquo; (F2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eProgram increases students\u0026rsquo; confidence and psychological readiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eConfidence building; Psychological preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003ePositive perception of program value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eWhat challenges or doubts do facilitators express about the program\u0026rsquo;s impact?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;We put in a lot of effort, but the results are minimal. Students\u0026rsquo; abilities remain the same.\u0026rdquo; (F8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eHigh effort but limited observable improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eLimited effectiveness; Minimal learning gains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eNegative perception of effectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;The format keeps changing\u0026mdash;sometimes online, sometimes face-to-face\u0026mdash;so it\u0026rsquo;s hard to judge whether it really works.\u0026rdquo; (F5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eInconsistent delivery makes effectiveness difficult to assess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eInconsistent implementation; Evaluation difficulty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eImplementation-related concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;I have never seen clear evidence of improvement, so it\u0026rsquo;s difficult to say the program is truly effective.\u0026rdquo; (F10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eLack of measurable evidence of program impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eLack of monitoring; No objective evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eEvaluation gap\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eWhat is the facilitators\u0026rsquo; overall stance on maintaining the program?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;It\u0026rsquo;s not perfect, but removing it would mean losing a space to prepare students gradually.\u0026rdquo; (F4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003eProgram is flawed but still needed as a transitional space\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eNeed for improvement; Retain program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eShared consensus on program necessity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHow do facilitators perceive the overall value of the pre-matriculation program?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003e\u0026ldquo;Without pre-matriculation, students would be even less prepared. It is still important to bridge those whose foundations are weak.\u0026rdquo; (F9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.8003%;\"\u003e\n \u003cp\u003ePre-matriculation is needed to support students with weak academic foundations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003eProgram necessity; Bridging weak foundations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.2995%;\"\u003e\n \u003cp\u003ePositive perception of program value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTen facilitators from 5 biomedical disciplines (anatomy, physiology, biochemistry, histology, chemistry) participated in the focus group discussions. Their teaching experience ranged from fewer than five years to more than two decades, and most had been involved in the pre-matriculation program since its inception (table 2).Thematic analysis produced five overarching themes: 1) reflecting how facilitators perceived the effectiveness; 2) weekly mastered biomedical content; 3) the challenges of delivering biomedical sciences within a short preparatory course and 4) recommendation for program refinement and sustainability. Table 3 shows the data analytic framework of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Characteristics of facilitators participating in the pre-matriculation program\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiscipline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnatomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePhysiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBiochemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHistology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYears of teaching experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5–10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt; 10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInvolvement in pre-matriculation program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSince initiation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDiscipline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnatomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePhysiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBiochemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHistology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eChemistry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eDifferent Perceptions of Program\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacilitators had different opinions about the value and impact of the pre-matriculation program. Some saw it as an important bridge to help new medical students adjust to academic and personal challenges. Others, however, questioned how effective or sustainable the program really was. These differences showed that there was still uncertainty about whether the program’s design and results matched its main purpose.\u003c/p\u003e\n\u003cp\u003eSeveral facilitators believed the program was essential, especially for students from non-science or weaker academic backgrounds. They felt it helped students prepare mentally and academically before entering the main curriculum.\u003c/p\u003e\n\u003cp\u003e“\u003cem\u003eWithout pre-matriculation, students would be even less prepared. It is still important to bridge those whose foundations are weak.”\u0026nbsp;\u003c/em\u003e(Facilitator 9)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Pre-matriculation is like a warm-up so they won’t be shocked when they start their first module.”\u003c/em\u003e (Facilitator 3)\u003c/p\u003e\n\u003cp\u003e“\u003cem\u003eThe benefit is not only academic but also mental. They become more confident in the first few weeks of medical school.”\u003c/em\u003e (Facilitator 2)\u003c/p\u003e\n\u003cp\u003eThese facilitators viewed the program as a way to reduce differences among students with varied educational backgrounds. They believed it helped students build confidence, understand learning expectations, and start forming effective study habits before facing regular coursework.\u003c/p\u003e\n\u003cp\u003eIn contrast, other facilitators were less positive. They felt that the results did not match the effort and time invested by faculty. Although students attended classes and completed activities, they saw little improvement in students’ academic readiness. The lack of a consistent format, sometimes online and sometimes face-to-face, also made it hard to measure progress.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“We put in a lot of effort, but the results are minimal. Students’ abilities remain the same.”\u003c/em\u003e (Facilitator 8)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“The format keeps changing—sometimes online, sometimes face-to-face—so it’s hard to judge\u003c/em\u003e whether it really works.” (Facilitator 5)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I have never seen clear evidence of improvement, so it’s difficult to say the program is truly effective.”\u003c/em\u003e (Facilitator 10)\u003c/p\u003e\n\u003cp\u003eThese facilitators also pointed out that the program lacked systematic evaluation. Success was usually based on personal impressions rather than data, such as student grades or later performance. Despite their different opinions, all facilitators agreed that the pre-matriculation program served an important purpose: helping students adjust to the demands of medical school. They believed that even if the program was not perfect, it should be improved not removed.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“It’s not perfect, but removing it would mean losing a space to prepare students gradually.”\u003c/em\u003e (Facilitator 4)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWeakly Mastered Biomedical Content\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacilitators consistently pointed out that students had the greatest difficulty mastering three core biomedical disciplines (biochemistry, physiology, and anatomy\u003cstrong\u003e)\u003c/strong\u003e. These subjects were described as essential for understanding medicine but also the most conceptually demanding. As a result, they revealed clear gaps in students’ ability to reason scientifically and integrate basic concepts.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Students struggle the most in biochemistry; they memorize reactions but don’t understand what they mean.”\u003c/em\u003e (Facilitator 7)\u003cbr\u003e\u003cem\u003e“Physiology is difficult because it requires logical thinking, not just memorization.”\u0026nbsp;\u003c/em\u003e(Facilitator 2)\u003cbr\u003e\u003cem\u003e“Anatomy is memorized without understanding its relation to physiology or clinical relevance.”\u0026nbsp;\u003c/em\u003e(Facilitator 1)\u003c/p\u003e\n\u003cp\u003eFacilitators agreed that these difficulties stemmed mainly from students’ long-standing learning habits. Many were accustomed to rote learning focusing on remembering facts for exams rather than understanding the underlying principles or mechanisms.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“They’re used to memorizing for exams, not understanding processes. When you ask ‘why,’ they get confused.” (Facilitator 6)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis surface-learning approach made it hard for students to grasp how different biomedical concepts were connected. Instructors often found that students could recall isolated details but struggled to apply or explain them logically.\u003c/p\u003e\n\u003cp\u003eIn addition to learning habits, differences in academic background contributed to uneven readiness among students. Those from non-science or religious-based high schools entered the program with limited exposure to chemistry, physics, or biology, making biomedical topics especially challenging.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Some come from social science or religious schools; their science background isn’t the same.” (Facilitator 10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEven among students from science tracks, facilitators observed that their knowledge was fragmented across disciplines. Students could often recall anatomical structures but failed to relate them to physiological functions or biochemical mechanisms.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“They know the organs in anatomy but not their functions in physiology or reactions in biochemistry.”\u003c/em\u003e (Facilitator 8)\u003c/p\u003e\n\u003cp\u003eFacilitators viewed this lack of integration as one of the biggest barriers to higher-level reasoning in medical studies. Without understanding how systems connect, students struggled to see the relevance of basic sciences to clinical problem-solving.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“When asked to explain the link between anatomy and pathophysiology, they go silent. Their concepts are not connected.”\u003c/em\u003e (Facilitator 7)\u003c/p\u003e\n\u003cp\u003eThe short duration and heavy content of the pre-matriculation program further limited students’ ability to build these connections. The rapid pace encouraged superficial learning, with students rushing to complete topics rather than engage deeply with them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“The time is too short and the content too dense, so students just rush to finish instead of truly understanding.”\u003c/em\u003e (Facilitator 3)\u003c/p\u003e\n\u003cp\u003eOverall, facilitators believed that although the program successfully introduced students to basic biomedical sciences, it did not allow enough time or depth for meaningful understanding. They stressed the need for more integrated, case-based, and contextualized teaching approaches that could help students connect basic knowledge to its clinical relevance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChallenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudent motivation and engagement\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacilitators overwhelmingly described low intrinsic motivation among students. Many joined medical faculty because of family influence, particularly when parents were physicians or owned clinics, rather than out of personal interest. This resulted in superficial participation, with students attending sessions to “comply” rather than to learn. One facilitator explained:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Their desire to learn was very minimal … many only joined the program because their parents already have a clinic.”\u0026nbsp;\u003c/em\u003e(Biochemistry facilitator).\u003c/p\u003e\n\u003cp\u003eLow motivation often manifested as lack of accountabilityarriving late, skipping sessions, or disengaging during class. Without consequences for absenteeism, facilitators felt it was difficult to foster a sense of seriousness.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Some arrived late or did not attend at all, because there were no clear consequences.”\u003c/em\u003e (Anatomy facilitator).\u003c/p\u003e\n\u003cp\u003eThese patterns of disengagement suggested to facilitators that unless the program incorporated mechanisms to build intrinsic motivation—through relevance, mentorship, or assessment—students would continue to treat pre-matriculation as optional or low-stakes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003cem\u003eLiteracy and learning culture\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother challenge was the weak literacy skills and fragile study culture of students. Facilitators observed that many had never finished reading a textbook in their academic lives, reflecting both inadequate preparation in high school and the dominance of shortcut-based learning.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“I asked them, have you ever in your life finished reading a whole book? They said: never.”\u003c/em\u003e (Physiology facilitator).\u003c/p\u003e\n\u003cp\u003eInstead of developing habits of critical reading, students relied on lecture slides, seniors’ notes, or condensed summaries. With the rise of digital tools, they increasingly turned to AI-generated content. While this provided quick answers, facilitators worried it discouraged critical evaluation and fostered a “surface learning” mindset.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“They rely on AI-generated answers without knowing how to validate the correctness.”\u003c/em\u003e (Histology facilitator).\u003c/p\u003e\n\u003cp\u003eThis reliance on shortcuts, coupled with low reading stamina, undermined the very purpose of pre-matriculation: to cultivate readiness for the heavy reading, comprehension, and synthesis required in medical school. Facilitators felt that without explicit literacy support—such as structured reading tasks or guided study skills—the program risked reinforcing poor habits rather than correcting them.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConceptual understanding and clinical linkage\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacilitators expressed concern that students approached biomedical sciences primarily through memorization rather than conceptual understanding. This was particularly evident in anatomy and physiology, where students memorized terms or processes without grasping their functional relationships.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Anatomy was only memorized, without understanding its correlation with physiology and clinical relevance.”\u0026nbsp;\u003c/em\u003e(Anatomy facilitator).\u003c/p\u003e\n\u003cp\u003eSimilarly, in biochemistry, students often failed to see the value of learning abstract pathways, asking why such content mattered for their future careers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“They struggled to link basic concepts, such as biochemical reactions, with clinical applications.”\u003c/em\u003e (\u003cem\u003e“Mereka kesulitan mengaitkan konsep dasar, seperti reaksi biokimia, dengan aplikasi klinis.”\u003c/em\u003e, Biochemistry facilitator).\u003c/p\u003e\n\u003cp\u003eFacilitators believed this disconnect reflected both students’ immature epistemological beliefs or knowledge as facts to memorize and curricular design that emphasized content coverage over clinical contextualization. They argued that unless the program explicitly demonstrated how biomedical sciences underpin clinical reasoning, students would continue to see them as irrelevant hurdles rather than as foundations of medical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGenerational and cultural gaps\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA striking theme was the generational gap between facilitators and students. Many facilitators described today’s learners as “digital natives” who display short attention spans, become easily distracted, and expect rapid, visually engaging content delivery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Their attention is lost quickly; during long lectures they immediately lose focus.”\u003c/em\u003e (Physiology facilitator).\u003c/p\u003e\n\u003cp\u003eThis digital fluency did not translate into intellectual curiosity. Instead, facilitators felt that students demonstrated low curiosity and critical thinking, often giving shallow, AI-like responses to probing questions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Their curiosity is low … when asked, their answers are short, like AI.”\u003c/em\u003e (Histology facilitator).\u003c/p\u003e\n\u003cp\u003eBeyond generational learning styles, facilitators also pointed to a cultural gap in academic discipline. Students were perceived as permissive, reluctant to commit to self-directed study, and unaccustomed to rigorous academic norms.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“There is an academic culture gap … they are too permissive and difficult to engage in building an independent learning culture”\u003c/em\u003e. (Physics facilitator).\u003c/p\u003e\n\u003cp\u003eThese generational and cultural gaps required facilitators to rethink pedagogy. However, many admitted they felt ill-equipped to design learning experiences tailored to students with such different expectations and habits.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePedagogical and curricular challenges\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the program level, facilitators identified content overload as a significant challenge. The pre-matriculation course attempted to cover a broad range of biomedical content in a condensed timeframe, which overwhelmed students and discouraged deep engagement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“The content is too heavy … reading textbooks feels boring, so innovative strategies are needed.”\u0026nbsp;\u003c/em\u003e(Biochemistry facilitator).\u003c/p\u003e\n\u003cp\u003eFacilitators advocated for greater integration of biomedical sciences with clinical context. By connecting abstract concepts to case-based or problem-based learning, they believed students could better appreciate the value of biomedical sciences in medical practice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“We need a teaching model that connects basic concepts with clinical cases so students can see the benefit.”\u003c/em\u003e (Physiology facilitator).\u003c/p\u003e\n\u003cp\u003eThey also highlighted the need for pedagogical innovation. Traditional lectures, even if well-prepared, were poorly suited for students with limited attention spans. Facilitators suggested incorporating active learning methods, small-group discussions, and interactive technologies. However, they acknowledged institutional constraints, including limited training in educational methods and rigid curricular structures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations for a More Effective Program\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite these challenges, facilitators agreed that the pre-matriculation program should be retained but redesigned to better achieve its goals. They advocated shifting the program’s focus from content transmission toward cultivating self-directed learning skills.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Don’t just fill them with material—teach them how to learn.” (Facilitator 4)\u003cbr\u003e\u0026nbsp;“The focus shouldn’t be on how much we teach, but how well they can learn independently.”\u0026nbsp;\u003c/em\u003e(Facilitator 8)\u003c/p\u003e\n\u003cp\u003eThey also emphasized the need for structured evaluation through pre- and post-tests to assess progress objectively.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“We need pre-tests and post-tests to clearly see whether students improve.” (\u003c/em\u003eFacilitator 10)\u003c/p\u003e\n\u003cp\u003eFacilitators recommended linking basic sciences to clinical cases to enhance relevance and engagement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“If we relate the topics to clinical cases, students become more interested and understand why basic science matters.”\u003c/em\u003e (Facilitator 7)\u003c/p\u003e\n\u003cp\u003eFinally, they underscored the importance of faculty development and institutional support to ensure quality and consistency.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“Tutors also need training so that teaching methods and commitment are aligned.”\u003c/em\u003e (Facilitator5)\u003cbr\u003e\u003cem\u003e“If the institution wants good results, it must provide time, facilities, and training.”\u003c/em\u003e (Facilitator 2)\u003c/p\u003e\n\u003cp\u003eCollectively, these recommendations reflected a shared aspiration to transform the pre-matriculation program into an integrated, evidence-informed, and learner-cantered foundation for medical study.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored facilitators’ experiences in implementing a pre-matriculation program in basic biomedical sciences for medical students. Five key themes emerged: (1) low student motivation and engagement, (2) weak academic literacy and reliance on shortcuts, (3) limited conceptual understanding and difficulty linking basic sciences to clinical practice, (4) generational and cultural gaps between students and facilitators, and (5) curricular and pedagogical challenges, including content overload and lack of integration.\u003c/p\u003e\n\u003cp\u003eOur findings reinforce concerns raised in previous research that medical students often enter with heterogeneous academic backgrounds, leading to varying levels of preparedness in basic sciences (1–3). Low motivation and external pressure to pursue medicine, as reported by facilitators, align with studies showing that students’ intrinsic motivation is critical for academic performance and professional identity formation (11,12,13).\u003c/p\u003e\n\u003cp\u003eWeak literacy and reading habits were a recurring theme. Facilitators noted that students rarely complete textbooks and often depend on AI or summaries. This resonates with evidence that poor academic literacy and surface learning strategies can undermine critical thinking in medical education (14,15). The generational shift towards digital learning may exacerbate this issue, requiring innovative approaches to foster deep learning (16).\u003c/p\u003e\n\u003cp\u003eThe challenge of rote memorization without integration into clinical relevance echoes long-standing debates about the basic sciences’ place in medical curricula. Harden argued for integration across preclinical and clinical phases to enhance knowledge transfer (17).\u003c/p\u003e\n\u003cp\u003eGenerational gaps and cultural mismatches between faculty and students were also evident. Short attention spans, reliance on gadgets, and limited curiosity mirror findings in studies of “Generation Z” learners (18,19). Faculty development is thus essential to bridge expectations and adapt pedagogy.\u003c/p\u003e\n\u003cp\u003eFinally, the lack of standardization in pre-matriculation programs is consistent with reports that such interventions are often designed based on tradition rather than evidence (6). While prior research has primarily examined students’ perspectives, our study contributes novel insights from facilitators, underscoring the need to evaluate these programs from multiple stakeholder viewpoints.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe insights from facilitators highlight several strategies to enhance the effectiveness of pre-matriculation programs (Table 2). First, structured efforts to foster intrinsic motivation and accountability are needed to ensure active participation. Second, targeted support in academic literacy, particularly reading comprehension and critical appraisal of digital and AI-generated information—may reduce reliance on superficial learning strategies. Third, embedding case-based and problem-based learning, with early clinical integration, can improve conceptual understanding and relevance. Fourth, faculty development initiatives are essential to adapt pedagogical approaches to the preferences of Generation Z learners, including the use of technology-enhanced and interactive methods. Finally, curricular redesign to streamline content and improve integration with the first-year medical curriculum may help reduce overload and increase perceived value. Together, these recommendations provide a roadmap for institutions seeking to strengthen pre-matriculation as a meaningful bridge into medical education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study offers novel insights into how biomedical sciences facilitators perceive the value and challenges of pre-matriculation programs designed to support students’ transition into medical school. Its strength lies in addressing an under-explored area within medical education and drawing on perspectives from facilitators representing multiple biomedical disciplines who have been involved since the program’s initiation. The use of focus group discussions provided a rich platform for interactive reflection and for capturing shared experiences across departments.\u003c/p\u003e\n\u003cp\u003eHowever, the study’s scope was limited to one institution and focused solely on facilitators’ perceptions, which may not fully represent the views of students, administrators, or clinical educators. In addition, as a qualitative inquiry, the findings are context-specific and not intended for generalization.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides insight into facilitators\u0026rsquo; perspectives on a basic biomedical sciences pre-matriculation program designed to support students\u0026rsquo; transition into medical school. Facilitators generally perceived the program as a useful bridging mechanism. However, its perceived impact was limited by ongoing challenges, including low student motivation, weak academic literacy, fragmented conceptual understanding across biomedical disciplines, and inconsistencies in curriculum structure and delivery. Despite its limitations, facilitators agreed that the program fulfills an important transitional role and should be improved rather than discontinued. The findings indicate that pre-matriculation programs are most likely to be effective when they are learner-centered, conceptually integrated, and supported by systematic evaluation and faculty development. Further research involving diverse participant groups, including students and institutional stakeholders, as well as longitudinal evaluation of academic progression and early clinical performance, is needed to more comprehensively assess program effectiveness and sustainability.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors sincerely thank the biomedical science facilitators at the Faculty of Medicine, Sultan Agung Islamic University, for their valuable insights and participation in this study. We also acknowledge the support of the Department of Medical Education, Faculty of Medicine, Sultan Agung Islamic University for facilitating data collection and discussions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by a research grant from the Indonesian Ministry of Higher Education, Science Technology in 2025 (No. 127/C3/DT.04.00/PL/2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets (interview transcripts and coded data) generated and analyzed during the current study are not publicly available due to confidentiality agreements with participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYI, EL, and RR, DF conceptualized the study and designed the methodology. Data collection and transcription were conducted by RR and DF. RR performed data analysis with input from YI and EL. All authors contributed to the interpretation of findings. The manuscript was drafted by RR and critically revised for intellectual content by YI and EL. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Committee of the Faculty of Medicine (No. 514/XI/2025/Komisi Bioetik), Universitas Islam Sultan Agung.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Medical Education, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eUndergraduate Program in Medicine, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSchmidt HG, Cohen-Schotanus J, Arends LR. Impact of problem-based, active learning on graduation rates for 10 generations of Dutch medical students. Med Educ. 2009;43(3):211\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStegers-Jager KM, Cohen-Schotanus J, Themmen AP. Motivation, learning strategies, participation and medical school performance. Med Educ. 2012;46(7):678\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWijnen-Meijer M, Ten Cate OT, van der Schaaf M, Borleffs JC. Vertical integration in medical school: effect on the transition to postgraduate training. Med Educ. 2010;44(3):272\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaufman DM, Mann KV. Teaching and learning in medical education: how theory can inform practice. In: Swanwick T, editor. Understanding Medical Education. 2nd ed. Wiley-Blackwell; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite CB, Dey EL, Fantone JC. Analysis of factors that predict clinical performance in medical school. Adv Health Sci Educ. 2009;14(4):455\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyse TD, et al. Pre-matriculation programs in U.S. medical schools: prevalence, structure, and outcomes. Acad Med. 2018;93(11):1640\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4th ed. Thousand Oaks: Sage; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: Sage; 1985.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKusurkar RA, Croiset G, Mann KV, Custers E, ten Cate O. Have motivation theories guided the development and reform of medical education curricula? A review. Acad Med. 2012;87(6):735\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWingate U. A framework for transition: supporting \u0026lsquo;learning to learn\u0026rsquo; in higher education. High Educ Q. 2007;61(3):391\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrince M. Does active learning work? A review of the research. J Eng Educ. 2004;93(3):223\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSandars J, Morrison C. What is the Net Generation? The challenge for future medical education. Med Teach. 2007;29(2\u0026ndash;3):85\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarden RM. The integration ladder: a tool for curriculum planning and evaluation. Med Educ. 2000;34(7):551\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTwenge JM. iGen: Why today\u0026rsquo;s super-connected kids are growing up less rebellious, more tolerant, less happy\u0026mdash;and completely unprepared for adulthood. Atria Books; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-Morales VJ, Garrido-Moreno A, Mart\u0026iacute;n-Rojas R. The transformation of higher education after the COVID disruption: Emerging challenges in an era of digitalisation. Innov Educ Teach Int. 2021;58(5):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 3","content":"\u003cp\u003eTable 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pre-matriculation, basic biomedical sciences, medical education, faculty perspectives, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-8378558/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8378558/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePre-matriculation programs in basic biomedical sciences are commonly used to help new medical students transition into medical school, especially when students come from varied educational background.. Little is known about facilitators\u0026rsquo; perspectives, even though they play a key role in designing and delivering these programs. This study aimed to explore facilitators\u0026rsquo; views on the effectiveness, challenges, and future improvement of a basic biomedical sciences pre-matriculation program\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative exploratory study was conducted using a focus group discussion involving ten biomedical science facilitators (anatomy, physiology, biochemistry, histology, and chemistry) at a private medical faculty in Indonesia. Participants were purposively sampled to represent diverse disciplines and teaching experience. Data were audio-recorded, transcribed verbatim, translated into English, and analyzed using thematic analysis following Braun and Clarke\u0026rsquo;s framework.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFour main themes were identified. First, facilitators had different views on the program\u0026rsquo;s effectiveness. Some saw it as an important bridge that supports students\u0026rsquo; academic and mental readiness, while others questioned its impact due to inconsistent delivery and lack of systematic evaluation. Second, students showed weak understanding of key biomedical subjects, often relying on memorization rather than understanding concepts. Third, challenges in implementation included low student motivation, weak literacy and learning culture, generational and cultural gaps, curriculum overload, and limited pedagogical support. Fourth, facilitators proposed recommendations for improvement, emphasizing a shift toward learning skills, stronger integration of basic and clinical sciences, structured evaluation, faculty development, and institutional support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eFacilitators viewed the pre-matriculation program as valuable but identified ongoing challenges. Addressing these through targeted program redesign may enhance program effectiveness. These findings highlight the importance of learner-centered design, integrated teaching approaches, and systematic evaluation in pre-matriculation programs. Further research involving diverse participant groups and longitudinal evaluation of student outcomes is needed to assess program effectiveness and sustainability.\u003c/p\u003e\u003ch2\u003eTrial Registration\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Facilitators’ perspectives on a pre-matriculation program in basic biomedical sciences for medical students: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-14 09:06:52","doi":"10.21203/rs.3.rs-8378558/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-25T10:06:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-11T13:40:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333745241933299121852092301506216119670","date":"2026-02-10T00:56:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T12:05:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46924997899839394541947248034249178125","date":"2026-01-30T02:25:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297771257271695323987007400870325121227","date":"2026-01-12T15:05:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-12T14:47:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-06T16:04:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-06T05:48:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-02T18:24:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-02T18:17:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee0d972d-385f-4c88-ac52-3380fe75a452","owner":[],"postedDate":"January 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T11:08:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-14 09:06:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8378558","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8378558","identity":"rs-8378558","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}