Preprints—manuscripts publicly shared prior to peer review—have transformed the pace and openness of scholarly communication. Widely adopted in fields such as physics and computer science for decades, preprints enable rapid dissemination, open peer commentary, and broader visibility of research findings [1]. In recent years, the biomedical community has increasingly engaged with preprint platforms, particularly during public health crises such as the COVID-19 pandemic. For instance, between June 2020 and June 2022, the US National Library of Medicine made more than 3300 National Institutes of Health–funded COVID-19 preprints accessible in PubMed Central, marking a pivotal shift toward preprint integration in mainstream biomedical publishing [2].

Despite this global momentum, the adoption of preprints in clinical and medical sciences remains uneven [3]. In countries like Türkiye, where academic evaluation systems and journal structures still emphasize traditional peer-reviewed publication, the concept and utility of preprints are often misunderstood or undervalued. Anecdotal observations suggest hesitancy among medical faculty, fuelled by concerns about plagiarism, duplication, and lack of recognition in academic promotion criteria.

Journal editors also play a crucial role in shaping scholarly norms. Editorial policies on preprints vary widely across journals: while some encourage their use, others either prohibit them or do not explicitly mention them at all [4-7]. The absence of a clear preprint policy creates uncertainty for authors and may contribute to low adoption, particularly among early-career researchers concerned about publication eligibility [8].

While international studies have explored general attitudes toward preprints [3,9-11], little is known about how these perspectives vary within academic subgroups. Factors such as career stage and departmental discipline may influence both knowledge and perception. For instance, basic science researchers are often more open to experimentation with publishing models, whereas clinical academics may prioritize peer-reviewed evidence with clear implications for practice [12]. Similarly, younger faculty may view preprints as tools for early visibility and career advancement, while more senior academics may adhere to traditional notions of scholarly validation and prestige.

To date, no systematic assessment has examined the knowledge, attitudes, and editorial perspectives regarding preprints within Türkiye’s medical academic community. To address this gap, this study used a mixed methods design, integrating three data sources: a cross-sectional survey of medical academics at Marmara University School of Medicine; a document-based review of preprint and article processing charge (APC) policies from Turkish biomedical journals; and a descriptive analysis of qualitative feedback from journal editors.

In addition to characterizing general patterns, we examine subgroup differences by age and academic discipline to uncover nuanced barriers and opportunities for preprint adoption in the evolving landscape of scientific communication.

Our findings reveal a notable gap in both awareness and practical engagement with preprints among medical academics at Marmara University School of Medicine. Despite the global momentum toward open science and rapid communication [14], many respondents exhibited limited familiarity with the concept, and a majority expressed hesitance or skepticism about its use. A recent global survey found that approximately 10% of medical and health sciences researchers in the United States were unfamiliar with preprints, and around 40% had never posted one [15]. In contrast, one-fifth of our participants had never heard of preprints, and four-fifths had never submitted one, highlighting a relatively greater degree of unawareness and hesitancy in our sample.

Misconceptions regarding peer review, duplicate publication, and ethical validity were widespread among respondents, underscoring the need for targeted education and clearer guidance. Maggio and Fleerackers [16] have proposed formally integrating preprint education into health professions curricula to improve understanding and normalize early dissemination practices. Moreover, research shows that students and early career researchers often struggle to distinguish preprints from peer-reviewed journal articles, reflecting a significant knowledge gap [17]. Consistent with these findings, our participants under the age of 40 demonstrated lower preprint knowledge, emphasizing the urgency of tailored interventions for this group.

Journal editors’ responses reflected a similar ambivalence. While some recognized the potential of preprints for visibility and transparency, others raised concerns about incompatibility with traditional editorial workflows, ethical ambiguity, and the potential for misuse. Despite such skepticism, studies have shown that peer-reviewed articles that were first posted as preprints tend to receive more citations and broader attention [18], suggesting tangible benefits to early sharing.

Our complementary policy analysis of 118 Turkish biomedical journals further highlights the cultural and structural barriers impeding broader preprint adoption. Only a small proportion of journals explicitly permitted preprints, while the vast majority either prohibited them or failed to mention them altogether. This lack of clear guidance stands in contrast to many high-ranking international clinical journals, which now explicitly allow or even encourage the submission of manuscripts previously posted as preprints [7]. The absence of formal policies among Turkish journals likely contributes to hesitation among authors, reinforcing an environment of academic conservatism and uncertainty—a trend previously noted in the literature [9].

However, our longitudinal review of journal policies between February 2024 and April 2025 suggests a slow but positive shift in this landscape. During this period, 6 additional journals formally adopted policies allowing preprints, while only 1 new prohibition was identified. Although incremental, this trend points toward a growing acceptance and normalization of preprint use within the Turkish biomedical publishing ecosystem. As journal policies become more explicit and aligned with global standards, uncertainty among researchers may diminish, potentially encouraging wider adoption of preprints in academic practice [19].

Additionally, variability in APC policies—particularly the prevalence of “free” and “case-by-case” models—may influence authors’ motivations. While one of the advantages of preprints is their cost-free accessibility, this incentive may be undercut if authors are already publishing in fee-free journals or are unaware of preprint benefits [20]. Financial considerations, combined with policy ambiguity, could thus create a disincentive for broader adoption.

Our subgroup analyses revealed how age and academic discipline influence perceptions of preprints. Older academics (≥40 y) were more likely to have published on preprint servers and scored higher on objective knowledge measures but also displayed more conservative attitudes, valuing journal prestige and citation counts. Younger academics (<40 y), on the other hand, were more pessimistic about the future potential of preprints, despite their limited experience. These generational differences may reflect an evolving academic culture that increasingly values transparency, speed, and accessibility.

This interpretation aligns with the findings of Fraser et al [20], who noted that junior researchers often use preprints to increase the visibility of their work, whereas senior researchers are more motivated by competitive concerns such as staking a priority claim [7].

An interesting finding is that, even though younger academics display reformist attitudes toward the conventional publishing process, they show less openness toward the use of preprints in future. This could be due to their relative inexperience or misconceptions regarding preprints, which can be validated by their lower preprint test score.

We also observed differences between basic and clinical science faculty members. While overall knowledge levels were similar, clinical faculty were more hesitant about preprint use. This may be due to the conservative nature of clinical research, which is closely tied to patient safety, regulatory compliance, and reliance on peer-reviewed evidence. As previously described, clinical medicine tends to be more cautious regarding the role of preprints in academic communication [21].

It is important to acknowledge that this study was conducted at a single academic institution in İstanbul. As such, our findings represent a localized snapshot and should be interpreted with caution. Additionally, while the survey captured a range of perspectives, the response rate was modest, and some questions had incomplete responses. The number of editor responses was also limited, restricting the depth of qualitative analysis. Finally, the policy review was limited to publicly available information, which may not fully reflect internal editorial practices or unpublished updates. Broader, multicenter studies will be necessary to determine whether these patterns hold across other regions and institutions in Türkiye.

To enable broader and more equitable adoption of preprints in the country, we recommend the following:

Bridging both the awareness and policy gaps—and accommodating the diversity of views within academic institutions—is essential for aligning Türkiye’s scientific publishing culture with international standards.

This study identified a significant awareness gap and hesitancy toward preprints among medical academics at a Turkish university, driven by both individual misconceptions and a lack of clear, permissive policies from local biomedical journals. Despite a slow trend toward greater journal acceptance, attitudes remain divided by age and discipline. To foster a more open and timely research ecosystem, these findings underscore the need for strategic interventions, including targeted education to correct misconceptions, the establishment of transparent journal policies, and formal institutional recognition of preprints.