Key factors promoting student comprehension in medical biochemistry

Background Medical biochemistry is consistently perceived by students as conceptually dense and challenging. Identifying instructional strategies that enhance comprehension and engagement is critical for curriculum design and faculty development across medical education. Methods We conducted a mixed-methods, cross-sectional survey of medical students across all four years of training (M1–M4) enrolled in Doctor of Osteopathic Medicine (DO) and Doctor of Medicine (MD) programs in medical schools across the United States. While biochemistry instruction occurs primarily during the preclinical years (M1–M2), inclusion of students from all years allowed reflection on instructional practices in relation to both foundational learning and subsequent clinical application. Open-ended survey responses (n = 169) were analyzed using inductive thematic qualitative analysis. Results Six dominant themes emerged: (1) emphasis on high-yield and board-relevant content; (2) active learning through practice questions and problem-based approaches; (3) conceptual, stepwise explanations over rote memorization; (4) integration of clinical correlations and narrative frameworks; (5) visual organization using diagrams, flowcharts, and color-coding; and (6) instructor enthusiasm, approachability, and psychological safety. Students reported that dense slides, excessive memorization, monotone delivery, and unclear prioritization hindered comprehension. Conclusions Student perceptions across training stages support a learner-centered, concept-driven approach to medical biochemistry that emphasizes clinical relevance, high-yield prioritization, and active engagement. Faculty enthusiasm and supportive behaviors play a central role in student motivation and perceived comprehension. These findings have important implications for instructional design, faculty development, and preclinical curriculum reform in both osteopathic and allopathic medical education.