Background Preprints—scientific manuscripts shared publicly prior to formal peer review—are gaining momentum across academic disciplines. However, their adoption in clinical and biomedical sciences remains limited, particularly in countries where traditional publishing norms prevail. Editorial ambiguity and a lack of national policy further complicate their use.

Objective This study aimed to assess the awareness, experiences, and attitudes of medical academics at a major university in Istanbul, Türkiye toward preprints, and to explore the editorial landscape through both journal editor feedback and a review of journal-level preprint policies.

Methods A cross-sectional survey was conducted with 103 medical faculty members. The questionnaire included demographic questions, Likert-scale and multiple-choice items assessing knowledge, familiarity, and attitudes toward preprints, as well as open-ended items to explore concerns. A “Preprint Test Score” (0–4) was developed to quantify objective knowledge. Subgroup analyses were conducted by age (<40 vs. ≥40 years) and academic discipline (basic vs. clinical sciences). Additionally, five journal editors responded to open-ended questions about preprint policies, and 118 biomedical journals were manually reviewed for their declared stances on preprints and article processing charges (APCs).

Results Only 42.9% of participants reported familiarity with the concept of preprints, and 13% had previously published on a preprint server. Misconceptions about ethics, peer review, and compatibility with journal policies were common. Subgroup analysis revealed that older participants scored higher on the Preprint Test and had more experience with preprint publishing. Further younger academics expressed less openness toward future use. Clinical faculty were generally more hesitant than basic science faculty, although both groups raised concerns about the academic recognition of preprints. Editorial responses reflected a mix of cautious endorsement and scepticism. Among the 118 biomedical journals reviewed, most lacked clear preprint policies, while a small number either explicitly prohibited or permitted them.

Conclusion There is limited awareness and cautious engagement with preprints among medical academics and editors in Türkiye. Generational and disciplinary differences further influence knowledge and attitudes. The lack of clear editorial guidance from biomedical journals may reinforce academic uncertainty. Tailored educational initiatives, transparent journal policies, and institutional support will be essential to foster a more open and inclusive scientific publishing environment.

The authors have declared no competing interest.

This study did not receive any funding

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the Marmara University Faculty of Medicine Non-Drug and Medical Device Research Ethics Committee (protocol code 09.2024.600 and date of 17 May 2024)

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