The study of biochemistry is an essential component of medical education, providing students with a fundamental understanding of the molecular basis of life and its connection to scientific advancements in medicine, pharmacology, and nutrition. However, the abstract nature of this subject can present a challenge for novice students. Over the course of my twelve-year tenure as coordinator of this subject, I have been engaged in efforts to reform its pedagogical approach, to promote active and deep learning. A number of recent studies have highlighted the importance of threshold concepts in biochemistry education. For example, Pakay et al. have identified a set of critical threshold concepts for biochemistry students, including the steady state, biochemical pathway dynamics, the physical basis of interactions, the thermodynamics of macromolecular structure formation, and free energy. These concepts facilitate students' acquisition of a transformed understanding, which is a prerequisite for advancement in the discipline. Furthermore, the integration of Active learning strategies, including flipped learning and case-based learning, have been demonstrated to be effective in fostering a deeper understanding and application of biochemical concepts in medical education.

The objectives of the course reform are threefold: firstly, to adapt the content to the profile of first-year medical students; secondly, to facilitate the understanding of key biochemical concepts; and thirdly, to foster active and deep learning. Additionally, the course aims to develop essential competencies for future physicians, such as communication, teamwork, critical thinking, and professional ethics. A principal element of the reform has been the structuring of the content around threshold concepts. These concepts are fundamental to comprehension of other topics within and beyond biochemistry, including the structure of biomolecules, enzymatic reactions, and metabolism. The identification of these concepts was based on a comprehensive literature review, with a particular focus on their application to biochemistry education for medical students.

The methodology combines flipped learning, case-based learning, and peer instruction, integrating a variety of active learning methodologies. In the context of flipped learning, students are expected to acquire the basic knowledge required for the course autonomously through online resources. In the classroom, clinical cases are employed to discuss and apply biochemical concepts to real-world health situations, thereby promoting diagnostic capabilities and evidence-based decision-making. Peer instruction facilitates collaborative learning, allowing students to explain and debate concepts, thereby strengthening their understanding and communication skills. The initial feedback has been extremely positive, indicating a significant improvement in students' understanding of fundamental concepts and their application to real-world situations. It is recommended that this model be applied to other subjects, with a literature review being conducted to identify threshold concepts, collaborative activities being designed, and practical cases being used to foster knowledge transfer. From my own perspective, I find this reform process challenging but rewarding. I am committed to continuing to improve the course's methodology and content based on student feedback and advances in the field of biochemistry.

Keywords: Biochemistry, Medicine, threshold-concepts, Active learning.