Medical Students' Perceptions of and Attitudes Toward English as a Medium of Instruction at the Faculty of Medicine and Pharmacy of Rabat: A Cross-Sectional Study

This cross-sectional study of 102 medical students at the Faculty of Medicine and Pharmacy of Rabat reveals that despite varying self-reported English proficiency, the vast majority strongly favor implementing English as a medium of instruction, with higher support significantly predicted by advanced academic standing, personal interest in learning English, and the belief that English should be the language of higher education.

The Gist

Imagine the world of medicine as a giant, high-stakes video game. For a long time, the "cheat codes," the best strategy guides, and the global leaderboards have all been written in English.

For a long time, in Morocco, the local medical schools (the public ones) taught students using French (a legacy of colonial history) and Arabic. But the students are realizing that to reach the "end game"—to work internationally, read the latest research, or get certified to practice in places like the US—they need to switch their game language to English.

This paper is like a survey of the players (medical students) at a specific public university in Rabat, asking them: "Are you ready to switch the game language to English? How do you feel about it?"

Here is the breakdown of their findings, translated into everyday language:

1. The Players Are Eager (But Nervous)

The researchers asked 102 students. The result? Over 90% of them are cheering "Yes!"
They see English not as a scary foreign language, but as a golden ticket. They believe speaking English will:

• Open doors to jobs anywhere in the world.
• Let them read the latest medical "manuals" (research papers).
• Help them travel and study abroad.

The Catch: While they are excited, they admit they aren't all "pro gamers" yet.

• The Good News: They are great at the "casual" stuff. They watch English movies, listen to music, and chat with friends in English all the time.
• The Bad News: When it comes to the "hard mode" stuff—like writing a scientific paper, reading a thick medical textbook, or giving a lecture in English—they feel a bit shaky. They feel like they have the vocabulary for a coffee shop chat, but not for a brain surgery conference.

2. The "Level Up" Effect

The study found something really interesting: The higher the student's level, the more they want English.

• Freshmen (Year 3): They are okay with French or English.
• Seniors (Year 4+): They are desperate for English.
• Why? As they get closer to graduating, they realize that the "boss battles" (their final thesis and specialization) require English. They see that the older students who know English have a massive advantage. It's like realizing that to beat the final boss, you need that specific weapon, and you want to start training with it immediately.

3. The "Public vs. Private" Gap

Here is the most important part of the story.
Usually, only rich students at private schools get to learn in English because they can afford expensive language classes. The students at this public school come from all walks of life; some are wealthy, but many are not.

The study shows that these public school students are just as hungry for English as the rich kids. They don't see English as a "rich person's toy." They see it as a fairness tool. If the public school switches to English, it levels the playing field, allowing a student from a humble background to compete with a student from a private elite school.

4. The "Double-Edged Sword"

The students are worried about one thing: Cognitive Overload.
Imagine trying to learn how to perform heart surgery while simultaneously trying to learn a new language. That's what they are afraid of. They are worried that if the teacher speaks only English, they might get so confused by the language that they forget the actual medical facts.

However, they are not worried about losing their culture.

• They don't think switching to English will make them forget their Moroccan identity.
• They view English as a tool (like a Swiss Army knife), not a replacement for their soul. They are happy to keep French and Arabic for daily life and culture, while using English strictly for their medical career.

The Bottom Line

The paper concludes that the students are ready and willing to switch to English instruction, but they need a safety net.

Think of it like building a bridge. The students are standing on one side, ready to cross to the "Global Medical World." They have the motivation (the desire to cross), but they need the university to build the bridge carefully. The university needs to provide:

1. Language support: Helping them get better at reading and writing medical English.
2. Gradual steps: Not throwing them into the deep end immediately, but teaching them to swim first.

In short: The students are saying, "We want to speak English to become world-class doctors. We know it's hard, and we know we need help, but we are ready to do the work if you give us the right tools."

Technical Summary

1. Problem Statement and Context

• Global Context: English as a Medium of Instruction (EMI) is increasingly adopted globally to enhance employability, research output, and international mobility. However, implementation is often dominated by private institutions in high-income countries.
• The Gap: There is a significant lack of empirical data regarding EMI adoption in public medical schools within under-resourced, non-Anglophone, low- and middle-income countries (LMICs).
• Specific Context (Morocco): While Morocco is reforming its education system (2022–2026 Roadmap) to integrate English, public medical faculties like the Faculty of Medicine and Pharmacy of Rabat (FMPR) serve a socioeconomically diverse population. Many students lack the financial resources for private English training, creating a potential equity gap compared to private institutions.
• Research Question: What are the perceptions, attitudes, and self-perceived readiness of medical students at FMPR regarding EMI implementation, and what factors predict their preference for EMI?

2. Methodology

• Study Design: Exploratory, observational, monocentric cross-sectional study conducted during the 2023–2024 academic year.
• Participants:
  • Sample: 102 undergraduate medical students (2nd cycle: 3rd to 6th years) from FMPR.
  • Sampling: Convenience sampling.
  • Demographics: 63.7% female, 36.3% male; median age 21 (range 20–25).
• Instrument: A custom-developed, validated 23-item questionnaire divided into four domains:
  1. Demographics.
  2. Self-reported English Language (EL) proficiency (General and Academic).
  3. Perceptions and attitudes toward EL and EMI.
  4. EMI needs.
  • Validation: Content validity established via pilot testing and expert review. Construct validity confirmed via Exploratory Factor Analysis (EFA) (KMO = 0.782). Reliability assessed via Cronbach's alpha (0.565–0.874).
• Data Collection: Self-administered bilingual (French/English) survey. 130 distributed, 102 valid responses (78.5% response rate).
• Statistical Analysis:
  • Software: Jamovi (v2.6.26).
  • Methods: Descriptive statistics, Chi-square/Fisher's exact tests for bivariate analysis, and Univariate/Multivariate logistic regression to identify predictors of "EMI choice."
  • Significance Level: $p < 0.05$.

3. Key Results

A. Language Proficiency and Exposure

• Exposure: Students reported high frequency of speaking and listening (often used for movies, music, social interaction) but rare use of reading and writing in English.
• Self-Perceived Proficiency:
  • General EL: Rated as "good" (60.8%–75.5% positive).
  • Academic EL: Rated lower. While receptive skills (listening/reading) were "good," productive skills (writing scientific articles, delivering presentations) were rated as "average" or "basic."
  • Certification: Only 28.4% held CEFR certifications (B2–C2 levels).

B. Attitudes and Perceptions

• Overall Support: 92.2% of students were strongly in favor of implementing EMI at FMPR.
• Perceived Benefits:
  • International mobility (83.3%).
  • Better professional opportunities (80.4%).
  • Enhanced learning of medical content (69.6%).
  • Improved EL skills (65.7%).
• Perceived Disadvantages: Concerns were minimal. Only 36.3% feared subjects would be harder to learn in English; cultural identity loss was a concern for only 7.8%.
• Bilingual Preference: Despite supporting EMI, 72.5% preferred a bilingual curriculum (French + English) rather than a full switch to English.

C. Predictors of EMI Choice (Logistic Regression)

Multivariate analysis identified three significant positive predictors for a student's choice to support EMI:

1. Academic Year: Students in years 3 and 4 were significantly more likely to prefer EMI compared to year 3 (OR = 8.83, $p = .009$). Preference peaked at 96.4% in the 4th year.
2. Interest in Learning EL: Students who expressed an interest in learning English were 6.9 times more likely to support EMI (OR = 6.90, $p = .022$).
3. Belief in EL as Higher Ed Language: Students believing EL should be the language of higher education were 6.38 times more likely to support EMI (OR = 6.38, $p = .003$).

Note: Gender and EL certification status were not statistically significant predictors.

4. Key Contributions

• Empirical Evidence in LMICs: Provides rare data on EMI readiness in a public medical school in a non-Anglophone, middle-income country, challenging the notion that EMI is exclusively a privilege of private/wealthy institutions.
• Equity Perspective: Demonstrates that students from diverse socioeconomic backgrounds view EMI not as a barrier, but as a tool for educational democratization and access to global accreditation (e.g., WFME, ECFMG).
• Nuanced Readiness: Highlights the gap between Basic Interpersonal Communication Skills (BICS) (high in students due to digital media) and Cognitive Academic Language Proficiency (CALP) (lower in academic writing/speaking), suggesting a need for targeted pedagogical support.
• Policy Relevance: Offers a framework for implementing EMI in North African and similar Global South contexts, emphasizing that student receptivity is high, but structural support is required.

5. Significance and Implications

• Strategic Alignment: The findings align with Morocco's national educational roadmap and international agreements (e.g., UK-Morocco MoU) to integrate English into public higher education.
• Implementation Strategy: The study suggests that while enthusiasm is high, successful EMI integration requires:
  • Hybrid Models: A transition period utilizing bilingual instruction (French/English) to mitigate cognitive load.
  • Pedagogical Support: Structured language training focusing on academic writing and medical terminology to bridge the gap between conversational fluency and academic proficiency.
  • Equity Focus: Ensuring public institutions do not lag behind private ones, thereby preventing the widening of social inequalities in medical education.
• Limitations: The study relies on self-reported data (potential bias), is cross-sectional (no longitudinal tracking of performance), and is monocentric (limited generalizability to other regions).

Conclusion: Medical students at FMPR exhibit a highly positive attitude toward EMI, viewing it as a pragmatic professional resource rather than a cultural threat. However, the discrepancy between their enthusiasm and their self-reported academic English proficiency underscores the necessity for gradual, well-resourced, and supportive implementation strategies to ensure equitable outcomes.