Embracing bilingualism in healthcare education: key stakeholders' voices.

Introduction: In recent decades, higher education institutions worldwide have increasingly adopted English as the Medium of Instruction (EMI) across various disciplines, including medicine, to promote internationalisation and enhance access to global knowledge and markets. While EMI facilitates access to international medical knowledge and improves graduates' global competitiveness, it also introduces linguistic and cognitive challenges, particularly in non-Anglophone contexts such as Saudi Arabia. This study aims to explore stakeholders' perceptions of the medium of instruction in three medical programmes in a non-Anglophone country, Saudi Arabia. Methods: A mixed-methods approach was employed, integrating data from questionnaires, interviews, and classroom observations. Participants included a broad range of stakeholders-students, faculty members, and administrators-from three medical programmes in Saudi Arabia. Quantitative questionnaire data were used to identify general trends in perceptions toward EMI, while qualitative interviews and observations provided deeper insights into participants' experiences and contextualized perspectives on language use in medical education. Results: Findings revealed that the majority of stakeholders supported EMI, citing its role in enhancing knowledge competency, professional preparedness, and English language proficiency. Despite this support, notable concerns emerged regarding content comprehension difficulties, increased cognitive load, and time constraints during teaching and learning processes. A recurring theme across data sources was the advocacy for a bilingual approach, whereby both English and students' first language (Arabic) would be strategically employed to facilitate understanding, improve learning efficiency, and strengthen conceptual knowledge in both languages. Discussion: The results highlight the complex balance between globalisation goals and local linguistic realities in medical education. EMI is widely valued for its alignment with global medical standards and professional communication demands; however, its exclusive use may hinder learning outcomes for students with limited English proficiency. The strong endorsement of a context-sensitive bilingual approach underscores the need to integrate students' first language and language support mechanisms within EMI policies. These insights provide actionable recommendations for policymakers, curriculum designers, and educators to optimise EMI implementation while maintaining educational equity and quality.