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

Background: The global adoption of English-medium instruction (EMI) in higher education has introduced complex implementation challenges, the severity of which often depends on the resources available within specific educational contexts. Evidence remains limited in public medical schools in under-resourced, non-Anglophone countries, which serve a socioeconomically and educationally diverse student population. In such settings, the direct transfer of existing EMI integration models presents significant practical challenges. Objective: This exploratory, observational, monocentric study aimed to investigate medical students' perceptions and attitudes toward EMI implementation at the Faculty of Medicine and Pharmacy of Rabat (FMPR) in Morocco and to evaluate their readiness for EMI adoption. Methods: A cross-sectional survey was administered to 102 second-cycle medical students at FMPR. The 23-item questionnaire included Likert-type scales and multiple-choice questions across 4 domains: demographic data, self-reported English language proficiency, language perceptions and attitudes, and EMI needs. Bivariate, univariate, and multivariate logistic regression analyses were conducted to determine the effects of the explanatory variables on EMI choice. Results: The sample comprised 65 female and 37 male participants. Most reported using English speaking and listening skills "often" on a daily basis, while writing skills were reported as being used "rarely." Participants rated their general English proficiency and their academic listening and reading skills as "good." Overall, 82.4% (84/102) of students were strongly in favor of implementing EMI at FMPR. Bivariate analysis showed significant positive associations between EMI choice and age (P=.04), course year (P<.001), interest in learning English (P=.006), and the belief that English should be the language of higher education (P=.02). Preference for EMI increased alongside course year, peaking at 96.4% (27/28) among students in the third and fourth years. Multivariate logistic regression confirmed that being in the fourth vs third course year (adjusted odds ratio 22.12, 95% CI 2.56-190.84; P=.005) and having an interest in learning English (adjusted odds ratio 5.12, 95% CI 1.05-25.03; P=.04) were significant positive predictors of EMI choice. Conclusions: Medical students at FMPR exhibit highly positive perceptions and attitudes toward the potential implementation of EMI, despite variations in their self-reported English readiness. These findings provide actionable insights for the successful integration of EMI that extend beyond the Moroccan context, offering a valuable framework for medical institutions in other under-resourced, low- and middle-income, non-Anglophone settings across the Global South.