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BMC Med Educ. 2019 Jan 9;19(1):15. doi: 10.1186/s12909-018-1452-3.

Challenges and adaptations in implementing an English-medium medical program:a case study in China.

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Department of Foreign Languages, Shantou University Medical College, Shantou, China.
Center for Faculty Educators, School of Medicine, University of California San Francisco, San Francisco, USA.
Department of Foreign Languages, Shantou University Medical College, Shantou, China.
Department of Histology & Embryology, Medical Education Assessment and Research Center, Shantou University Medical College, Shantou, China.



Increasingly, non-English speaking countries use English as the medium of instruction (EMI) to teach academic subjects. This study investigated the challenges and adaptation strategies of teachers and students in an EMI medical education program in China.


Data were collected on EMI and non-EMI students' test performances and student and teacher perceptions of the program. Test scores and survey results were analyzed using SPSS. Focus group transcripts and open-ended comments from surveys were examined using thematic coding.


There were no significant differences in admission and graduation test scores for EMI and non-EMI students. Four challenges with the EMI program were identified: (1) insufficient/inappropriate teaching materials, (2) unsatisfactory teaching, (3) inadequate class interactions, and (4) failure to teach medical humanities. To address these challenges, teachers and students used adaptive strategies, such as the use of alternative textbooks, self-learning skills and Chinese language.


EMI programs are difficult to initiate, requiring faculty development and institutional support, and student self and peer group learning strategies to be successful. The adaptive strategies employed by both students and teachers offer insights into how other EMI programs might strengthen their implementation.


Adaptive teaching and learning strategies; Challenges; English as the medium of instruction

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