Bridging language gaps: a study of linguistic transfer perceptions among Chinese medical students in an English-medium instruction program

Background English-Medium Instruction (EMI) in medical education aims to cultivate globally competent physicians, yet a significant challenge arises when students must subsequently pass high-stakes licensure examinations administered in their native language. This pilot study explores this critical linguistic transition by examining the post-examination perceptions of Chinese EMI medical students who completed the National Competency Test (NCT), a major Chinese-language benchmark examination. Methods A cross-sectional survey was administered to 24 fourth-year EMI medical students following their NCT. Participants rated their confidence in performing parallel medical tasks in English and Mandarin (10 items each) and evaluated the perceived utility of EMI training for the Chinese clinical context (7 items). Data were analyzed using descriptive statistics, effect sizes (Cohen’s d), and paired t -tests to quantify language-based confidence gaps. Results Despite achieving outstanding NCT results substantially above national averages, students reported a notable confidence gap favoring Mandarin for productive clinical communication skills, while receptive tasks showed minimal language differences. Students’ confidence in completing an Objective Structured Clinical Examination in Mandarin correlated positively with their actual examination performance. However, students did not attribute their examination success to their EMI training, revealing a disconnect between objective achievement and perceived utility. Conclusion This study reveals a critical disconnect in EMI medical education: while students successfully transfer English-acquired knowledge to excel in a native-language licensing examination, they do not attribute this success to their EMI training and express low confidence in clinical English communication. These findings underscore the urgent need for EMI curricula to incorporate explicit pedagogical strategies that bridge English-acquired medical knowledge with native-language clinical application, thereby enhancing both perceived utility and readiness in linguistically diverse healthcare environments.