Arab Medical Students’ Attitudes Toward the Arabization of Medical Education: A Multiregional Cross-Sectional Study

Introduction

Language is the primary tool for learning and acquiring knowledge. In fields such as medicine, the language of instruction influences not only how information is presented but also how effectively students understand and retain it.^1,2 Evidence suggests that learning in one’s native language reduces unnecessary cognitive load,^3,4 allowing students to focus on problem-solving and developing clinical reasoning. Therefore, aligning the language of instruction with a student’s mother tongue can enhance learning efficiency. Nevertheless, despite the cognitive advantages of native-language instruction, English remains the dominant language of medical education and practice globally.^5,6

In the Arab world, the shift toward English as the medium of instruction was adopted and sustained as it was widely perceived to facilitate alignment with Western medical advances, improve access to international research, and enhance global competitiveness.^7,8 Consequently, most medical schools across the region currently use English as the primary language of instruction.⁶ However, the impact of teaching future physicians in a language other than their mother tongue remains debated.^9–11

In their systematic review of educational language barriers in countries using a foreign language for instruction, Hamad et al analyzed 56 studies, most of which were conducted in Arab countries, and identified two key themes: academic barriers and clinical communication barriers.¹² Academically, students frequently struggled to comprehend textbooks, lectures, and examinations,^13–15 resulting in poorer performance,^16,17 higher stress,^17,18 and increased dropout rates.¹⁹ Clinically, students reported that foreign-language instruction limited their ability to communicate effectively with patients in their native language, affecting empathy, history-taking, and overall confidence in patient care.^20–24

The literature on Arab medical students’ attitudes toward Arabization presents a complex and evolving picture, reflecting a tension between pedagogical efficiency and global competitiveness. In this context, Arabization refers not only to fully Arabic-medium instruction but also to bilingual or hybrid models, encompassing the language of teaching, learning materials, and selected subject translation. Historically, students showed strong support for instruction in their mother tongue; for example, a 1996 study reported that 70.3% of Saudi medical students preferred Arabic, noting that it reduced their study time by nearly half.²⁵ More recent evidence, however, suggests a marked shift toward English as the preferred medium of instruction, with 83.4% of Libyan students and over 85% of Saudi students now favoring English to access updated global resources and succeed in international licensing examinations.^8,26 At the same time, institutional initiatives continue to shape the discourse. For instance, in early 2025, Egypt’s Al-Azhar University announced a formal feasibility study on Arabizing its medical, pharmacy, and dentistry curricula,²⁷ while Algeria phased out French in favor of English across schools and universities to align with global academic and economic standards.²⁸ The contrast between evolving student preferences and ongoing policy shifts underscores the need for contemporary, large-scale data to inform regional medical education strategies.

Despite extensive debate, research on medical students’ attitudes toward Arabization remains largely limited to small, single-institution studies with primarily descriptive analyses, with socio-demographic and career-related determinants of language preferences remaining underexplored at a regional level. To address these gaps, this study examined medical students’ attitudes toward Arabization, their preferences for the language of medical education, and the socio-demographic and career-related factors associated with these views among Arab medical students, with data collected across five countries representing the four major Arab regions. It further investigated perceived advantages, disadvantages, barriers, and subject-specific language preferences, providing broader evidence to inform language policy in Arab medical education.

Methods

Study Design and Period

A descriptive cross-sectional study with an analytical component was conducted from August 2025 to October 2025. This study followed the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines.²⁹

Target Population and Settings

To enhance the generalizability of the study’s findings to the Arab region, the study targeted medical students across each of the four major Arab regions: the Maghreb, the Levant, the Nile Valley, and the Arabian Peninsula. From each region, one or two countries were included based on the availability of collaborators: Algeria and Mauritania from the Maghreb, Syria from the Levant, Egypt from the Nile Valley, and Saudi Arabia from the Arabian Peninsula.

The included countries also represent the three curriculum languages used in medical education across the Arab world: Arabic (Syria), English (Egypt and Saudi Arabia), and French (Algeria and Mauritania).

Sample Size

The sample size was calculated using R³⁰ with the samplingbook package³¹ based on the primary outcome of the study (preferred curriculum language). We estimated that 50% of students would prefer a specific language, which yields the most conservative sample size calculation. Using a 95% confidence level and a 5% margin of error, the minimum required sample size was calculated to be 385 participants per region. Since the study included four regions, the total target sample size was 1540 (385 × 4). A total of 1727 participants completed the questionnaire, exceeding the target.

Sampling Method and Data Collection Approach

A convenience sampling approach was used in data collection. Students participated in the study by answering the questionnaire online on Google Forms. To ensure the sample accurately reflected the local populations and to exclude international students whose native tongue may have differed from that of the locals of the region (ie. Arabic), participation was restricted to nationals of the included countries. This was enforced via a mandatory screening question at the beginning of each country-specific online form (eg, “You must hold Saudi nationality”). These forms were distributed through official student channels and groups on Telegram and other social media platforms. Google Forms was configured to allow one response per participant. At least one author was responsible for data collection in each country, with additional collaborators assisting in some countries. The questionnaire was disseminated in official groups for all academic years, guaranteeing extensive reach and making it accessible to all students. Participants were able to answer the questions freely and anonymously.

Study Questionnaire

We used a self-administered anonymous online questionnaire to gather information. The questionnaire was developed in a bilingual format (Arabic and English), with each question and response option presented in both languages. It was developed by the authors after a review of the existing literature on the Arabization of medicine, students’ attitudes toward Arabization, and supplemented with items developed by the authors based on factors potentially influencing students’ preferences.^8,12,13,32 The questionnaire underwent review by a professor and a public health professional. Pilot testing was conducted among members of the research team and a small group of their contacts, all of whom were students at the time of the study, and the questionnaire was deemed appropriate for the target population. A copy of the questionnaire is provided as Supplementary File 1.

In the first section, we collected sociodemographic characteristics of the studied population: age, sex, place of residence, and academic year. We also collected the primary language of the curriculum in pre-university education.

In the second section, we assessed students’ language preferences, including the preferred primary language of the medical curriculum (eg, textbooks, handouts) and the preferred primary language of teaching and explanation (eg, lectures, practical sections, clinical rounds). We also collected information on self-reported factors that may be associated with language preference, including plans to practice or study medicine abroad after graduation and medical research involvement.

In the third section, we explored students’ perceptions of Arabization through four multi-choice questions where respondents could select more than one option. These addressed the perceived advantages of Arabizing the medical curriculum, the perceived disadvantages, the subjects or topics preferred for Arabization, and the expected barriers to Arabizing the medical curriculum. Each question also included a free-text “Other” option. Students already studying an Arabic curriculum (Syrian students) were excluded from the questions on preferred subjects and expected barriers, which addressed anticipated implementation choices among students not already studying in an Arabic curriculum.

Ethical Approval

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board of the Faculty of Medicine at Mansoura University, under the reference number R.25.06.3211.R2. Participation was voluntary, with no financial incentives offered. Written electronic informed consent was obtained from each participant. Data were collected anonymously through an online questionnaire, maintaining strict confidentiality and protecting participants’ privacy throughout the study.

Statistical Analysis

In this study, R³⁰ was used for statistical analysis. The gtsummary package³³ was used for generating descriptive and analytical summary tables. Categorical data were presented as frequencies and percentages, whereas continuous data were presented as means and standard deviations (SD). For multi-choice questions (advantages, disadvantages, barriers, and preferred subjects), percentages were calculated based on the total number of respondents, as participants could select more than one option.

Bivariable analysis was performed by stratifying the study sample by preferred primary curriculum language using Pearson’s chi-square test (without continuity correction) for categorical variables with all expected cell counts ≥5, and Fisher’s exact test (with Monte Carlo simulation using 10,000 replicates) for categorical variables with any expected cell count <5. Row-wise percentages were used for the stratified analysis.

Firth-penalized multinomial logistic regression was used to examine factors associated with the preferred primary curriculum language, using the brglm2 package.³⁴ This approach was selected to reduce estimation bias and improve coefficient stability in the presence of sparse and zero cells in the French-preference equation. Arabic was set as the reference category for the outcome variable. Results are presented as adjusted odds ratios (AOR) with their corresponding 95% confidence intervals (CI). A p-value less than 0.05 was considered statistically significant.

Results

Participant Characteristics

A total of 1727 Arab medical students completed the survey. The mean age of participants was 21.8 years (SD = 2.0). Over half were female (56.5%), and the majority resided in urban areas (86.3%). Participants were distributed across four geographical regions: Levant (27.0%), Maghreb (25.7%), Arabian Peninsula (23.8%), and Nile Valley (23.5%). The majority of participants had Arabic as their pre-university education language (73.0%), followed by English (15.6%) and French (10.7%). Current curriculum languages were English (47.3%), Arabic (27.0%), and French (25.7%). Most participants had no medical research involvement (64.6%), and the most common future plan was being undecided about practicing or studying medicine abroad (37.5%) (Table 1).

Table 1 Characteristics of the Study Sample of Arab Medical Students (N = 1727)

Curriculum and Teaching Language Preferences

The preference for primary medical curriculum language varied across regions (Table 2). In the Levant (Syria; Arabic curriculum), Arabic was the most preferred curriculum language (73.7%; 95% CI = 69%, 78%). In the Nile Valley (Egypt; English curriculum) and the Arabian Peninsula (Saudi Arabia; English curriculum), English was the dominant preference (76.1%; 95% CI = 72%, 80% and 72.5%; 95% CI = 68%, 77%, respectively). In the Maghreb (Algeria and Mauritania; French curriculum), preferences were more evenly distributed, with Arabic being the most preferred (43.5%; 95% CI = 39%, 48%).

Table 2 Characteristics of the Study Sample of Arab Medical Students Stratified by Preferred Primary Curriculum Language (N = 1709)

Regarding teaching language, nearly all students who preferred Arabic as a curriculum language also preferred Arabic for teaching (96.2%). Among those preferring English as a curriculum language, the teaching language preference was split between Arabic (47.6%) and English (45.5%). Among those preferring French, the majority preferred French for teaching (70.5%), while a quarter preferred Arabic (25.0%) (Table 2).

Perceived Advantages and Disadvantages of Arabization

The most frequently endorsed advantages of Arabizing the medical curriculum were improving communication with patients and healthcare teams (66.0%), better understanding and retention of medical concepts (56.4%), and preserving cultural and religious identity (55.4%). Conversely, 12.6% reported seeing no advantages (Table 3).

Table 3 Perceived Advantages of Arabizing the Medical Curriculum Among Arab Medical Students (N = 1727)

The most commonly perceived disadvantages were making preparation for international medical exams more difficult (65.6%), hindering direct access to medical advances and learning resources (56.7%), and reducing opportunities for working or specializing abroad (51.6%). Conversely, 13.9% reported seeing no disadvantages (Table 4).

Table 4 Perceived Disadvantages of Arabizing the Medical Curriculum Among Arab Medical Students (N = 1727)

Expected Barriers to Arabization

Among the 1261 students not currently studying an Arabic curriculum, the most frequently anticipated barriers were difficulty keeping an Arabized curriculum updated with global medical advances (51.2%), insufficient faculty expertise for teaching in Arabic (49.9%), and inadequate Arabic terminology and learning resources (49.0%). Conversely, 11.6% expected no barriers (Table 5).

Table 5 Expected Barriers to Arabizing the Medical Curriculum Among Arab Medical Students (N = 1261)

Subjects Preferred for Arabization

Among the same 1261 students, the subjects/topics most frequently preferred for Arabization were Ethics (40.5%), Communication skills (35.0%), and Medical law (33.0%), followed by History taking (29.4%). Notably, 27.8% expressed a preference for all subjects/topics to be Arabized, while 15.1% preferred no subject/topic to be Arabized. The least preferred subjects for Arabization were from the basic sciences, such as Histology (2.3%), and Parasitology (2.4%) (Table 6).

Table 6 Subjects/Topics Preferred for Arabization Among Arab Medical Students (N = 1261)

Factors Associated with Preferred Curriculum Language

Multivariable Firth-penalized multinomial logistic regression was used to identify factors independently associated with preferred primary curriculum language, with Arabic as the reference category (Table 7).

Table 7 Multivariable Multinomial Logistic Regression (Firth-Penalized) of Factors Associated with Preferred Primary Curriculum Language (N = 1709)

English vs Arabic

Male students had lower odds of preferring English over Arabic compared to female students (AOR = 0.63; 95% CI = 0.49, 0.80). Rural residence was associated with lower odds of preferring English (AOR = 0.62; 95% CI = 0.44, 0.88). Compared to 1st-year students, those in the 2nd year (AOR = 1.46; 95% CI = 1.02, 2.09), 3rd year (AOR = 2.01; 95% CI = 1.40, 2.89), 4th year (AOR = 1.76; 95% CI = 1.25, 2.47), and 5th year (AOR = 1.76; 95% CI = 1.17, 2.65) had higher odds of preferring English. Students with English pre-university education had higher odds (AOR = 1.64; 95% CI = 1.14, 2.36), whereas those with French pre-university education had lower odds (AOR = 0.45; 95% CI = 0.28, 0.73), both compared to those with Arabic pre-university education. Students currently studying in an Arabic curriculum had markedly lower odds of preferring English (AOR = 0.14; 95% CI = 0.10, 0.19), and those in a French curriculum also had lower odds (AOR = 0.38; 95% CI = 0.26, 0.55), both compared to English curriculum students. Regarding future plans, students planning to go to a non-Arab country (AOR = 3.58; 95% CI = 2.57, 4.98) and those who had not decided yet (AOR = 1.53; 95% CI = 1.13, 2.07) had higher odds of preferring English compared to those planning to stay in their country (Table 7).

French vs Arabic

Male students had lower odds of preferring French over Arabic compared to female students (AOR = 0.27; 95% CI = 0.13, 0.52). Compared to 1st-year students, those in the 3rd year had higher odds of preferring French (AOR = 2.51; 95% CI = 1.21, 5.23). Students currently studying in a French curriculum had substantially higher odds of preferring French (AOR = 47.87; 95% CI = 10.31, 222.25) compared to English curriculum students. Regarding future plans, students planning to go to a non-Arab country had higher odds of preferring French compared to those planning to stay in their country (AOR = 2.84; 95% CI = 1.41, 5.76) (Table 7).

Discussion

This study examined preferences regarding the language of education and attitudes toward the Arabization of the medical curriculum in a sample of Arab medical students across four Arab regions, representing Arabic-, English-, and French-based curricula. Our findings revealed that curriculum language preferences are associated with students’ current curriculum language, and vary by sex, residence, academic year, and career aspirations. Participants were most supportive of Arabizing patient-facing subjects (eg, ethics, communication skills, medical law). The primary perceived benefits of Arabization were improved communication with patients and healthcare teams, alongside better understanding of medical concepts. Conversely, the main perceived disadvantages were making preparation for international medical exams more difficult and hindering direct access to medical advances and learning resources. Collectively, these findings provide evidence that may aid in informing language policy decisions in Arab medical education.

Regarding preferred curriculum language, a general pattern emerged across regions, as students tended to prefer the language in which they were already studying, with the distinct exception of French-medium students. The high level of support for Arabic as the primary language of the curriculum among Arabic-medium students in our study is consistent with findings from two previous studies of Arabic-medium medical students, in which approximately two-thirds preferred Arabic as the primary language of instruction.^1,2 Among students studying in English, the 25.3% preference for Arabic in our study is comparable to the 19.5% reported in an earlier Egyptian study,¹³ higher than the 16.6% observed in Libya²⁶ and the 15% in Saudi Arabia,⁸ and substantially higher than the 4% reported in Bahrain.³⁵ Notably, among French-medium students, Arabic was the most preferred language of instruction (43.5%), surpassing French. This strong inclination toward Arabization aligns with previous studies in Algeria reporting a low preference for French in university settings.^36,37 Ultimately, this reflects a broader trend among Francophone Arab countries reconsidering their linguistic policies in higher education, characterized by a shift away from French.²⁸

Notably, in our study, the preference for curriculum language did not necessarily align with the preferred language of teaching and explanation. Among students who preferred English as their curriculum language, nearly half preferred Arabic for teaching, while the vast majority of those preferring Arabic and French curricula preferred the same language for teaching. This dissociation between curriculum and teaching language preferences is consistent with the well-documented practice in non-native-medium educational settings, where instructors commonly use the local language for conceptual clarification alongside the formal language of instruction.^6,13 One explanation is that learning complex medical content through a non-native language may impose additional cognitive demands, which could potentially be partially alleviated through explanation in the mother tongue.^3,4 Supporting this, 96.2% of Syrian students—whose curriculum is already Arabized—preferred Arabic for instruction, demonstrating near-complete alignment between curriculum and teaching language when both rely on the native tongue.

In our study, male students were significantly more likely to prefer an Arabic curriculum, consistent with reports from Egypt,¹³ Jordan,³⁸ and Palestine,³⁹ which may reflect unmeasured sociocultural or educational factors and should be interpreted cautiously. Additionally, we found that rural students were significantly more likely than urban students to prefer Arabic as the primary curriculum language. This is consistent with a study among medical students in Jordan, which found that students living in suburban areas had significantly more positive attitudes toward Arabicized medical terms compared to urban students.³⁸ This may reflect rural students’ greater exposure to patients from lower socioeconomic backgrounds with limited English proficiency, making Arabic a more practically relevant medium of instruction for both their anticipated clinical environment and their everyday clinical interactions. Notably, improved patient communication was the most commonly perceived advantage of Arabization (66.0%) and communication skills were the second most preferred subject to be Arabized (35.0%), lending further support to this interpretation.

We also observed that higher academic years were associated with increased odds of preferring English over Arabic. This shift may reflect the cumulative effect of years of exposure to English-language medical resources that progressively familiarize students with English-medium medical education. It is also possible that students who strongly prefer Arabic face greater challenges in English-dominant systems and may be less represented in advanced years due to survival bias. This aligns with previous studies in the Arab world, where English tends to be perceived as a barrier primarily in the early years of medical training,^13,40 though our cross-sectional design cannot confirm this. Additionally, students intending to practice outside the Arab world had significantly higher odds of preferring English or French over Arabic compared to those planning to remain in their home countries. This suggests an inverse association between international career aspirations and preference for Arabic, aligning with evidence from studies among Arab medical students that favor English due to its perceived utility in passing international examinations and accessing global career opportunities.^35,39

The main perceived advantages of Arabization in our study included improved communication with patients and healthcare teams (66.0%), better understanding and retention of concepts (56.4%), and reduced cognitive load of studying (48.7%). Similar patterns have been reported elsewhere: students in Bahrain³⁵ and Morocco⁴¹ noted that Arabic terminology facilitates patient communication, while students in Sri Lanka¹⁶ and Saudi Arabia⁸ reported enhanced comprehension when learning in their native language. Conversely, the principal perceived disadvantages centered on difficulty preparing for international medical examinations (65.6%) and reduced opportunities for working or specializing abroad (51.6%), mirroring concerns documented among students in Jordan,³⁸ Libya,²⁶ Palestine,³⁹ and Saudi Arabia,⁸ where English-medium instruction is regarded as essential for facilitating international licensure and postgraduate mobility.

Given the heterogeneous perceptions and non-uniform preferences regarding Arabization, a rigid monolingual transition may not be universally desired. Instead, our findings suggest that initial implementation could prioritize patient-facing disciplines—such as communication skills, medical ethics, and history-taking—in Arabic, while preserving English for the basic sciences. Importantly, such models have proven successful within the region. One study found that integrating Arabic explanations with English terminology significantly enhanced students’ scientific comprehension,² and another found that bi-nomenclature pedagogy yielded superior academic performance and knowledge retention.¹ Nevertheless, because language preferences vary significantly across sociodemographic lines and career aspirations, institutional stakeholders conducting situational analyses must utilize representative sampling to accurately capture the diverse needs of their student bodies before enacting curricular changes.

The recommendation against a monolingual transition is further reinforced by the students’ concerns about Arabization, including the challenge of keeping the curriculum aligned with global medical advances (51.2%), limited faculty expertise for Arabic instruction (49.9%), and the scarcity of Arabic medical terminology and learning resources (49%). This is highly consistent with recent data from Jordan, where the unavailability of medical references in Arabic was identified as a primary barrier to Arabicization.³⁸ Similar concerns were also reported by decision-makers in Saudi Arabia, who noted that translating the massive, continuously evolving volume of medical literature requires immense institutional resources and specialized faculty.⁷ Together, these findings suggest that a shift to Arabic-medium instruction may be associated with substantial challenges and should therefore be approached cautiously, with careful consideration of the resources, infrastructure, and academic support required to ensure educational quality and continued access to global medical knowledge.

Limitations

Several limitations should be considered when interpreting the findings of this study. The cross-sectional design precludes establishing causal relationships between sociodemographic factors and language preferences. Additionally, the reliance on a self-administered online questionnaire disseminated via convenience sampling may have introduced selection bias, potentially overrepresenting students who are more digitally engaged or those with a pre-existing interest in the Arabization of medicine, thus limiting the generalizability of the results. Furthermore, the study did not assess several factors that may influence language preferences, such as language proficiency, educational experiences, and other individual-level determinants. Finally, some regression estimates were associated with wide confidence intervals and should therefore be interpreted with caution.

Conclusion

The Arab medical students in this study exhibited conditional, subject-specific support for Arabization. They generally favored Arabic for patient-facing subjects (eg, communication and ethics) while preferring English for basic sciences, reflecting a perceived balance between local clinical practice and international career opportunities. Preference for an Arabic curriculum is significantly associated with male sex, rural residence, earlier academic years, Arabic pre-university education, currently studying in an Arabic curriculum, and intentions to pursue a local career. These findings highlight the complexity of language policy in Arab medical education and underscore the importance of considering students’ backgrounds, career aspirations, and subject-specific preferences when evaluating future Arabization initiatives and broader language-of-instruction policies in medical education.