Metacognitive mismatch in medical ESP: Exploring the recognition–production gap

This study examines the recognition–production gap (metacognitive mismatch) in Medical English for Specific Purposes (ESP) among 214 second-year medical students. Using paired receptive (definition matching) and productive (sentence writing) tasks for 10 medical terms, results show near-ceiling receptive knowledge (97.38%) but significantly lower productive performance (~79%), yielding a gap of approximately 17.7–18.6 percentage points. Error analysis indicates that most production failures are near-misses (morphosyntactic and collocational errors) rather than lack of semantic knowledge. The findings highlight the limitations of recognition-based assessment and the need for production-focused instruction in medical ESP. This study serves as the empirical foundation for the development of MedLex, a diagnostic and pedagogical framework targeting productive vocabulary use in medical English. Originally presented at the Second National Scientific Conference with International Participation “Language and Science” (27–28 September 2025), Medical University of Plovdiv, Department of Language and Specialized Training (Втора национална научна конференция с международно участие „Език и наука“). Notes:This record is intended to provide a citable pre-publication version of the study. A peer-reviewed version is forthcoming.