Language choice in Saudi medical education: stakeholder perspectives on avoiding Arabic as the medium of instruction

Introduction English-medium instruction remains dominant in Saudi medical education despite growing recognition that Arabic, the official language, can support comprehension, participation, and clinical communication. This qualitative study examined why Arabic continues to be avoided as a medium of instruction in Saudi medical schools and what this reveals about language-of-instruction policy in higher education. Methods Drawing on 71 semi-structured interviews with students, educators, administrators, residents, and physicians across three Saudi medical schools, the study employed hybrid inductive–deductive thematic analysis to identify the institutional and pedagogical factors shaping language choice. Results Four interconnected factors emerged: the limited availability of Arabic medical resources, terminological instability, the perceived indispensability of English for access to scientific knowledge and professional mobility, and learners' cognitive adaptation to English-medium instruction (EMI). Three potential pathways for reform were also identified: immediate bilingual support, transitional hybrid instruction, and the longer-term development of Arabic-medium instruction (AMI) supported by translation and terminology-development initiatives. Discussion The findings suggest that the avoidance of AMI is driven primarily by practical constraints, professional demands, and long-term adaptation to EMI, rather than by opposition to Arabic itself.