English-medium instruction in Thai medical education: teachers’ readiness, pedagogical practices and student experiences

As English-medium instruction (EMI) expands in medical education, its impact on teaching practice remains insufficiently understood, particularly in non-Anglophone contexts. This study examines how EMI is enacted in Thai medical education through a mixed-methods design combining survey data from 65 medical teachers with qualitative insights from teachers and students. Despite moderate to high reported readiness, EMI is experienced less as a language issue than as a constraint on pedagogy, limiting explanation, interaction and student engagement. Teachers reported increased cognitive and emotional labour, while students experienced uneven access to learning due to tensions between English-only policies and Thai-dominant clinical practice. Translanguaging emerged as an informal but necessary strategy to manage these challenges. The paper argues that EMI should be understood as a form of constrained pedagogy rather than a technical language shift. It contributes to teaching in higher education by showing how readiness, pedagogy and institutional context interact to shape learning.