Motivation of Chinese Medical Students in Learning English as a Second Language: A Quantitative Study ()
1. Introduction
The English language has long served as a lingua franca for international communication, particularly in fields such as business and education. Recognizing the significance of English proficiency in an era of internationalization, the Chinese government has emphasized the importance of English education as a means to broaden students’ international vision and to enhance their cross-cultural communication skills. Consequently, learning English as a second language has become a fundamental pillar of Chinese primary, secondary, and tertiary education systems. In recent decades, English education in China has undergone numerous reforms to meet students’ growing demand for language skills necessary to thrive in this globalized world.
The need for high levels of English proficiency is particularly pronounced among medical students in the Chinese context. Previous studies have indicated that medical students must possess adequate English proficiency to navigate scientific journals, to stay updated with global medical advancements, and to publish their own empirical work in prestigious journals indexed by the Science Citation Index (SCI) (Li & Heron, 2021; Deng et al., 2022) . Moreover, English proficiency has gained significant weight in the selection process for graduate school admissions in China, evident through the inclusion of an English testing segment in graduate school application procedures, such as the Postgraduate Admission Test and graduate school interviews. As a result, English education has become mandatory in most Chinese medical schools, with courses such as Medical English, general College English, and supplemental English courses like English Listening or English Writing integrated into the curriculum.
Despite past research shedding light on medical students’ perception of English language learning, there has been limited focus on identifying the specific English language needs of medical students within the Chinese context. Why motivates them to study English? What are their expectations from university-level English courses? In what area do they need assistance? Answering these questions is crucial for adapting the current English education curriculum in China, yet they remain unanswered. Therefore, this research aims to investigate the motivations of Chinese medical students for studying English as a second language, addressing this critical gap in the literature.
2. Literature Review
2.1. English Learning Environment in Chinese Universities
When investigating English language education in Chinese universities, the presence of CET-4/6 cannot be overlooked. CET-4/6 is standardized national English tests that have been held twice a year since 1987 for non-English major students from all institutions of higher learning in China. In the past, passing of CET-4/6 was a compulsory graduation requirement for most Chinese universities.
Since the introduction of the CET exams, their impact on improving university-level English education, textbook quality, and students’ English proficiency has been widely acknowledged. For instance, over a 15-year period, the average raw score in the writing category for students from key universities has gone up by 3 points on a 15-point scale (Ma, 2014) . Furthermore, Li’s (2021) empirical study suggested that CET test preparation could enhance students’ general reading and translation strategies.
While the positive contributions of standardized English exams cannot be denied, it is essential to recognize their drawbacks as well. The passing rate of standardized English tests like the CET-4/6 is regarded as a crucial index in evaluating the teaching quality of Chinese universities. Consequently, the English learning environment in Chinese higher education emphasizes the achievement of passing scores in standardized English language examinations, including the Postgraduate Admission Test and CET-4/6. As a result, the College English curriculum primarily focuses on developing students’ test-taking skills particularly in reading and writing, as these two areas are heavily assessed in the CET exams and other standardized English language tests. Although some schools have since detached the passing of CET-4/6 from obtaining a Bachelor’s degree, Chen et al. (2020) argued that students’ motivation for learning English remained unchanged due to the importance placed on CET-4/6 scores in the job market.
Consequently, a major issue in English education in China is the lack of communicative English proficiency among Chinese students (Xing & Turner, 2020; Zhao, 2023) . This is a result of the CET-4/6-centered English education system. Although CET-4/6 is no longer graduation requirements, English syllabi and curricula in Chinese universities have remained unchanged (Chen et al., 2020) . This situation has perpetuated the use of previous exam-centered teaching approaches in the classroom, which primarily focus on providing strategies for improving test-taking skills.
In recent years, efforts have been made to address the limitations of a test-centered English curriculum in China. Some universities have adopted Communicative Language Teaching strategies to create opportunities for students to engage in real-world activities. Empirical studies have highlighted that methods such as flipped classrooms and role play can improve students’ English speaking and listening abilities (Phoeun & Sengsri, 2021; Riniati, 2020) . By incorporating more student-centered approaches in English classrooms, Chinese universities might be able to equip students with effective communication skills in English beyond the scope of standardized English language exams.
2.2. English Education in Chinese Medical Schools
English education for medical students and their motivation for studying English have been the subject of numerous research studies worldwide. When assessing students’ motivation for second language learning, the concept of integrative and instrumental motivation, proposed by Gardner and Lambert (1972) , cannot be neglected. Integrative learners are those willing to identify with the communities behind a language, while instrumental motivation refers to the tendency to focus on the practical value of language learning.
The integrative and instrumental motivation framework is often adopted by researchers. In a study conducted by Mathis et al. (2022) , quantitative and qualitative methods were used to investigate the motivation of second-year Japanese medical university students for learning English. Mathis et al.’s research findings reported that students’ motivation for studying English was primarily instrumental, driven by the desire to perform adequate research in English and by the possibility of working with foreigners in Japan. The qualitative survey analysis also revealed that Japanese medical students exhibited high levels of openness toward internationalization and international space in general, as evident from their selection of “communicate with foreigners” as the highest-ranked motivational statement. Similar findings have been reported by others, including Ugla (2021) , who found that a majority of Iraqi university students in medicine-related majors were instrumentally motivated learners.
The professional medical environment is one of the key factors driving medical students’ desire to improve their English abilities. A study conducted in Saudi Arabia by Banafi (2023) , focusing on nursing students’ motivation for studying Communicative English and Medical English, found that 79.7% of the participants recognized the challenges associated with using English in the medical field. This indicates that students experience stress when they need to utilize English in a professional medical environment. The limited proficiency in English can lead to adverse consequences, as highlighted by Al Shamsi et al. (2020) , since it might result in miscommunication between healthcare providers and patients.
English education in Chinese medical schools has also gained momentum in recent years, particularly in line with President Xi Jinping’s call for producing leading talents in science and technology (Xi, 2017) . Xi’s words are particularly applicable to Chinese medical students, as they have emerged as key contributors to cutting-edge research in international conferences, seminars, and journals. Many graduate medical schools in China have even made the publication of Science Citation Index (SCI) papers a graduation requirement, which not only necessitates innovative ideas but also cohesive English language abilities (Wang, 2023) . Consequently, English education has become a strong emphasis across almost all medical schools in China.
Of particular interest to Chinese researchers has been whether English for General Academic Purposes (EGAP) or English for Specific Purposes (ESP) is more suitable for medical students. The structure of English education varies across different Chinese medical schools with two main types of English courses identified: Those focusing on non-scientific general English and those focusing on scientific or medical terminology. While the former provides a cultural learning experience that cultivates medical students’ general English abilities in listening, speaking, reading, and writing, the latter concentrates on areas such as reading research papers in English and presenting English-medium research findings in international seminars or journals.
Several researchers have argued in favor of replacing EGAP with ESP. In Li and Heron’s (2021) study, first- and third-year medical students from a Chinese university claimed that EGAP only catered to mediocre students and could not meet the needs of more advanced students such as those who already obtained adequate scores in IELTS. Some participants even viewed EGAP as an impediment to their English learning. These findings align with previous studies that have observed a shift from EGAP to ESP to better satisfy students’ needs for professional English proficiency in their chosen specialization (Dou et al., 2023; Gaikwad, 2016) .
Despite existing studies on English education in Chinese medical schools and teaching methodologies, research focusing on Chinese medical students’ motivation for learning English is scarce. Gaining a better understanding of why Chinese medical students are motivated to study English is essential not only for university instructors but also for students themselves in order to enhance their English proficiency. Therefore, this research adopts a quantitative method to investigate Chinese medical students currently enrolled in undergraduate-level English courses. Two research questions have been proposed: (1) What are the motivations of Chinese medical students for studying English? (2) In which specific areas of the English language are Chinese medical students motivated to improve?
3. Research Methodology
3.1. Participants
The study was conducted during the 2022-2023 academic year at a university in China. Participants comprised 145 first- and second-year undergraduate medical students (aged between 17 and 21; 27.6% male) majoring in nine medicine-related specializations. Although male participants were underrepresented, the female-to-male ratio in this study closely resembled the general ratio of 2:1 commonly observed in many Chinese medical schools (Liao et al., 2022) . These students represented 10 provinces in China, and all of them were of Chinese ethnicity who studied English as a second language. It is important to note that no English proficiency test was administered at the beginning of their undergraduate studies. As a result, all students, regardless of their English proficiency levels, were placed into the same English course. The assumption made in this study was that participants’ English abilities followed a normal distribution, which was later verified by their final exam results at the end of the first semester.
3.2. Data Collection
Prior to the distribution of the questionnaire, semi-structured interviews were conducted with 10 first- and second-year medical students to identify important factors to be included in the questionnaire. Taking into account their interview responses, a structured questionnaire written in Chinese was designed to ensure accurate understanding and was distributed to 145 participants. All 145 completed questionnaires were returned without any missing data, resulting in a usable questionnaire rate of 100%.
The questionnaire consisted of four parts: students’ demographic information (4 items), self-perceived English proficiency level (8 items), students’ motivation for learning English (10 items), preference for teaching methods (6 items), and an open-ended section for comments and matters not covered. Except for demographic questions (multiple-choice) and the open-ended section, the Likert scale was employed for other items, ranging from 1 (Strongly Disagree/Very Poor) to 5 (Strongly Agree/Excellent). Mean values and standard deviations were computed for the Likert scale items.
4. Results and Discussion
4.1. Motivation for Studying English
To answer the research question “What are Chinese medical students’ motivations for studying English?,” participants completed 10 motivation-related items. Table 1 presents these items along with their mean scores and standard deviations.
Based on the data collected from the questionnaire, the highest motivation for learning English as a second language among Chinese medical students was to achieve satisfactory scores on standardized tests, with a mean score of 4.26 (SD = 0.62). Additionally, passing the school’s graduation requirements was a significant motivation, as indicated by a mean score of 4.17 (SD = 0.61). These findings align with previous research, which emphasized the focus on passing standardized
![]()
Table 1. Motivation items and scores.
tests and meeting graduation requirements in the current English education system of Chinese universities (Chen et al., 2020) . Study participants also expressed high motivation for studying English for research purposes with a mean score of 4.12 (SD = 0.54), which is consistent with the research findings of Wang (2023) , who highlighted the importance of adequate English proficiency for engaging in scientific research activities and producing high-quality research. In the context of discussing students’ motivation for studying English, it is essential to highlight the presence of instrumental motivation among Chinese medical students. The top three motivations selected by students reflect their desire to learn English as a means to achieve practical goals or outcomes such as academic pursuits and professional advancements.
Conversely, motivations associated with communicative English skills such as listening and speaking ranked low on the scale, indicating a potential lack of integrative motivation among Chinese medical students. The low rankings of motivations related to listening and speaking skills suggest that students may not perceive English as a means of facilitating interpersonal communication or cross-cultural communication. This can be attributed to the predominant focus on grammar, vocabulary, and translation in Chinese classrooms, where English is often treated as knowledge rather than a skill (Wright & Zheng, 2016) . As a result, the development of communicative abilities, including listening and speaking, may receive inadequate attention and, therefore, impact students’ integrative motivation and their ability to engage in real-world English scenarios.
4.2. Self-Perceived English Proficiency Level
To address the research question “Which specific area in the English language are participants motivated to improve?,” the study adopted the framework designed by Huang et al. (2022) to examine students’ challenges with eight language areas: listening, writing, speaking, reading, grammar, culture, pronunciation, and vocabulary. The mean scores and standard deviations for these items are presented in Table 2.
![]()
Table 2. Students’ self-perceived English language proficiency.
Overall, research participants demonstrated a lack of confidence in their English language proficiency, with few perceiving themselves as proficient in all eight areas. Among the areas assessed, listening received the lowest mean score of only 2.18 (SD = 0.83), indicating a significant challenge for students. This finding aligns with previous empirical studies that identified listening as a particular difficult skill for language learners.
Several factors could have contributed to the lower self-perceived listening proficiency among research participants. One major factor would be the lack of exposure to an authentic English environment. Research studies, such as the one by Huang et al. (2022) , have highlighted that limited opportunities to engage in meaningful English interactions or access authentic listening materials could hinder students’ development of listening skills. Additionally, insufficient listening vocabulary and unfamiliarity with English pronunciation systems and word forms could further contribute to the challenges faced by students in listening comprehension (Zhu, 2021) .
The results align with existing research that emphasizes the need to target specific areas of weakness. By integrating instruction that incorporates activities and tasks focusing on listening, educators could provide tailored interventions to help students develop their listening skills and improve their overall English proficiency. Such interventions could include listening exercises with different accents, interactive discussions, and vocabulary training to enhance students’ ability to understand English in real-life situations.
4.3. Preferred Teaching Methods
Table 3 offers insights into students’ preferences for teaching methods used in university-level English classes, which align with the research questions regarding the motivations of Chinese medical students for studying English and their areas of motivation for improvement. Among the six items presented, multimedia resources obtained the highest mean score of 4.58 (SD = 0.53), indicating students’ strong desire to incorporate mixed media resources such as movies and songs into English education. This preference corresponds with their motivation to enhance their listening and speaking skills, as multimedia resources provide opportunities for exposure to authentic language use and practice in an engaging
![]()
Table 3. Preferred teaching methods for learning English.
manner. The use of multimedia resources in second language learning has long been recognized as beneficial. These resources encompass components such as text, sound, video, and graphics, which provide eye-catching content that connects language learning with daily life. Existing research has highlighted the positive impact of visual and auditory materials on students’ learning motivation, pronunciation, vocabulary, grammar, and fluency (Mahdi, 2022) . By favoring multimedia resources, students demonstrate their motivation to improve these specific areas of the English language.
Additionally, the preference for language learning games, which closely followed multimedia resources with a mean score of 4.32 (SD = 0.63), indicates that students are motivated to enhance their overall language proficiency and their ability to use English in communicative contexts. Language learning games provide fun and interactive learning environments that allow for practice in various language skills. These games can be either digital or non-digital, with popular examples including bingo, scrabble, Pictionary, matching, and hangman. Through participation in language learning games, students not only develop a willingness to communicate in the target language but also foster social skills through interactions with classmates (Liu et al., 2021) . Additionally, game elements such as points, badges, and teammates fulfill players’ psychological needs for competence and autonomy, exerting positive effects on students’ engagement and learning outcomes (Sailer et al., 2017) . Students’ inclination towards language learning games can reflect their motivation to develop proficiency across these areas and their desire for interactive learning experiences.
Understanding students’ preferred teaching methods, including multimedia resources and language learning games, offer valuable insights into how educators can promote students’ motivation in learning English. By incorporating teaching methods that resonate with Chinese medical students, educators can create an engaging and effective learning environment that contributes to increased satisfaction, participation, and better learning outcomes.
5. Conclusion
The research findings established in this study make a valuable contribution to the limited literature on the motivation of Chinese medical students to learn English. However, it is important to acknowledge the limitations of this study. First, the single-institution sample pool was relatively small, and, in particular, there was an imbalance in the ratio of male to female participants. While efforts were made to include a diverse range of participants, including both genders, the observed skew towards female participants may introduce a potential bias in the study’s findings. To address this limitation and enhance the generalizability of the findings, future studies should consider a larger consisting of students of both genders from more diverse demographic backgrounds, thereby improving the validity and reliability of the research.
Second, this study employed a quantitative research method, relying on a 5-point scale to gather numerical responses. To gain a more comprehensive understanding of students’ motivation for learning English, it is recommended that future studies on relevant topics should incorporate both quantitative and qualitative measures when possible. By integrating qualitative approaches, researchers can elicit rich narratives and deeper insights into the experiences, beliefs, and aspirations of Chinese medical students regarding English language learning. This combined approach can offer a more holistic exploration of motivational factors.
Third, this study relied on a single source of information, neglecting opinions from instructors and other stakeholders. Including multiple sources of information would provide a more comprehensive view of the motivations and experiences of Chinese medical students in English classrooms. Future research should aim to include input from instructors, administrators, and other relevant stakeholders to gain a well-rounded understanding of the subject. Conducting interviews or surveys with these stakeholders can provide valuable insights into the strategies, challenges, and perspectives related to English language instruction in medical education.
Given the above-mentioned limitations, the findings of this research should be interpreted with caution. However, they also present several fruitful directions for future research and pose implications for Chinese educators, policymakers, and other stakeholders working with medical students. For example, faculty and staff from Chinese institutions of higher learning should investigate medical students’ motivation for learning English and consider these motivations when designing university-level English curricula tailored to the needs of medical students. Results of this study indicate that most students are primarily instrumentally motivated and may respond well to teaching methods that facilitate the acquisition of practical English skills. Additionally, identifying the specific areas in which students lack proficiency and integrating their preferred teaching methods into English classrooms can greatly benefit Chinese medical students. By addressing these implications, Chinese educators can enhance the effectiveness of English language instruction for medical students and ensure that they acquire the necessary language proficiency for their academic and professional careers.