English has a leading role as the international language of science, the majority of medical textbooks and publications are written in English. The use of English as the medium of medical education is adopted by many non-English speaking countries. Medical students and practitioners need to learn English to follow up the development of science and enhance communication with other colleagues worldwide. Additionally, mastering writing and speaking skills in the English language will influence the socio-economic status of physicians [19].
However, the “Language bias” is a phenomenon reported as a result of the tendency to publish important findings in English language journals [20]. Non-English articles are neither cited nor accessed as much as articles written in English [5], non-English-speaking physicians could face a barrier when practicing Evidence-based Health Care (EBHC) [7, 21]. Learning English is mandatory since the majority of physicians and researchers need to keep up with the latest scientific innovations and wish to deliver their work to the largest population possible.
Teaching medicine in mother tongue or in English has been discussed. The various difficulties for both students and teachers were noted [22], learning medical sciences in mother tongue was proposed to resolve the linguistic dualism and to facilitate communication with patients [23].
An Indian questionnaire results showed that importance of English as a medium of instruction equals the importance of regional/national language to enhance attending to patients [1]. In another study, Scandinavian physicians who read a review article in their mother tongue had the best comprehension and retention of medical information [8].
In Serbia, an investigation with a questionnaire was carried out among 312 Medical students, [19] the results showed that writing and speaking skills in the mother tongue and in English were associated with students’ satisfaction of their social and economic status, while their ability of verbal expression in the mother tongue was associated with achievements at the Faculty.
Proficiency in the English language can pose serious problems for discussion in Problem-based Learning tutorials, this problem required a novel approach allowing students to engage in discussions using the native language and English [24].
The Arabic language is one of the widely used languages in the world. It is one of the six official languages of the United Nations, and it is the official language of 25 countries in two continents (14). During the Middle Ages, textbooks in medical sciences were written in Arabic such as the works of the Persian Avicenna (Ibn Sina), the Damascene Ibn al-Nafis and the Andalusian Avenzoar (Ibn Zahr).
The Ottoman Empire occupied Arab countries for four centuries in which the dominant of Arabic as a language of science was retracted.
In the last two centuries, early experiments in teaching medical science using Arabic were performed. The first one was at the beginning of the nineteenth century during Muhammad 'Ali period in Egypt. Teaching in Abu Za’abal School of medicine and pharmacy was conducted in Arabic. This school was established in 1826 and transfer to al-Kaser al-Ini in Cairo in 1837. The Arabic language was used in teaching medical science until 1882 when the British entered Egypt replaced it with English. The second experience took place in Lebanon in 1866 at the Syrian Protestant College. This college taught medicine in Arabic. In 1873, the college moved to Beirut and was renamed the American University of Beirut (AUB) [12]. Medical staff mastered Arabic and made important contributions to Arabization. Teaching in Arabic did not last long, after the fall of the Ottoman Empire and the arrival of French to the region.
The third experience is still ongoing in Syria, where the Arabic College of Medicine opened in 1919 in Damascus. The experience of Damascus University in the field of teaching medical sciences in Arabic is a pilot experience [25]. Since the university’s inception until now, the language of instruction was Arabic.
In other Arabic countries, the colonizers’ languages replaced Arabic as the language of teaching. For example, French was used in Algeria, Tunisia, and Morocco [26], while English was used in Egypt, Iraq, and Golf countries [15, 17].
In a questionnaire study designed in Saudi Arabia, the advantage of using Arabic language in teaching Arab speaking students was summarized, the use of Arabic avoids communication barrier and thoughts ideas clearly in a non-mastered foreign language [15]. Teaching science subjects in English could increase the difficulty of the topics for the students and thus creates educational barriers. Additionally, Students will spend time to translate information into Arabic. In addition, they do not gain a deep understanding of science subjects because they tend to concentrate on memorizing English terms and their spelling and pronunciation. English and Arabic belong to different language families and have different structures, and this may create problems of comprehension for Arab students [3]. Instructors also felt that using English to teach science subjects for Arab students promotes the hegemony of English. As students may fail to appreciate their mother language. Students found it is easier to concentrate and to understand when they used Arabic rather than English. The student is likely to be stressed when mother-tongue language is not similar to the school education language and has difficulties to understand the subject completely to participate in discussions.
Simultaneously, it is difficult to find enough science resources in Arabic regarding the lack of Arabic translations of science textbooks. Lack of proficiency in English also creates a barrier for Arab science students when participating in international conferences or continuing studies overseas. English allows them to study and in due course work almost anywhere in the world [20].
In all Arab countries except Syria, English or French have been the medium of instruction universities. Some uncompleted efforts to Arabization were attempted in Sudan for teaching medical science [27]. A gap in clinical communication may develop in Arab countries where the native language is different from the language of medical education, and the confidence problem was posed in history-taking skills in native language [16]. Teaching medicine in a foreign language did not bring leadership for Arab medicine. Moreover, it could be an indicator of Arab underdevelopment [28].
In Morocco, the use of the mother tongue in teaching medicine was considered as an educational necessity [26], some efforts were made to introduce bilingual programs [2].
In a questionnaire survey of 400 medical students in Egypt [17], 44.8% of students translated English terms to Arabic to facilitate studying and 70.6% of students in their clinical study years would prefer learning to register patient history in Arabic.
Teaching medical sciences in the Arabic language did not handicap the Syrian students, as Damascus University medical school was ranked seventh regarding the number of actively licensed physicians in the United States (US), the rank contains ten universities all of which teach medical science in English [13]. Based on physician practice data, the contribution of Arab-trained physicians to the US healthcare workforce was explored [29], results of medical students and graduates from 15 Arab countries were revised. The performances (1st attempt pass rates) of individuals on the United States Medical Licensing Examination (USMLE) Step 1, Step 2CK (clinical knowledge), and a combination of Step 2CS (clinical skills) and ECFMG CSA (clinical skills assessment) were scaled and compared by country. This study had shown that Syrian students were in the fifth position in USMLE Step 1 attempt, with pass rate reach 85.98%, and in the first position regarding the approximate US workforce retention rate (73.6%), comparing with students from other Arab countries where English is the language of medical school instruction medical education.
Students fluent in the foreign language or the mother tongue should be able to be better in acquiring the scientific language [25].
The question is how to benefit from the advantage of teaching in mother language, and to provide the student with the English medical terms, which are necessary to follow the scientific development? The recommended system is bilingual. This system depends on the mother tongue as the main medium of instruction while an international second language is gradually introduced using the mother tongue, in which the proportion of bilingual terms should be about 30 %, because, when the proportion of English was raised to 50%, student’s satisfaction rates declined significantly [30, 31]. Another study also found that using a bilingual method in learning doesn’t harm the educational process and carries similar outcomes to those of the monolingual methods [32].
In Germany, bilingual approaches in dental terminology resources were discussed, a new semi-bilingual language guide was issued to help German-speaking dental professionals to develop their language skills [33].
One of the trials explored medical students' perceptions of supporting pharmacology learning in English by focused materials prepared in Arabic. The study was conducted in Bahrain, slides containing endocrine and metabolism information were presented in Arabic preceded detailed English ones. Most participants reported a better comprehension and memorization of the ensigned subject. Most respondents thought that this method would help them during the clinical phase of their study and in communicating drug therapy to patients in Arabic [34].
After a century of experience, the University of Damascus is the leading university in the field of teaching medical sciences in Arabic. It has also paid attention to empowering its students in the medical English language that students must pass four English courses and medical terms in curricula were demanded in both Arabic and English.
We have previously designed a study using one-step-interactive-experimental-online test to assess participants' scientific comprehension of three distinct medical written paragraphs; in Arabic, in English, and in bi-lingual, our previous results propose that simplified Arabic combined with English terminology may present a viable method for medical-educational written texts in Arabic-speaking population [18]. To the best of our knowledge, our current study is the first experimental trial study that evaluates the influence of three different pedagogic methods experimentally during students’ courses.
Use of the bi-lingual method presents a pedagogic method combining the advantage of mother language-based education and encourage students to enrich their information from English resources. In which the main context was presented in Arabic with the use of essential English terms beside medical Arabic terms.
Although, our study has limitations; the relatively small size of participants, the selection of only three topics and the fact that the curricula of Faculty are in Arabic. Our results indicate the importance of bi-lingual method in teaching medical science, further studies are demanded with larger number of participants from other countries to determine the best pedagogic method.