Language barriers and MCQ duration for non-native English students
Submitted: 23 September 2025
Accepted: 20 November 2025
Published online: 7 April, TAPS 2026, 11(2), 127-128
https://doi.org/10.29060/TAPS.2026-11-2/LE3891
Nghia Phu Nguyen1,2 & Phillip Tran1,3
1College of Health Sciences, Nam Can Tho University, Vietnam; 2Cardiovascular Research Laboratories, Methodist Hospital, Merrillville, Indiana, United States of America; 3Yavapai Regional Medical Centre, Prescott, Arizona, United States of America
Dear Editor,
The recent article by Kreepala et al. provides valuable insights into factors influencing the duration of answering multiple-choice questions (MCQs) in medical examinations (Kreepala et al., 2025). The authors identified word count, question difficulty, language, visual aids, and exam environment as important determinants of test-taking time (Kreepala et al., 2025). These findings resonate strongly with our experiences from medical education in Vietnam, where English has increasingly become the medium of instruction.
In our setting, both Vietnamese and international medical students are non-native English speakers. While they possess adequate medical knowledge, the language of the examination itself often represents a substantial barrier. This is particularly evident in anatomy courses that integrate clinical applications and imaging, where examination items are frequently written as long case-based scenarios. Such stems in English, especially when containing complex syntax or uncommon terminology, consume disproportionate time for comprehension before reasoning can be applied. As a result, even well-prepared students may spend excessive time reading rather than problem solving, frequently resorting to guessing when exam time runs short. Such observations reinforce the conclusion of Kreepala et al. (2025) that language is a major determinant of MCQ duration.
The broader significance of this issue is supported by a recent systematic review synthesizing evidence from 49 studies with over 14,500 students worldwide (Hamad et al., 2025). The review demonstrated that using a foreign language as the primary medium of medical education impedes comprehension of textbooks, lectures, and assessments, leading to poorer outcomes, increased stress, and higher dropout rates (Hamad et al., 2025). It further noted that language barriers can hinder communication with patients in the native language, thereby compromising the quality of care (Hamad et al., 2025). These findings emphasize that language challenges affect not only examination performance but also long-term educational and professional competencies.
Given this evidence, exam designers and curriculum planners in non-native English contexts should carefully consider the linguistic load of MCQ assessments. Simplifying question wording, avoiding unnecessary complexity, and providing glossaries of key terms may help ensure that MCQs measure medical competence rather than English proficiency.
This study highlights an often overlooked aspect of assessment design. Further research in Vietnam and similar settings could compare student performance and timing across English and native-language versions of the same test to quantify this effect more precisely.
Notes on Contributors
Phu Nghia Nguyen conceptualised and drafted the letter, and approved the final version for submission.
Phillip Tran contributed to critical revision of the letter for clarity and intellectual content, and approved the final version for submission.
Funding
This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Declaration of Interest
The authors have no conflicts of interest to disclose.
References
Hamad, A. A., Mustaffa, D. B., Alnajjar, A. Z., Amro, R., Deameh, M. G., Amin, B., & Alkhawaldeh, I. M. (2025). Decolonizing medical education: A systematic review of educational language barriers in countries using foreign languages for instruction. BMC Medical Education, 25(1), 701. https://doi.org/10.1186/s12909-025-07251-2
Kreepala, C., Thongsombat, S., Wattanavaekin, K., Danjittrong, T., Keeratibharat, N., & Juntararuangtong, T. (2025). Understanding the factors affecting duration in answering MCQ examination: The students’ perspective. The Asia Pacific Scholar, 10(2), 57–64. https://doi.org/10.29060/TAPS.2025-10-2/OA3332
*Nghia Phu Nguyen, M. D.
College of Health Sciences,
Nam Can Tho University,
168 Nguyen Van Cu Street,
An Binh Ward, Can Tho City, Vietnam
Email: npnghia@nctu.edu.vn
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