{"id":73254,"date":"2026-04-07T08:00:56","date_gmt":"2026-04-07T00:00:56","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=73254"},"modified":"2026-04-07T08:24:04","modified_gmt":"2026-04-07T00:24:04","slug":"language-barriers-and-mcq-duration-for-non-native-english-students","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/","title":{"rendered":"Language barriers and MCQ duration for non-native English students"},"content":{"rendered":"<p>Submitted: 23 September 2025<br \/>\r\nAccepted: 20 November 2025<br \/>\r\nPublished online: 7 April, TAPS 2026, 11(2), 127-128<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2026-11-2\/LE3891\">https:\/\/doi.org\/10.29060\/TAPS.2026-11-2\/LE3891<\/a><\/p>\r\n<p><span lang=\"EN-GB\">Nghia Phu Nguyen<\/span><sup><span lang=\"EN-GB\">1,2<\/span><\/sup><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">&amp; Phillip Tran<sup>1,3<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">College of Health Sciences, Nam Can Tho University, Vietnam; <sup>2<\/sup>Cardiovascular Research Laboratories, Methodist Hospital, Merrillville, Indiana, United States of America; <sup>3<\/sup>Yavapai Regional Medical Centre, Prescott, Arizona, United States of America<\/span><\/i><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p>Dear Editor,<\/p>\r\n<p style=\"text-align: justify;\">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.<\/p>\r\n<p style=\"text-align: justify;\">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.<\/p>\r\n<p style=\"text-align: justify;\">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.<\/p>\r\n<p style=\"text-align: justify;\">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.<\/p>\r\n<p style=\"text-align: justify;\">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.<\/p>\r\n<p style=\"text-align: center;\"><strong>Notes on Contributors<\/strong><\/p>\r\n<p style=\"text-align: justify;\">Phu Nghia Nguyen conceptualised and drafted the letter, and approved the final version for submission.<\/p>\r\n<p style=\"text-align: justify;\">Phillip Tran contributed to critical revision of the letter for clarity and intellectual content, and approved the final version for submission.<\/p>\r\n<p style=\"text-align: center;\"><strong>Funding<\/strong><\/p>\r\n<p style=\"text-align: justify;\">This work received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.<\/p>\r\n<p style=\"text-align: center;\"><strong>Declaration of Interest<\/strong><\/p>\r\n<p style=\"text-align: justify;\">The authors have no conflicts of interest to disclose.<\/p>\r\n<p style=\"text-align: center;\"><strong>References<\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Hamad, A. A., Mustaffa, D. B., Alnajjar, A. Z., Amro, R., Deameh, M. G., Amin, B., &amp; Alkhawaldeh, I. M. (2025). Decolonizing medical education: A systematic review of educational language barriers in countries using foreign languages for instruction. <i>BMC Medical Education, 25<\/i>(1), 701. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-025-07251-2\">https:\/\/doi.org\/10.1186\/s12909-025-07251-2<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Kreepala, C., Thongsombat, S., Wattanavaekin, K., Danjittrong, T., Keeratibharat, N., &amp; Juntararuangtong, T. (2025). Understanding the factors affecting duration in answering MCQ examination: The students\u2019 perspective. <i>The Asia Pacific Scholar, 10<\/i>(2), 57\u201364. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.29060\/TAPS.2025-10-2\/OA3332\">https:\/\/doi.org\/10.29060\/TAPS.2025-10-2\/OA3332<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p>*Nghia Phu Nguyen, M. D.<br \/>\r\nCollege of Health Sciences,<br \/>\r\nNam Can Tho University,<br \/>\r\n168 Nguyen Van Cu Street,<br \/>\r\nAn Binh Ward, Can Tho City, Vietnam<br \/>\r\nEmail: npnghia@nctu.edu.vn<\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":16,"template":"","issues_category":[19],"archive_category":[],"issue_type":[24],"volume_category":[],"class_list":["post-73254","issues","type-issues","status-publish","hentry","issues_category-letter-to-editor","issue_type-current-issue"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Language barriers and MCQ duration for non-native English students - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Language barriers and MCQ duration for non-native English students - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"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 &amp; 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, [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-07T00:24:04+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/\",\"name\":\"Language barriers and MCQ duration for non-native English students - The Asia Pacific Scholar\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\"},\"datePublished\":\"2026-04-07T00:00:56+00:00\",\"dateModified\":\"2026-04-07T00:24:04+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/taps\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Language barriers and MCQ duration for non-native English students\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/\",\"name\":\"The Asia Pacific Scholar\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Language barriers and MCQ duration for non-native English students - The Asia Pacific Scholar","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/","og_locale":"en_US","og_type":"article","og_title":"Language barriers and MCQ duration for non-native English students - The Asia Pacific Scholar","og_description":"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 &amp; 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, [&hellip;]","og_url":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/","og_site_name":"The Asia Pacific Scholar","article_modified_time":"2026-04-07T00:24:04+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/","url":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/","name":"Language barriers and MCQ duration for non-native English students - The Asia Pacific Scholar","isPartOf":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/#website"},"datePublished":"2026-04-07T00:00:56+00:00","dateModified":"2026-04-07T00:24:04+00:00","breadcrumb":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/language-barriers-and-mcq-duration-for-non-native-english-students\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/medicine.nus.edu.sg\/taps\/"},{"@type":"ListItem","position":2,"name":"Language barriers and MCQ duration for non-native English students"}]},{"@type":"WebSite","@id":"https:\/\/medicine.nus.edu.sg\/taps\/#website","url":"https:\/\/medicine.nus.edu.sg\/taps\/","name":"The Asia Pacific Scholar","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues\/73254","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues"}],"about":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/types\/issues"}],"wp:attachment":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/media?parent=73254"}],"wp:term":[{"taxonomy":"issues_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues_category?post=73254"},{"taxonomy":"archive_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/archive_category?post=73254"},{"taxonomy":"issue_type","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issue_type?post=73254"},{"taxonomy":"volume_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/volume_category?post=73254"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}