Beyond vocabulary: linguistic, cognitive, and affective barriers facing international medical students in Persian-medium medical education

Amidst globalising medical education, research on non-English medical language acquisition is limited. This qualitative study explored barriers for international medical students learning Medical Persian. Using a dual-phase design grounded in Interlanguage, Cognitive Load, and Sociocultural theories, we analysed reflective journals from 52 medical students (Urdu, Arabic, Hindi speakers) and conducted an expert focus group. Results revealed three primary challenges with L1-specific manifestations: lexical interference, including false cognates and vocabulary overload (92%); syntactic complexity, particularly Persian's SOV structure (79%); and affective barriers like pronunciation anxiety (75%). Students developed coping strategies such as trilingual glossaries and translanguaging. Expert analysis advocated for structured multilingual materials, explicit comparative grammar, and translanguaging-validating pedagogies. These findings demonstrate that effective support in non-English medical education must extend beyond vocabulary to address syntactic complexity and sociocultural identity through institutionalised multilingual resources and culturally responsive pedagogy, advancing a more nuanced understanding of this critical educational context.