Al-Ishlah: Jurnal Pendidikan Vol. 16, 1 (March, 2. , pp. ISSN: 2087-9490 EISSN: 2597-940X. DOI: 10. 35445/alishlah. StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Komilie Situmorang1. Santa Maya Pramusita2 Universitas Pelita Harapan. Banten. Indonesia. situmorang@uph. Universitas Pelita Harapan. Banten. Indonesia. pramusita@uph. ARTICLE INFO Keywords: EMI. Article history: Received 2023-06-12 Revised 2023-09-05 Accepted 2024-02-18 ABSTRACT Achieving international recognition has motivated the universities in Indonesia to shift to international programs. An unmistakable and notable initiative is the adoption of English as the Medium of Instruction (EMI), which has elicited both positive and negative This study investigates the obstacles and educational approaches of nursing students when utilising EMI. The study aims to examine students' perceived problems related to language and learning in an EMI context, as well as the techniques they use. The participants of this study are 176 Indonesian students majoring in Nursing. The participants were asked to fill in the survey questionnaires on the challenges they face and the strategies they use in EMI learning. The collected data were analysed using SPSS The major findings are that most students encountered a moderate level of language and learning challenges and sought L2 support strategies in coping with their language and learning challenges. There is less pressure on the studentsAo side as no native-speaker teacher is involved in establishing the EMI program. This study concludes that the students are ready for the EMI The study further suggests the potential of supporting the students through the concurrent support model by MacaroAos language support model. This is an open access article under the CC BY-NC-SA license. Corresponding Author: Komilie Situmorang Universitas Pelita Harapan. Banten. Indonesia. situmorang@uph. INTRODUCTION English medium Instruction (EMI) is the most notable and massively implemented initiative in the internationalization of higher education. It has garnered much attention and is believed to be the lynchpin that will produce a workforce that meets the global market and help catalyse (Macaro, 2. (Macaro, 2. defines EMI as Authe use of the English language to teach academic subjects . ther than English itsel. in countries or jurisdictions where the first language (L. of the majority of the population is not English. Ay It is a situation where people speak other first http://journal. id/index. php/alishlah Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 159 of 168 languages, yet English is used to teach basic and advanced content. Therefore, it is simply the mode of delivery of the subject and language proficiency is not the goal. In practice, however, along with this growing trend, conflict follows. As programs with EMI echo internationalization, people voluntarily pay for higher tuition as they believe it is an investment in future careers. A study by G. Hu et al. shows that students in the EMI program willingly pay higher tuition compared to those in the regular programs. Though the high-paying tuition revives the economic cash flow, the study further adds to the literature on how EMI contributes to the inequalities in society. Besides, there is a misconception that EMI will improve language proficiency. In fact. EMI is not responsible for teaching the language to students or the academicians using it. It is solely the media of delivering the material. Though exposed to big amount of English. EMI does not improve Rogier . finds that there is insignificant improvement in students' IELTS scores after four years of undergoing the EMI program. Similarly, students have expressed that understanding the content is more difficult compared to when using their first language due to the lack of English proficiency in both professors and students, even trouble navigating the material, resources, and textbooks as they are written in English (G. Hu & Lei, 2. There are expectations that are not well justified. The major problem has been centred on the fact that English is not the studentAos native tongue therefore the acquisition and teaching of the content in English has not been smoothly delivered. Teachers and students prefer EMI when their English are not Yet at the same time, they do not seek language support because they believe it is not necessary (G. Hu & Lei, 2. On the other side, 55 countries surveyed indicate that they are given little or no support for EMI-specific content (Macaro. Curle. Pun, & An, 2. (Macaro. Curle. Pun, & An, 2. Although linguistic barriers pervasively happen to those who adopt EMI, people continuously favour it. Research has indicated that EMI puts pressure on non-English speaking countries, creating an uneven global higher education market and a tendency to integrate into modern academic systems like those in Western institutions (Trice et al. , 2. In Asian countries, the driving factors of the trend toward EMI include the dominance of English in academics and publication, the desire to join the HEIs global league through the increase of international students, income from fee-paying international students, and graduates' competition in entering the global labour market competition (Luis & Moncayo, 2. In addition, the British Council . can be accessed by clicking or tapping Reports indicate that legislation for entry into EMI programmes lacks consistency, leading to implementation challenges in Asian countries. There is still uncertainty around the EMI implementation process, which essentially involves changing the language of instruction. Different studies have revealed different challenges faced by students in implementing EMI in different countries. The language challenges highlight most of the challenges where teachers and students struggle with limited language proficiency thus having unfamiliarity with the terms and content (Esther, 2021. Hu, 2022. Muttaqin & Chuang, 2022. Rabea et al. , 2018. Yang et al. , 2. the staffing (Goodman, 2. , language and content assessment (Kim, 2. , the language support (Kim. Pun & Jin, 2. , less interactive class (Yang et al. , 2. Additionally. Simbolon . highlights the irrelevant support provided to lecturers and students due to a limited understanding of EMI These studies are a few of hundreds which have highlighted the problems of implementing EMI. The statement "Should we stop EMI for the number or the complications it has caused?" is not a EMI is a rising trend that continues to thrive. It is an inexorable locomotive. It is preferable to ensure that the train stays on track and safely reaches its destination rather than attempting to impede its journey. (Macaro, no dat. The train is in motion. Tight . conducts a rigorous analysis of countries not in Europe. Asia. Africa, or Latin America, outlining the conflicting perceptions found in many countries. He proposes that variations in its execution should be embraced and promoted rather than anticipating uniform standards and procedures. Hence, the focus should not be on locating the stop button, but on facilitating EMI to unlock the full potential of teachers and pupils. Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 160 of 168 As a result, the research of EMI strategies has also been taking the spotlight in EMI research. The research of Macaro, n. has focused on the vocabulary used by teachers and students and how L1 can help EMI. Xiao & Qiu . look at cognitive, and meta-cognitive strategies used to solve problems related to reading and listening. Further. Farrell . suggests that reflective practice leads to EMI teachersAo professional development. The existence of EMI in Indonesia was initially seen in the implementation of the International Standard School or referred to as Rintisan Sekolah Berstandar International (RSBI) in early 2000. However, this has become a national conflict as it was suspected to create a gap and elitism in public school (Jusuf Ibrahim, 2. It was cancelled and also seen as a threat to the regular schools. However, not for long, private international schools flourish along with Higher Education ministerial announcing the bilingual use of Bahasa Indonesia and English, supporting the use of the Implementation EMI program. Today. EMI is expanding in IndonesiaAos HEIs and is provided at all levels of the education system (Luis & Moncayo, 2. and continues to be the key driver in keeping up with the internationalization (Galloway. Kruikow. , & Numajiri, 2. Meanwhile, as reported by the EF Proficiency Index Field (EF EFI, 2. English proficiency in Indonesia ranks 80 out of 112 countries surveyed, meaning Indonesia has low proficiency. Interestingly, the statistic shows a consistent decrease each year. This result poses a significant challenge to implementing EMI in Indonesian higher education. Despite the results, initiatives, policies, and strategies have been proposed by the Ministry of Higher Education as the stakeholders in Indonesia. They also have organised several pieces of training and research by joining hands with the British Council of Indonesia. The focus of these collaborations is to support EMI implementation effectively and achieve optimal education results (British Council, 2. In short. EMI implementation in Indonesia has been believed as the panacea to joining the international league. In its process, the research findings have varied, both positive and negative. (Oktaviani, 2. show that there are pros and cons to the using EMI teaching content as teachers are faced with quality, guidelines, resources, and studentsAo proficiency problem. Meanwhile, (Husarida & Dollete, 2. find that EMI was perceived to be highly effective in improving content and language Interestingly. Simbolon, . found that stakeholders perceived that language specialists should implement EMI. Limited research has been done to explore the nursing students' perceived challenges and strategies, which will serve this research's purpose. A Faculty of Nursing at a private university in Tangerang. Indonesia is looking forward to answering the HEIs internationalization call by the government. The universities are demanded to internationalise their curriculum and switch the teaching to EMI. Regardless of all the controversies that has been reiterated as the product of the EMI, university finds that EMI is the only way as the existence of the international program influences the university ranking. Therefore, it screened the nursing students with a higher English proficiency the international track and sent the lecturers to EMI curriculum training in preparation. In this study, the researchers seek to find the nursing students' perceived challenges and strategies through EMI implementation. In this context, the students are at the beginning of the EMI program. They are prepared to be put in EMI class by changing Bahasa Indonesia into English in the class. They have been learning for a year in Bahasa Indonesia, and 50 are to be screened to be put in the international program. This study, therefore will contribute to the gap that no study has been done in the areas on pre-implementation of EMI in the nursing context in Indonesia. As far as the research is concerned, no research on EMI implementation has investigated the nursing context in Indonesia, but more on language use, vocabulary, and English for specific purposes. The purpose of the research seeks to find out the level of perceived challenges and strategies by the nursing students in EMI implementation to better know how they could be supported from their current English proficiency level. This will help the lecturers to identify the students challenges and the strategies faced by the students nursing in EMI, therefore providing support the students may need. Research questions are structured as follows: . what are the studentsAo learning and language Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 161 of 168 challenges in EMI? . what are the studentsAo strategies for studying EMI. what are strategies are used based on the learning challenges? METHODS This research was designed as quantitative research. The population of this study was a cohort of 176 nursing students who were about to be screened to enter the EMI program. The faculty of nursing where they study prepared to start an international track. Therefore, the students would shortly be given an English test to screen 40 of them to be put on the international track. The participants comprised 26 male students and 150 female students. Their ages range from 18-22 years old. The length of time spent studying English ranges from 2-4 years, and most use Bahasa Indonesia and Bahasa Daerah as their daily communication tool. The instrument was adopted from the existing questionnaires from the study of (Pun & Jin, 2. with a five-point Likert scale and thus has been confirmed statistically. The instrument covers language challenges, learning challenges, and learning strategies. While the former study approached this research from the perspective of gender, year at university, and length of language exposure against the challenges and the strategies, this study approached it from a wider perspective. This study focused on the level of the studentAos language and learning challenges, the dominant strategies used, and the strategies used to cope with the language and learning challenges. The data analysis went through the level of the learning and language challenges which are categorized into high, moderate, and low. The learning strategies were also analysed based on the dominant used. Then, crosstabulation was done to find out which strategies were used the most to cope with the language and learning challenges. The result was presented in the table in percentages and FINDINGS AND DISCUSSION 1 Results Table 1. StudentsAo Learning Challenges Level Learning Challenges Category Valid Low Missing Moderate High Total System Total Frequency Percent Valid Percent Cumulative Percent The finding indicates that more than half of the students . have moderate levels of learning Students experience a high level of learning challenges and only 14 students face a low level of learning challenges. Within the language challenges questionnaires there were categories harboured to specify their challenges. The three variables included learning adaptability, content comprehension, and knowledge application. Each category of challenges was obtained by dividing the respondentsAo total score by the maximum score. Learning adaptability, which included learning from individual lecturersAo teaching methods was found to be the most common challenge among the students . 9%). Meanwhile, the content comprehension and knowledge application were only 1% different, meaning that students found these challenges to give the same pressure on them. Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 162 of 168 Table 2. StudentsAo Languages Challenges Level Language Challenges Category Valid Frequency Percent Valid Percent Cumulative Percent Low Moderate High Total The finding from the language challenges also reported that most of the students . indicated moderate language challenges. 13% of the students experienced high levels of language challenges, and the other 10. 2% faced low levels of language challenges. Within the language challenges, there were two categories harboured including communication with peers and with professionals . ecturers, laboratory assistants, and other health practitioner. By dividing the respondentsAo total score by the maximum score, the respondents' challenge in each category was Communication with peers, which involved delivering questions and opinions, an invitation to do something, and giving information among friends, appeared to be the most challenging for the students . 7%). Meanwhile, communication with professionals was close with only a 7% difference. Table 3. StudentsAo Dominant Strategies use Dominant Strategies Valid Frequency Percent Valid Percent Cumulative Percent Mixed Total The data indicated that the dominant strategies used by the students were seeking support through the L2 support 77 . 8%). Mixed strategies were used as the second most used strategy . 3%), where students mixed L1 and L2 to support them. Using L1, in this case. Bahasa Indonesia was the least used strategy. Table 4. Strategies based on the level of learning challenges. Dominant Mixed Total Low Moderate High Total By running crosstabulation between the learning challenges to the strategies used, the strategies used from each level of learning challenges were found. The findings indicate that students with low levels of learning challenges tend to seek L2 assistance . out of 14 student. The students with moderate levels of learning challenges tend to seek L2 assistance . out of . Lastly, mixed use of L1 and L2 assistance was utilized by the students with high levels of learning challenges. Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 163 of 168 Table 5. Strategies based on the level of language challenges. Dominant Mixed Total Low Moderate High Total The crosstabulation was also run between the language challenges and the strategies used to find out where studentsAo at based on their language challenge level. The data analysis showed a similar finding of the learning challenges where students with moderate levels tend to use L2 assistance, while those on high and low were used mixed and L1 assistance. 2 Discussion This study seeks to find out the level of perceived challenges in language and learning and the strategies used by the students to cope with them. By analysing the level of their challenges, students were grouped into high, moderate, and low levels of the challenges. In addition, the strategies were also scrutinized to find the dominant use based on the challenge level. The major findings indicate an interesting twist. As the participants are in preparation to be screened and be put on the international track where English is used as a medium of instruction, there is a tendency for them to feel pressured and at the same time excited about the new change. The finding in learning challenges was unique as most of the students perceived that their learning challenges were at a moderate level. At this point, there are several possibilities that emerge from this finding of why the students. First, this is contrary to what is pre-expected before the research because the report from the EF EFI . ) indicates the low proficiency of the Indonesian English level. Additionally, it is also in contrast to the mainstream findings of EMI perception where students were found to be struggling with the language proficiency (Esther, 2. On the one side, the students may not be aware of the EMI context as this questionnaire examine their perception if they should be put on the International Track. Therefore, the students have not yet had the whole picture of how EMI will change not only the language of instruction but also the material, resources, and assessment The absence of native speakers in the incoming international track may also lessen their perception of challenges because both lecturers and students speak the same language, so they feel less This finding resonates with the study of Kym & Kym . study, which find that studentsAo level of pressure and ability to study depend on the instructorsAo background . ative or nonnative speaker. The learning challenge in this study is grouped to learning adaptability, content comprehension, and knowledge application. Through the data analysis, the students were found to choose learning adaptability as the most challenging one. Learning adaptability itself consists of calculating and solving problems in English, expressing ideas in English, and using the correct English vocabulary and technical terms. This finding only indicates that although students think that their challenges to be in the EMI context are moderate, they are unprepared to switch to EMI. Basic adaptation to changing English as the sole instruction in learning, assessment, and expressing ideas are the core problem in the mainstream research of EMI where students are not confident enough (Tanjung et al. , 2. Besides, understanding the terminologies that are unique to specific expertise, such as nursing, is surely a challenge that has also been raised by previous research. The other two challenges, knowledge application and content comprehension, come closely behind learning adaptability. Knowledge application thought as the second most challenging in learning reflects a more personal use of English such as in understanding the technical terms in English, understanding the content, the course, and the teaching style. Therefore. Therefore, not having to use Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 164 of 168 it in public becomes the reason why the students feel it is less challenging. Similarly, content comprehension consists of a more individual skill which does not require interaction with others providing the reason why students feel less challenged in this part of the questionnaires. Studying to meet teachersAo expectations, understanding exam questions, providing the right answer, and measuring topic comprehension is such a reflection of oneself so students think that this could be done on a personal level. However, to examine these two findings, assuming that knowledge application and content comprehension as insignificant is the real problem itself. As the whole curriculum is shifted into EMI, there is a potential for a negative impact on their personal learning trajectory. The studentsAo tendency to think that they could tackle these two challenges on their own has been shown to cause anxiety, fear, embarrassment, and poor educational outcomes in other studies. Al Zumor . and Yang et al. , . reported that content comprehension and knowledge application have negatively impacted the students where class interaction becomes inadequate. The language challenges level highlights a similar trend to that of the learning challenge. The majority of the students find themselves to have a moderate level of language challenge and only a few find themselves to have a high level of language challenge. This finding is interesting because this only indicates that the students are confident enough with their language proficiency. Students having enough language comprehension will be an asset to the EMI context and make the process of transition become smooth. As reported by mainstream research, the most frequent problem emerging is the studentAos language competence and proficiency (G. Hu et al. , 2014. Hung et al. , 2020. Muttaqin & Chuang, 2022. Rabea et al. , 2. Having just enough proficiency will surely help students cope with EMI implementation and lessen the teachersAo burden as teachers have claimed that students mostly fail in EMI because of lacking language proficiency. Therefore, it is a good sign that if these students are put into the EMI context, they will survive. However, the language challenges finding also offers a fresh and updated view about to whom the language use is challenging. As most study expresses that students find difficulty with expressing ideas and communicating with their lecturers, the findings of these studies show that students find it more challenging to communicate with peers. Communication among peers, including asking questions, presenting arguments, communicating ideas, and presenting information are the most Why would students feel more pressurized when talking to friends than to their lecturers, lab assistant, and health practitioners? ThereAos a possibility that they feel reluctant to speak English to their friends and thus refuse to speak English to each other because they speak the same first language. Another explanation provided by the research is that they may feel embarrassed to speak to each other. Al ZumorAos . findings offered a perspective where students are feeling frustrated, tense, and anxious about using English in communication and in assessment. Additionally. An & Thomas . showed that students avoid and are not committed to interaction in the classroom during the EMI class. However, this is not final, as there are other studies that find students support each other when using English in the classroom. Chen et al. indicate learners experience improvement in language use through repairs during peer interactions. On the other side, this study finding indicates that students feel less pressurized speaking to professionals rather than to their peers. The explanation that supports this finding includes the simplicity of the conversation when asking and giving answers to the lecturers. The students also usually get support from the lecturers when producing their commands. Besides, the lecturers focus more on the content rather than the language itself. As a result, the language used in EMI does not provoke a problem. KhanAos. study indicates that lecturers utilize strategies that help them organize EMI classes by transferring the L1 to L2 strategies thus they can support quality EMI. The dominant strategies use projects an expectation rather than the truth. The majority of the students indicate that they prefer to seek support in English (L. rather than in Bahasa Indonesia (L. This is unique to EMI research, which is why it looks more at expectations rather than truth. assistance that is using English to help grow in English is surely a dreamland. Students demand EMI and native speakersAo teachers, but in practice, the use of L1 has been the panacea for class interaction Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 165 of 168 and content transfer. L1 benefits students and lecturers as it promotes L2 production, promotes the definition of terminologies and provides explanation, translation, and elaboration of the content taught in the L2 (Lin. F & Morrison, 2017. Macaro. Curle. Pun, & An, 2018. Yang et al. , 2. The crosstabulation between the learning and language challenges to the strategies also results in the same trend. Students with a moderate level of challenges tend to seek help with L2 assistance. broken down, this L2 assistance includes seeking and requesting additional support and feedback in English. To find that students seek L2 assistance rather than L1 is unique. The findings of this research highlight moderation rather than the real challenge. Setting aside the factors that may have caused that, the students indicate their favourable language choice. Little to no study has indicated that students prefer to seek L2 support. In fact, students who have been put in EMI have foundo significant improvement in their language proficiency (Rogier, 2. The students in this research were asked to reflect if they are put into an EMI context. The finding could serve as a strength to the faculty as well as the reason why this research finding may not resonate with the mainstream finding from the EMI research. For the former reason, this research will give an overview of how students see EMI. The answer is clear: the students will most likely experience challenges in language and learning. The students will also utilize strategies to cope with the challenges they face most likely using L1 to support their EMI program. The EMI and the problem that comes close within are real. The implementation that is waiting in line is also real. As Macaro. Curle. Pun. An, et al. , . put it, it is unstoppable. Therefore, this research takes MacaroAos side and aims to support EMI implementation in the faculty. With that said, this study along with Yang et al. , . and Alhassan et al. , are aware of the need for training and professional development. The students in the faculty of nursing are screened to be put into the international track where EMI is in use, and language support is paramount. Macaro. Curle. Pun. An, et al. , . suggest four models of language support which are divided into pre-sessional and in-sessional supports. Pre-sessional includes a preparatory year model in which students take a year or less to prepare their English before entering the program and a selection model in which students who are put into the international programs are those who have met the minimum standards of English proficiency before starting the The former may need to provide tutoring and facilitations for language enrichment, while the latter only requires a language test certificate to prove proficiency. The in-sessional support consists of a concurrent support model where in between the EMI program, the students are given language support aside from the content class, and the ostrich model is where no support is provided at all, and no language requirements are required from the students. Al Zumor . recommends that pre-sessional support through the foundational year is the best However, considering these students are now in the middle of their studies and are in their second year of four, the available option is providing them with language support while having their EMI program. These students in this research indicate the clueless direction of EMI as they choose to be moderate in their challenges and thus show the contrast in their strategies use. Therefore, it is important for the faculty to think about the support that could be provided to these students to have better EMI implementation. CONCLUSION The study seeks to find the level of the perceived challenges and strategies of Nursing students in an EMI context. The findings suggest that there is a gap between the practice and the expectations of the students. While the students perceive that their level of language and learning challenges are moderate, they choose their strategies, such as using L2 to support their learning and language These findings contrast with the mainstream EMI research, where students were faced with difficulties in dealing with the EMI context and utilized L1 to help with language and content Students, having not been exposed to the EMI context, favour English and find it as a dream language with all the hopes of one day studying in an EMI program. Therefore, the study proposes that these students will need language support given to them along with their EMI program. Komilie Situmorang. Santa Maya Pramusita / StudentsAo Perceived Challenges and Learning Strategies of English Medium of Instruction in the International Nursing Program Ae A Descriptive Quantitative Study Al-Ishlah: Jurnal Pendidikan,Vol. 16, 1 (March 2. : 158-168 166 of 168 The language and learning support will help them better understand their content in nursing. As a result, they will reap more positive outcomes than negative ones, as previous research has reported. This study is aware of the limitation of the study, where the participants are at the beginning of the EMI program and are waiting to be screened to be put into the EMI program. Therefore, it is too early to say that these students have enough proficiency needed to be on EMI. Further study will need to examine the factors affecting their perceptions of the EMI program, and once they get into the EMI context, a study regarding supporting the trajectories in EMI will also be of paramount importance. Examining their perceptions will reveal the gap between their perceptions to the reality of EMI itself. Lastly, support through their EMI journey will help uncover the best ways to help students succeed in their EMI. Acknowledgments: The research team express their gratitude to all the participants who participated in the research and to Universitas Pelita Harapan for funding the research with research number P-47FoN/Vi/2022. Conflicts of Interest: The authors declare no conflict of interest. REFERENCES