Global mobility insurance or status compensation? A mixed-methods study of stratification in medical education

The global expansion of English medium instruction (EMI) has transformed medical education, increasingly serving as a strategic tool for institutional marketization and internationalization. However, the structural and pedagogical implications of this shift remain underexplored. This study investigates the stratification of EMI and Turkish medium instruction (TMI) medical programs across the admission spectrum in Turkey, exploring how the intersection of linguistic branding and financial resources fosters a dual-market structure that shapes the professional identities and clinical competencies of future physicians. This study utilized an explanatory sequential mixed-methods design. First, a quantitative analysis of national university admission data (2023–2025) was conducted to map the distribution of EMI and TMI medical programs across four admission score quartiles, institutional types (state vs. foundation), and funding structures. Second, qualitative, semi-structured interviews were conducted with 40 stakeholders (24 clinical-year students and 16 university administrators). Participants were purposefully sampled across the four quartiles to explore how they interpret these admission patterns. Qualitative data were analyzed using Braun and Clarke’s thematic analysis framework. Quantitative analyses revealed a dual-market structure: upper admission quartiles are dominated by fully funded elite programs, while the lower quartile is heavily populated by paid foundation EMI programs. Qualitative findings identified divergent motivations based on this structural placement. In the upper quartiles, students utilize EMI as an “elite-globalist passport” and global mobility insurance to pursue careers abroad. Conversely, in the lower quartiles, students use paid EMI degrees as a status-compensatory mechanism to offset lower centralized exam scores. Consequently, a clinical paradox emerges during the clinical years (Years 4–6); EMI students acquire global scientific capital but experience significant language barriers when treating local patients, whereas TMI students report superior communicative competence and clinical resilience. EMI in medical education operates as a highly stratified commodity rather than a purely pedagogical tool. While it successfully functions as global mobility insurance for top-tier students and a status-compensatory brand for those with lower scores, it simultaneously creates a pedagogical gap. This clinical paradox threatens the communicative and altruistic core of medical practice, highlighting the need for institutions to better bridge the transition between English-medium scientific theory and localized clinical practice.