The study investigated the perceptions of English-language instruction (EMI) among students, faculty, and administrators at three medical programs in Saudi Arabia. The research combined questionnaires, interviews and classroom observations to gain a comprehensive view of stakeholder experiences. Most of the participants supported teaching in English because it increases the knowledge competences, professional readiness and English language skills needed in the global medical market. At the same time, however, there were significant concerns regarding difficulties in understanding the content, increased cognitive load, and time constraints during classes. Research participants advocated a bilingual approach in which English and Arabic would be strategically combined to improve understanding and learning outcomes. The study concluded that the exclusive use of English can hinder the academic performance of students with limited English proficiency. The researchers recommend that policymakers and educators integrate support for students' first language into English instruction policies to maintain equity and quality of education.