Language of Healthcare: Chain of Education to Reduce Barriers

Language of Healthcare: Chain of Education to Reduce Barriers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Language of Healthcare: Chain of Education to Reduce Barriers Perla Nafeh, Mohammad Kabakibi, Yasin Jazieh, Asher Freund, Jonanne Talebloo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8007732/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Many health professional students in Arabic-speaking countries face a linguistic transition when advancing from high school to health professional school, as the language of instruction changes from their native language Arabic, to English. This change presents a barrier as it might limit their ability to understand core health concepts taught in the medical school, or even access third-party educational resources which are available only in English. This study examines the impact of Arabic captioned educational videos on comprehension and academic performance among Arabic-speaking health professional students. Methods: To reduce language barriers faced by Arabic-speaking students using English-language content, Arabic captions were created for freely available Osmosis videos on their YouTube channel. Chain of Education partnered with Osmosis from Elsevier to assemble a team of qualified healthcare students and professionals fluent in both Arabic and English who captioned the videos. We investigated the efficacy of this intervention in improving Arabic-speaking healthcare students’ retention of material and access to educational opportunities. We performed research on a convenience sample of 82 students solicited through the partnership, who completed a confidential survey via Google Forms . Findings: Response rate was 65%, the majority of whom were medical students. Of respondents, 83% self-reported their understanding of healthcare concepts as greatly improved. Interpretation: Our findings suggest that providing Arabic captions for English-language medical content enhances self-reported confidence and learning. This may reduce linguistic barriers in accessing healthcare education. Interventions similar to ours can improve health literacy and further reduce barriers in healthcare education. Other interventions, such as preparing healthcare educational content originally in Arabic, would be helpful to further reduce barriers in healthcare education. Medical education Arabic reducing barriers healthcare system Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Language proficiency significantly influences educational outcomes in healthcare professions, affecting academic success, clinical effectiveness, and the quality of patient care. Healthcare students whose native language differs from their language of instruction face documented challenges compared to their native-speaking peers. These students often need to mentally translate instructional content between their native language and English, increasing cognitive load and impairing efficient information processing ( 1 , 2 ). Limited English Proficiency (LEP) specifically compromises students’ comprehension of curricular materials ( 2 , 3 ), and evidence from nursing education indicates that non-native English-speaking students encounter numerous academic and clinical obstacles. These include language barriers, cultural adaptation difficulties, academic struggles, discomfort with spoken clinical English, and challenges mastering technical vocabulary and electronic health documentation ( 2 – 7 ). Such impediments have been associated with higher attrition rates among students who speak English as a second language ( 8 ). Critically, inadequate language proficiency may lead to decreased quality of patient care, increased medical errors, poor protocol adherence, and difficulties with informed consent communication ( 9 – 12 ). In the Arab world specifically, the abrupt transition from high school instruction predominantly conducted in Arabic to medical school courses taught in English or French creates significant education and linguistic hurdles ( 13 , 14 ). While research strongly supports learning in one’s native language as optimal for knowledge acquisition and retention in medical and scientific education ( 13 , 15 – 17 ), most medical schools in Arab countries continue to deliver curricula in foreign languages, typically English. Consequently, Arab medical students often struggle not only academically but also clinically, facing a “reverse language barrier” after graduation, when communicating diagnosis and treatment plans to Arabic-speaking patients ( 13 , 18 ). Although the complete Arabization of medical curricula has been historically advocated, efforts have repeatedly encountered significant logistical, cultural, and academic barriers, rendering full Arabization impractical in the short term ( 13 ). Given these persistent challenges, partial or targeted linguistic interventions have emerged as promising alternatives. For example, a recent U.S. initiative demonstrated improved patient-doctor communication outcomes when medical students who spoke Mandarin as their native language enrolled in elective courses specifically designed to enhance clinical communication in Mandarin ( 19 ). Participating students reported greater comfort and increased efficiency communicating with Mandarin speaking patients. Similarly, a study from 2023 showed positive student perceptions and improved clinical interactions when medical instruction in Arab contexts was supplemented with Arabic medical terminology. Students suggested that further integration of Arabic language supplements into their clinical training might yield additional benefits in patient communication, diagnostic accuracy, and patient-provider rapport ( 13 ). These findings reinforce the potential benefits of targeted linguistic interventions for healthcare students operating in second-language instructional environments. Nevertheless, empirical evidence exploring the specific benefits of partially integrating native-language medical content into predominantly English-based medical education for Arab healthcare students remains limited. Addressing this lack, our study aims to evaluate the impact of Arabic-language captioning of medical education videos on comprehension, learning efficacy, and overall academic confidence among Arab healthcare students. We hypothesize that supplementing English-language medical educational materials with Arabic captions will improve students’ educational outcomes by reducing cognitive load associated with linguistic translation tasks, thereby enhancing both comprehension of instructional content and clinical communication potential. Methods Study Design This was a cross-sectional, multi-country observational study designed to assess the perceived impact of Arabic-language captions on the comprehension and academic experience of healthcare students using medical education videos published by Osmosis from Elsevier on their free access YouTube channel. The study was conducted in collaboration with Chain of Education , a global social enterprise educational organization on a mission to reduce barriers in healthcare education. Data was collected between December, 2023 and August, 2024 and included participants from across the Middle East and North Africa (MENA) region. Prior to initiation, this study was approved by the Institutional Review Board (IRB) of the Lebanese American University (LAU). Participants Eligible participants were native Arabic-speaking students aged 18 years or older who were currently enrolled in a health-related undergraduate or graduate academic program at a university in the MENA region. Fields of study included medicine, nursing, pharmacy, dentistry, nutrition, dietetics, physician assistant studies, and pre-medical sciences. No additional exclusion criteria were applied. Participants were recruited using a combination of institutional outreach and snowball sampling through social media platforms and academic peer networks in countries such as Lebanon, Syria, Algeria, Saudi Arabia, and Egypt. To ensure that participants had engaged with the intervention, the survey began with a screening question that asked whether the respondents had previously utilized Osmosis from Elsevier videos with Arabic captions. Only those who confirmed watching the videos were included in the final data analysis. Procedures Data were collected using a self-administered, anonymous online questionnaire created via Google Forms. The Questionnaire was distributed between December, 2023 and August, 2024. It consisted of 18 items, including multiple choice questions, Likert-scale items, and one open response question (see Appendix 1). The survey was developed by the authors based on the review of existing literature. To ensure face and content validity, we piloted the survey among five volunteer students who verified clarity and relevance of the items. To protect respondent confidentiality and autonomy, informed consent was waived and replaced with implied consent. The survey introduction included a study information sheet detailing the research purpose, data protection measures, participant rights, and contact information for the research team. Participation was entirely voluntary, anonymous, and uncompensated. To maximize participant comfort, all demographic questions were optional. Outcomes and Variables The primary outcome was participants’ self-reported improvement in comprehension of medical content as a result of utilizing Arabic-captioned Osmosis videos. Secondary outcomes included perceived enhancement of educational experience and perceived impact on clinical practice. Our study also aimed to provide recommendations on additional improvements that may be included by Osmosis from Elsevier to enhance the learning experience of Arabic speaking (and reading) health professional students. Self-reported variables collected for descriptive analysis included sex, country of residence, field of study, level of education, and prior exposure to English-language instruction. These variables were considered potential confounders or effect modifiers and were analyzed descriptively. Statistical Analysis No formal power calculation was conducted. Based on prior studies and practical feasibility, a target sample size of approximately 100 participants was deemed sufficient to ensure diversity across geography, academic disciplines, and training levels while keeping the study manageable. All data were entered into Microsoft Excel (version 2505). Frequencies and percentages were used to summarize categorical responses. Continuous variables were calculated using the Statistical Package for Social Sciences (SPSS) Version 25. Due to the exploratory nature of the study and reliance on self-report measures, no inferential statistics or subgroup comparisons were conducted. Results A total of 82 healthcare students participated in the study. The average age was 22 years (range: 17–28), with the largest age group being 20 years old (24.4%) (Fig. 1 A). Most participants were medical students (67.1%), followed by nursing students (26.8%), and a smaller proportion representing pharmacy, nutrition, and other health-related fields (~ 6.1% combined) (Fig. 1 B&C). Just over half of the participants (54.9%) reported being proficient in English (Fig. 1 D). Baseline characteristics, including age distribution, gender, program and year of study, as well as the number of spoken languages, are summarized in Table 1 . The primary outcome assessed was self-reported improvement in comprehension of healthcare concepts after using Arabic-translated Osmosis videos. On a scale of 1 (no improvement) to 9 (greatest improvement), the mean reported improvement was 7.22 (SD: 2.08), with the most common response being 9 (40.2%) (Fig. 2 A). Similarly, 25.6% of the participants reported an improvment in their test grades since watching the translated videos (Fig. 2 B). Additionally, 51% of participants (n = 42) selected “yes” when asked whether their understanding of the material improved through the use of Arabic subtitles (p-value = 0.9124; 95% CI (0.3984, 0.6136) (Fig. 2 C). Regarding usage patterns, 23.2% of participants reported watching Osmosis videos for 16 minutes or more per week (Fig. 3 A). When asked about typical viewing behaviors, 46.3% stated that they watched each video twice, although they only read the Arabic captions once (Fig. 3 B and Fig. 4 A). Among the third-year medical students (n = 56), 20 reported using supplementary resources such as Board and Beyond or YouTube alongside Osmosis (Fig. 4 B). When asked whether they intended to continue using Osmosis with Arabic subtitles in the future, 78% of participants responded affirmatively (Fig. 4 C). Our open-ended survey item asked three primary themes: ( 1 ) improved clarity and understanding of difficult concepts, ( 2 ) increased engagement and motivation, and ( 3 ) support for memorization (Supplementary figures). Table 1 Baseline characteristics of the participants (N = 82) Variable Category Total (N = 82) Mean ± SD % Age (years) 22.01 ± 2.38 17 1 1.2% 18 1 1.2% 19 3 3.7% 20 20 24.4% 21 18 22% 22 9 11% 23 12 14.6% 24 6 7.3% 25 5 6.1% 26 1 1.2% 27 3 3.7% 28 2 2.4% 29 1 1.2% Gender ---------------- (categorical) Female 44 53.7% Male 38 46.3% Program of Study ---------------- (categorical) Medicine 55 67.2% Nursing 22 26.8% Pharmacy 1 1.2% Dentistry 1 1.2% Public Health 1 1.2% Doctor of Pharmacy (PharmD) 1 1.2% Other 1 1.2% Year of study 3.90 ± 1.576 1st year 2 2.4% 2nd year 12 14.6% 3rd year 27 32.9% 4th year 9 11% 5th year 10 12.2% 6th year 16 19.5% 7th year 1 1.2% 8th year 1 1.2% Other 4 4.9% Number of spoken languages 2.29 ± 0.762 1 language 9 11% 2 languages 45 54.9% 3 languages 24 29.3% 4 languages 3 3.7% 5 languages 1 1.2% Discussion and Future Perspectives Our study aimed to understand the impact of watching Arabic-captioned Osmosis from Elsevier YouTube videos on the academic performance of students in healthcare disciplines. Altogether, survey respondents experienced improvements in their comprehension of health educational content, as measured by quantitative self-assessment. Overall, our findings indicate that the incorporation of native-language captions into educational content might significantly reduce cognitive burden and improve the learning process for students. Specifically, our results are consistent with earlier studies showing positive correlations on academic performance when learning in one’s native language. Nevertheless, our results may be explained by additional factors. For example, Osmosis from Elsevier ’s videos apply Mayer’s Cognitive Theory of Multimedia Learning, which emphasizes presenting information through both verbal and visual modalities. This dual-channel processing not only reduces cognitive workload but also plays an instrumental role in enhancing memory efficiency, thereby contributing to improved retention and understanding. This aligns with the dual-coding theory, which posits that learners encode information both visually and verbally ( 20 ). Another possible explanation may be the usage of structured explanation, in which visual and narrative components work together to capture and hold students’ attention, minimizing distractions and maximizing focus ( 21 ). Another pivotal factor could be the self-paced learning model, in which students are allowed to consume content (such as the videos in this study), as many times as necessary, at their own pace and convenience. This flexibility allows learners to reinforce difficult concepts at a pace that works for them, which research has linked to higher levels of comprehension and retention ( 22 ). Having access to content in students’ native language likely improves their academic performance and enables them to fully maximize their educational potential. This is likely because students have received their education in their native language since early childhood, making it easier to grasp complex healthcare concepts within the same linguistic and cultural framework. Studying the health professions in Arabic, for example, can help Arabic-speaking students with limited English proficiency navigate their studies with fewer challenges and increase their chances of completing their education successfully. The improvement in conceptual comprehension and retention that results from native-language captions furthermore has the potential to support students as they prepare for their future licensing exams. The most substantial limitation of this study is the total reliance on self-reporting to assess improvements in comprehension of medical concepts and academic performance. After investing a certain amount of time in viewing captioned Osmosis videos, the wish to view that investment favorably may have biased the respondents towards deeming the captions more beneficial than they actually were. Recall inaccuracies and social desirability may also be factors. Additionally, while our sample size (82 participants) offers initial insights, it is not large enough to fully capture the diverse experiences of Arabic-speaking healthcare students across countries, institutions and disciplines. Finally, the cross-sectional design of the study limits our ability to make observations on the long-term effects of access to Arabic-captioned health videos on participants’ learning and academic achievement in their respective programs. As noted above, native Arabic speakers in the health professions may encounter a severe language barrier in the clinical setting, given that their technical medical knowledge was acquired mainly in English. An interesting future investigation might be a longitudinal study following a group of healthcare students who used Arabic-captioned medical content in the didactic setting as they transitioned into the clinical setting later in their educational journeys. When these students find themselves examining, diagnosing, and treating Arabic-speaking patients, it would be fruitful to study whether they experience greater ease in communicating technical concepts to their patients resulting from their prior exposure to these concepts mediated by native-language captions. This experimental group should be compared to a control group that learned technical concepts exclusively in English. While the present study focuses primarily on students’ increased comprehension of the material, their enhanced capacity to communicate medical concepts to patients with limited English proficiency is a secondary benefit that may foster a more trusting patient-provider relationship and lead to better patient outcomes. While this study concerns itself solely with the students who utilized Arabic captions, it is noteworthy that other healthcare students were involved in creating the captions. To fully comprehend the benefits of foreign language captions in health educational digital content, a future study might survey the captioners themselves to ascertain whether they experienced similar or unrelated benefits. While translation simultaneous with learning can introduce a counterproductive cognitive load, healthcare students afforded the necessary time and resources may find that the practice of translation enriches their understanding of the content covered in the videos they are captioning. Such a study would shed further light on the potential reciprocal benefits of foreign language captions. Abbreviations LEP : Limited English Proficiency IRB : Institutional Review Board LAU : Lebanese American University MENA : Middle East and North Africa SPSS : Statistical Package for Social Sciences Declarations Ethics approval and consent to participate : LAU Institutional Review Board IRB # : LAU.SAS.HH1.21/Aug/2024. This study was conducted in compliance with the Declaration of Helsinki, thus ensuring the ethical protection of all participants. The study was designed to minimize potential risks while maximizing the potential educational benefits. To elaborate, there are no harms or risks associated with this study beyond those encountered in our daily life. Consent for publication : Not applicable. Availability of data and materials : Data is provided within the manuscript or supplementary information files. Competing Interests : All authors declare no conflict of interest. Funding : No external funding was received for this study. Authors’ contributions : PN contributed in drafting the research proposal and submitted it to the Lebanese American University (LAU) Institutional Review Board (IRB), populating the survey among the targeted audience, data analysis and preparation of figures, writing the manuscript including the introduction and results, revising the manuscript, and contributed in other research and administrative duties such as distributing tasks to the team. MK contributed to the conception of the project and formulating the collaboration between Chain of Education, Osmosis from Elsevier , and Amara.org, recruiting the team, delegating tasks, formulation of research proposals, and other research and administrative duties, and contributed to the writing of the manuscript, data analysis, revision of the manuscript, writing the abstract and the conclusion, proposing modifications, writing the survey and disseminating it among the targeted audience. YJ contributed to writing the research proposal, crafting the survey and populating it among our population of interest, and drafting the methodology and discussion sections. AF contributed in writing the discussion and methods section, data analysis, and proofreading the manuscript while suggesting modifications. JT contributed in writing the results section and proofreading the manuscript while suggesting modifications. AA contributed in project administration, final revision, and supervision of the project. Acknowledgments: The authors acknowledge Dr. Shiv Gaglani for facilitating the collaboration between Osmosis from Elsevier and Chain of Education. We also acknowledge all the members and volunteers at Chain of Education that caption the content, review, or help logistically, Caleb Funras for his logistical support, and the members of Osmosis from Elsevier who facilitate this work. Lastly, we thank Amara.org for their insights on captioning. Clinical trial number : Not applicable. Data sharing statement: Data can be requested from Amin Azzam via email ( [email protected] ) after publication of this study. De-identified participant data, data dictionary, study protocol, informed consent language, statistical analysis plan etc. will all be made available based on a proposal with a valuable research question as assessed by the study team. 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Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigures.pdf Appendix1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Dec, 2025 Reviewers agreed at journal 20 Dec, 2025 Reviewers invited by journal 18 Dec, 2025 Editor assigned by journal 16 Dec, 2025 Editor invited by journal 21 Nov, 2025 Submission checks completed at journal 20 Nov, 2025 First submitted to journal 20 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8007732","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":563479789,"identity":"bff27180-dbc7-4635-ab61-10131e69fcc6","order_by":0,"name":"Perla Nafeh","email":"","orcid":"","institution":"Chain of Education","correspondingAuthor":false,"prefix":"","firstName":"Perla","middleName":"","lastName":"Nafeh","suffix":""},{"id":563479790,"identity":"93058e25-2eb0-4fc1-88b9-53fecc6f23c3","order_by":1,"name":"Mohammad Kabakibi","email":"","orcid":"","institution":"Chain of 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1","display":"","copyAsset":false,"role":"figure","size":239277,"visible":true,"origin":"","legend":"\u003cp\u003eCharts representing \u003cstrong\u003e(A)\u003c/strong\u003e the age of the participants. \u003cstrong\u003e(B \u0026amp;C)\u003c/strong\u003e their program of study. \u003cstrong\u003e(D)\u003c/strong\u003e the number of languages they speak.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/3c733bf9c928549bc27bc7ea.png"},{"id":99307130,"identity":"1ed99c9c-6684-468e-991b-087bcf9be16f","added_by":"auto","created_at":"2025-12-31 16:05:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":284682,"visible":true,"origin":"","legend":"\u003cp\u003eCharts representing \u003cstrong\u003e(A)\u003c/strong\u003e the improvement in the participants’ understanding. \u003cstrong\u003e(B)\u003c/strong\u003e improvement in test grades. \u003cstrong\u003e(C)\u003c/strong\u003e what type of improvement to their academic performance they noticed after using captioned Osmosis videos.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/0196558124bab90236d382f3.png"},{"id":99307272,"identity":"54890a50-29bb-4a19-aa59-e4254b7db4cb","added_by":"auto","created_at":"2025-12-31 16:05:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":259390,"visible":true,"origin":"","legend":"\u003cp\u003eCharts representing \u003cstrong\u003e(A)\u003c/strong\u003e the time spent watching the osmosis videos. \u003cstrong\u003e(B) \u003c/strong\u003ethe number of time the participants watched the videos.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/a6f085eb86b1b13976016c00.png"},{"id":98817864,"identity":"77906442-2301-4eec-a148-c7976bd2b50b","added_by":"auto","created_at":"2025-12-22 16:47:25","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":319652,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCharts representing (A)\u003c/strong\u003e the number of times they read the captions. \u003cstrong\u003e(B)\u003c/strong\u003e other resources used. \u003cstrong\u003e(C)\u003c/strong\u003eusage of the Osmosis with Arabic captions in the future.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/0d81f0d69f63b00742dfc35a.png"},{"id":100356202,"identity":"2f83d16e-02d7-4c40-a336-841165a7abf7","added_by":"auto","created_at":"2026-01-16 06:57:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1729876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/aecd5ce1-1821-4924-993d-bfc2e77e54fe.pdf"},{"id":99307174,"identity":"24690cc7-5c68-4340-90f7-e81386aaa7b7","added_by":"auto","created_at":"2025-12-31 16:05:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":627748,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/2e1974f122ff01a8f06cf414.pdf"},{"id":99307415,"identity":"2059c323-1a67-4376-b009-1b4778e9ad82","added_by":"auto","created_at":"2025-12-31 16:06:14","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":45584,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8007732/v1/1e373dfa1454fb3ed20b3ec7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Language of Healthcare: Chain of Education to Reduce Barriers","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLanguage proficiency significantly influences educational outcomes in healthcare professions, affecting academic success, clinical effectiveness, and the quality of patient care. Healthcare students whose native language differs from their language of instruction face documented challenges compared to their native-speaking peers. These students often need to mentally translate instructional content between their native language and English, increasing cognitive load and impairing efficient information processing (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Limited English Proficiency (LEP) specifically compromises students\u0026rsquo; comprehension of curricular materials (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and evidence from nursing education indicates that non-native English-speaking students encounter numerous academic and clinical obstacles. These include language barriers, cultural adaptation difficulties, academic struggles, discomfort with spoken clinical English, and challenges mastering technical vocabulary and electronic health documentation (\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Such impediments have been associated with higher attrition rates among students who speak English as a second language (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Critically, inadequate language proficiency may lead to decreased quality of patient care, increased medical errors, poor protocol adherence, and difficulties with informed consent communication (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the Arab world specifically, the abrupt transition from high school instruction predominantly conducted in Arabic to medical school courses taught in English or French creates significant education and linguistic hurdles (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While research strongly supports learning in one\u0026rsquo;s native language as optimal for knowledge acquisition and retention in medical and scientific education (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), most medical schools in Arab countries continue to deliver curricula in foreign languages, typically English. Consequently, Arab medical students often struggle not only academically but also clinically, facing a \u0026ldquo;reverse language barrier\u0026rdquo; after graduation, when communicating diagnosis and treatment plans to Arabic-speaking patients (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Although the complete Arabization of medical curricula has been historically advocated, efforts have repeatedly encountered significant logistical, cultural, and academic barriers, rendering full Arabization impractical in the short term (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven these persistent challenges, partial or targeted linguistic interventions have emerged as promising alternatives. For example, a recent U.S. initiative demonstrated improved patient-doctor communication outcomes when medical students who spoke Mandarin as their native language enrolled in elective courses specifically designed to enhance clinical communication in Mandarin (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Participating students reported greater comfort and increased efficiency communicating with Mandarin speaking patients. Similarly, a study from 2023 showed positive student perceptions and improved clinical interactions when medical instruction in Arab contexts was supplemented with Arabic medical terminology. Students suggested that further integration of Arabic language supplements into their clinical training might yield additional benefits in patient communication, diagnostic accuracy, and patient-provider rapport (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These findings reinforce the potential benefits of targeted linguistic interventions for healthcare students operating in second-language instructional environments.\u003c/p\u003e \u003cp\u003eNevertheless, empirical evidence exploring the specific benefits of partially integrating native-language medical content into predominantly English-based medical education for Arab healthcare students remains limited. Addressing this lack, our study aims to evaluate the impact of Arabic-language captioning of medical education videos on comprehension, learning efficacy, and overall academic confidence among Arab healthcare students. We hypothesize that supplementing English-language medical educational materials with Arabic captions will improve students\u0026rsquo; educational outcomes by reducing cognitive load associated with linguistic translation tasks, thereby enhancing both comprehension of instructional content and clinical communication potential.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis was a cross-sectional, multi-country observational study designed to assess the perceived impact of Arabic-language captions on the comprehension and academic experience of healthcare students using medical education videos published by \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e on their free access YouTube channel. The study was conducted in collaboration with \u003cem\u003eChain of Education\u003c/em\u003e, a global social enterprise educational organization on a mission to reduce barriers in healthcare education. Data was collected between December, 2023 and August, 2024 and included participants from across the Middle East and North Africa (MENA) region. Prior to initiation, this study was approved by the Institutional Review Board (IRB) of the Lebanese American University (LAU).\u003c/p\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eEligible participants were native Arabic-speaking students aged 18 years or older who were currently enrolled in a health-related undergraduate or graduate academic program at a university in the MENA region. Fields of study included medicine, nursing, pharmacy, dentistry, nutrition, dietetics, physician assistant studies, and pre-medical sciences. No additional exclusion criteria were applied. Participants were recruited using a combination of institutional outreach and snowball sampling through social media platforms and academic peer networks in countries such as Lebanon, Syria, Algeria, Saudi Arabia, and Egypt. To ensure that participants had engaged with the intervention, the survey began with a screening question that asked whether the respondents had previously utilized \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e videos with Arabic captions. Only those who confirmed watching the videos were included in the final data analysis.\u003c/p\u003e \u003cp\u003eProcedures\u003c/p\u003e \u003cp\u003eData were collected using a self-administered, anonymous online questionnaire created via Google Forms. The Questionnaire was distributed between December, 2023 and August, 2024. It consisted of 18 items, including multiple choice questions, Likert-scale items, and one open response question (see Appendix 1). The survey was developed by the authors based on the review of existing literature. To ensure face and content validity, we piloted the survey among five volunteer students who verified clarity and relevance of the items. To protect respondent confidentiality and autonomy, informed consent was waived and replaced with implied consent. The survey introduction included a study information sheet detailing the research purpose, data protection measures, participant rights, and contact information for the research team. Participation was entirely voluntary, anonymous, and uncompensated. To maximize participant comfort, all demographic questions were optional.\u003c/p\u003e \u003cp\u003eOutcomes and Variables\u003c/p\u003e \u003cp\u003eThe primary outcome was participants\u0026rsquo; self-reported improvement in comprehension of medical content as a result of utilizing Arabic-captioned \u003cem\u003eOsmosis\u003c/em\u003e videos. Secondary outcomes included perceived enhancement of educational experience and perceived impact on clinical practice. Our study also aimed to provide recommendations on additional improvements that may be included by \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e to enhance the learning experience of Arabic speaking (and reading) health professional students.\u003c/p\u003e \u003cp\u003eSelf-reported variables collected for descriptive analysis included sex, country of residence, field of study, level of education, and prior exposure to English-language instruction. These variables were considered potential confounders or effect modifiers and were analyzed descriptively.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eNo formal power calculation was conducted. Based on prior studies and practical feasibility, a target sample size of approximately 100 participants was deemed sufficient to ensure diversity across geography, academic disciplines, and training levels while keeping the study manageable.\u003c/p\u003e \u003cp\u003eAll data were entered into Microsoft Excel (version 2505). Frequencies and percentages were used to summarize categorical responses. Continuous variables were calculated using the Statistical Package for Social Sciences (SPSS) Version 25. Due to the exploratory nature of the study and reliance on self-report measures, no inferential statistics or subgroup comparisons were conducted.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 82 healthcare students participated in the study. The average age was 22 years (range: 17\u0026ndash;28), with the largest age group being 20 years old (24.4%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Most participants were medical students (67.1%), followed by nursing students (26.8%), and a smaller proportion representing pharmacy, nutrition, and other health-related fields (~\u0026thinsp;6.1% combined) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB\u0026amp;C). Just over half of the participants (54.9%) reported being proficient in English (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD). Baseline characteristics, including age distribution, gender, program and year of study, as well as the number of spoken languages, are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe primary outcome assessed was self-reported improvement in comprehension of healthcare concepts after using Arabic-translated Osmosis videos. On a scale of 1 (no improvement) to 9 (greatest improvement), the mean reported improvement was 7.22 (SD: 2.08), with the most common response being 9 (40.2%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Similarly, 25.6% of the participants reported an improvment in their test grades since watching the translated videos (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). Additionally, 51% of participants (n\u0026thinsp;=\u0026thinsp;42) selected \u0026ldquo;yes\u0026rdquo; when asked whether their understanding of the material improved through the use of Arabic subtitles (p-value\u0026thinsp;=\u0026thinsp;0.9124; 95% CI (0.3984, 0.6136) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding usage patterns, 23.2% of participants reported watching Osmosis videos for 16 minutes or more per week (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). When asked about typical viewing behaviors, 46.3% stated that they watched each video twice, although they only read the Arabic captions once (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). Among the third-year medical students (n\u0026thinsp;=\u0026thinsp;56), 20 reported using supplementary resources such as Board and Beyond or YouTube alongside Osmosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). When asked whether they intended to continue using Osmosis with Arabic subtitles in the future, 78% of participants responded affirmatively (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOur open-ended survey item asked three primary themes: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) improved clarity and understanding of difficult concepts, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) increased engagement and motivation, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) support for memorization (Supplementary figures).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the participants (N\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge (years)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGender\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---------------- (categorical)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eProgram of Study\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---------------- (categorical)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDentistry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctor of Pharmacy (PharmD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eYear of study\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8th year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNumber of spoken languages\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 language\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 languages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion and Future Perspectives","content":"\u003cp\u003eOur study aimed to understand the impact of watching Arabic-captioned \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e YouTube videos on the academic performance of students in healthcare disciplines. Altogether, survey respondents experienced improvements in their comprehension of health educational content, as measured by quantitative self-assessment. Overall, our findings indicate that the incorporation of native-language captions into educational content might significantly reduce cognitive burden and improve the learning process for students.\u003c/p\u003e \u003cp\u003eSpecifically, our results are consistent with earlier studies showing positive correlations on academic performance when learning in one\u0026rsquo;s native language. Nevertheless, our results may be explained by additional factors. For example, \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e\u0026rsquo;s videos apply Mayer\u0026rsquo;s Cognitive Theory of Multimedia Learning, which emphasizes presenting information through both verbal and visual modalities. This dual-channel processing not only reduces cognitive workload but also plays an instrumental role in enhancing memory efficiency, thereby contributing to improved retention and understanding. This aligns with the dual-coding theory, which posits that learners encode information both visually and verbally (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Another possible explanation may be the usage of structured explanation, in which visual and narrative components work together to capture and hold students\u0026rsquo; attention, minimizing distractions and maximizing focus (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Another pivotal factor could be the self-paced learning model, in which students are allowed to consume content (such as the videos in this study), as many times as necessary, at their own pace and convenience. This flexibility allows learners to reinforce difficult concepts at a pace that works for them, which research has linked to higher levels of comprehension and retention (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHaving access to content in students\u0026rsquo; native language likely improves their academic performance and enables them to fully maximize their educational potential. This is likely because students have received their education in their native language since early childhood, making it easier to grasp complex healthcare concepts within the same linguistic and cultural framework. Studying the health professions in Arabic, for example, can help Arabic-speaking students with limited English proficiency navigate their studies with fewer challenges and increase their chances of completing their education successfully. The improvement in conceptual comprehension and retention that results from native-language captions furthermore has the potential to support students as they prepare for their future licensing exams.\u003c/p\u003e \u003cp\u003eThe most substantial limitation of this study is the total reliance on self-reporting to assess improvements in comprehension of medical concepts and academic performance. After investing a certain amount of time in viewing captioned Osmosis videos, the wish to view that investment favorably may have biased the respondents towards deeming the captions more beneficial than they actually were. Recall inaccuracies and social desirability may also be factors. Additionally, while our sample size (82 participants) offers initial insights, it is not large enough to fully capture the diverse experiences of Arabic-speaking healthcare students across countries, institutions and disciplines. Finally, the cross-sectional design of the study limits our ability to make observations on the long-term effects of access to Arabic-captioned health videos on participants\u0026rsquo; learning and academic achievement in their respective programs.\u003c/p\u003e \u003cp\u003eAs noted above, native Arabic speakers in the health professions may encounter a severe language barrier in the clinical setting, given that their technical medical knowledge was acquired mainly in English. An interesting future investigation might be a longitudinal study following a group of healthcare students who used Arabic-captioned medical content in the didactic setting as they transitioned into the clinical setting later in their educational journeys. When these students find themselves examining, diagnosing, and treating Arabic-speaking patients, it would be fruitful to study whether they experience greater ease in communicating technical concepts to their patients resulting from their prior exposure to these concepts mediated by native-language captions. This experimental group should be compared to a control group that learned technical concepts exclusively in English. While the present study focuses primarily on students\u0026rsquo; increased comprehension of the material, their enhanced capacity to communicate medical concepts to patients with limited English proficiency is a secondary benefit that may foster a more trusting patient-provider relationship and lead to better patient outcomes.\u003c/p\u003e \u003cp\u003eWhile this study concerns itself solely with the students who utilized Arabic captions, it is noteworthy that other healthcare students were involved in creating the captions. To fully comprehend the benefits of foreign language captions in health educational digital content, a future study might survey the captioners themselves to ascertain whether they experienced similar or unrelated benefits. While translation simultaneous with learning can introduce a counterproductive cognitive load, healthcare students afforded the necessary time and resources may find that the practice of translation enriches their understanding of the content covered in the videos they are captioning. Such a study would shed further light on the potential reciprocal benefits of foreign language captions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLEP : Limited English Proficiency\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIRB\u0026nbsp;: Institutional Review Board\u003c/p\u003e\n\u003cp\u003eLAU\u0026nbsp;: Lebanese American University\u003c/p\u003e\n\u003cp\u003eMENA : Middle East and North Africa\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPSS : Statistical Package for Social Sciences\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLAU Institutional Review Board IRB # : LAU.SAS.HH1.21/Aug/2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was conducted in compliance with the Declaration of Helsinki, thus ensuring the ethical protection of all participants. The study was designed to minimize potential risks while maximizing the potential educational benefits. To elaborate, there are no harms or risks associated with this study beyond those encountered in our daily life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication :\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials :\u0026nbsp;\u003c/strong\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;:\u003c/strong\u003e All authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding :\u0026nbsp;\u003c/strong\u003eNo external funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;:\u003c/strong\u003e PN contributed in drafting the research proposal and submitted it to the Lebanese American University (LAU) Institutional Review Board (IRB), populating the survey among the targeted audience, data analysis and preparation of figures, writing the manuscript including the introduction and results, revising the manuscript, and contributed in other research and administrative duties such as distributing tasks to the team.\u003c/p\u003e\n\u003cp\u003eMK contributed to the conception of the project and formulating the collaboration between Chain of Education, \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e, and Amara.org, recruiting the team, delegating tasks, formulation of research proposals, and other research and administrative duties, and contributed to the writing of the manuscript, data analysis, revision of the manuscript, writing the abstract and the conclusion, proposing modifications, writing the survey and disseminating it among the targeted audience.\u003c/p\u003e\n\u003cp\u003eYJ contributed to writing the research proposal, crafting the survey and populating it among our population of interest, and drafting the methodology and discussion sections.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAF contributed in writing the discussion and methods section, data analysis, and proofreading the manuscript while suggesting modifications.\u003c/p\u003e\n\u003cp\u003eJT contributed in writing the results section and proofreading the manuscript while suggesting modifications.\u003c/p\u003e\n\u003cp\u003eAA contributed in project administration, final revision, and supervision of the project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors acknowledge Dr. Shiv Gaglani for facilitating the collaboration between \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e and Chain of Education. We also acknowledge all the members and volunteers at Chain of Education that caption the content, review, or help logistically, Caleb Funras for his logistical support, and the members of \u003cem\u003eOsmosis from Elsevier\u003c/em\u003e who facilitate this work. Lastly, we thank Amara.org for their insights on captioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData sharing statement:\u0026nbsp;\u003c/strong\u003eData can be requested from Amin Azzam via email ([email protected]) after publication of this study. De-identified participant data, data dictionary, study protocol, informed consent language, statistical analysis plan etc. will all be made available based on a proposal with a valuable research question as assessed by the study team.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors approved the final version of the manuscript prior to submission.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCaputi L, Engelmann L, Stasinopoulos J. An Interdisciplinary Approach to the Needs of Non-Native-Speaking Nursing Students: Conversation Circles. Nurse Educ. 2006 May;31(3):107\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eStarr K. Nursing Education Challenges: Students with English as an Additional Language. J Nurs Educ. 2009 Sep;48(9):478\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eDavis CR, Nichols BL. Foreign-Educated Nurses and the Changing U.S. Nursing Workforce. Nurs Adm Q. 2002 Winter;26(2):43. \u003c/li\u003e\n\u003cli\u003eOlson MA. 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NeuroImage. 2002 Apr 1;15(4):879\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eArdila A. Language representation and working memory with bilinguals. J Commun Disord. 2003 May 1;36(3):233\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eXue G, Dong Q, Jin Z, Chen C. Mapping of verbal working memory in nonfluent Chinese\u0026ndash;English bilinguals with functional MRI. NeuroImage. 2004 May 1;22(1):1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAlnahdi MA, Alhaider A, Bahanan F, Aldubaikhi A, Aljehani A, Omair A, et al. The impact of the English medical curriculum on medical history taking from Arabic speaking patients by medical students. J Fam Med Prim Care. 2021 Mar;10(3):1425. \u003c/li\u003e\n\u003cli\u003eZhong Y, Liu EA, Young KZ, Miller J, Heung M. Medicine in Mandarin: Introducing Native Language Training in a Medical School Curriculum. MedEdPublish. 2019 Nov 15;8:205. \u003c/li\u003e\n\u003cli\u003eDaniels BC, Flack JC, Krakauer DC. Dual Coding Theory Explains Biphasic Collective Computation in Neural Decision-Making. Front Neurosci. 2017 Jun 6;11:313. \u003c/li\u003e\n\u003cli\u003eKeller AS, Davidesco I, Tanner KD. Attention Matters: How Orchestrating Attention May Relate to Classroom Learning. CBE\u0026mdash;Life Sci Educ. 2020 Sep;19(3):fe5. \u003c/li\u003e\n\u003cli\u003eTullis JG, Benjamin AS. On the effectiveness of self-paced learning. J Mem Lang. 2011 Feb;64(2):109\u0026ndash;18. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical education, Arabic, reducing barriers, healthcare system","lastPublishedDoi":"10.21203/rs.3.rs-8007732/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8007732/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMany health professional students in Arabic-speaking countries face a linguistic transition when advancing from high school to health professional school, as the language of instruction changes from their native language Arabic, to English. This change presents a barrier as it might limit their ability to understand core health concepts taught in the medical school, or even access third-party educational resources which are available only in English. This study examines the impact of Arabic captioned educational videos on comprehension and academic performance among Arabic-speaking health professional students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eTo reduce language barriers faced by Arabic-speaking students using English-language content, Arabic captions were created for freely available Osmosis videos on their YouTube channel. Chain of Education partnered with Osmosis from Elsevier to assemble a team of qualified healthcare students and professionals fluent in both Arabic and English who captioned the videos. We investigated the efficacy of this intervention in improving Arabic-speaking healthcare students’ retention of material and access to educational opportunities. We performed research on a convenience sample of 82 students solicited through the partnership, who completed a confidential survey via Google Forms .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings: \u003c/strong\u003eResponse rate was 65%, the majority of whom were medical students. Of respondents, 83% self-reported their understanding of healthcare concepts as greatly improved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation: \u003c/strong\u003eOur findings suggest that providing Arabic captions for English-language medical content enhances self-reported confidence and learning. This may reduce linguistic barriers in accessing healthcare education. Interventions similar to ours can improve health literacy and further reduce barriers in healthcare education. Other interventions, such as preparing healthcare educational content originally in Arabic, would be helpful to further reduce barriers in healthcare education.\u003c/p\u003e","manuscriptTitle":"Language of Healthcare: Chain of Education to Reduce Barriers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 16:47:20","doi":"10.21203/rs.3.rs-8007732/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-12-20T18:37:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222077204611898777194657901351082602883","date":"2025-12-20T17:38:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-18T12:57:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T04:27:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-21T06:31:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-20T22:18:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-20T22:15:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7b4dbe97-2875-4d67-b470-11506662bae2","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:47:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 16:47:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8007732","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8007732","identity":"rs-8007732","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}