Background <p>The global expansion of English Medium Instruction (EMI) in medical education has intensified demands on students who must simultaneously acquire disciplinary knowledge and operate in a non-native language. This study investigates the coping strategies employed by Arabic-speaking medical students across three Saudi public universities, contributing empirical evidence on how learners adapt to linguistically complex EMI medical contexts.</p> Methods <p>A convergent mixed-methods design combined semi-structured interviews (<i>n</i> = 50 female students), questionnaires (<i>n</i> = 289), and non-participant observations (<i>n</i> = 9) across classrooms, study groups, and laboratories. Qualitative data underwent thematic analysis using NVivo; quantitative data were analysed using descriptive statistics (frequencies and percentages) in SPSS version 27. Triangulation enhanced validity, with trustworthiness ensured via member checking and reflexivity.</p> Results <p>Students deployed a dynamic repertoire of strategies: multimodal resource use (e.g. 60% commonly watched Arabic YouTube videos, 25% English), translanguaging and translation (68% translated terms), memorisation via flashcards, and collaborative practices (e.g., group translation of slides). Observations confirmed these as central mechanisms for accessing, processing, and consolidating medical knowledge, evolving with proficiency.</p> Conclusions <p>These practices are essential for disciplinary learning in EMI medical education and can also be understood as preparing students for participation in multilingual medical settings where English functions as a shared professional resource. Findings offer insights for policy, curriculum design (e.g., legitimising translanguaging, embedding multimodality), and pedagogical and language support, particularly where content is taught through a foreign language. They underscore the need for bilingual approaches to enhance clinical readiness and equity in EMI medical contexts.</p>