A good start in researching on language teaching and learning issues is to first analyse target learners’ actual performance and their needs. This mixed-methods 2-cycle study is aimed to analyse medical-college students’ language needs through two instruments—a self-rated report and a guided focus group. Out of the main four language skills (speaking, reading, listening, and writing), Cycle 1 aimed at exploring the most trouble-provoking skill for EMP students through a 7-item rating report with a sample of 45 participants. Based on the results of Cycle 1 which labelled speaking as the most problematic language skill for the target learners, Cycle 2 proceeded with 9 interviewees to narrow the study focus on the factors contributing to the inefficiency of speaking skills among EMP learners, discussing solutions from the learners’ perspectives. Pedagogically, this research helps practitioners innovate and integrate new techniques in language teaching and learning to overcome the issue of students’ speaking performance that has been deemed below expectations.