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This mixed-methods study investigates language attitudes and proficiency among 100 first-year medical science students at Tlemcen University, Algeria, focusing on their use of and perceptions toward Modern Standard Arabic (MSA), French, and Algerian Arabic (AA) as languages of instruction. Findings reveal a disconnect between official language policy-Arabisation through MSA-and actual linguistic practices. Despite expressing positive attitudes toward MSA, students demonstrate limited productive proficiency in French, the de facto language of scientific instruction, and frequently resort to code-switching between AA and French to navigate academic discourse. Surprisingly, many students express a strong preference for using Algerian Arabic as a medium for learning scientific content, highlighting its functional role in comprehension and communication. The study uncovers a significant gap between policy, practice, and student preference, exacerbated by negative attitudes toward code-switching despite its widespread use. It concludes with a call for educational reform and suggests a potential shift toward English as a medium for scientific education in Algeria.