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We explored the underlying mechanism for South Korean university students’ negative responses to English-medium instruction (EMI) courses. Specifically, English language anxiety and confidence, and EMI course attitudes and avoidance were analyzed using survey data from 187 Korean university students. Results showed that English language anxiety played a key role in both EMI course attitudes and avoidance, and also affected student achievement in EMI courses. Students’ English language confidence and their perceptions of their instructors’ English language competence were found to be unrelated to EMI course attitudes and avoidance, but were negatively related to English language anxiety. In addition, students’ EMI course content understanding and grades did not directly influence EMI course avoidance, but did indirectly influence course avoidance through EMI course attitudes. Our results highlight the importance of addressing students’ emotional challenges and attitudes to improve their motivation to take EMI courses.