This chapter revisits attitudes of and challenges faced by undergraduate students at English-medium instruction (EMI) universities in Hong Kong. The chapter compares findings from recently completed mixed-methods research into language-related challenges of first-year university students in Hong Kong with the findings from the seminal 2011 study by Evans and Morrison. EMI-related studies conducted in Hong Kong have largely focused on the attitudes, challenges and perceptions of the local Cantonese-speaking students at the secondary and tertiary level. While local students continue to make up the great majority of student populations at Hong Kong universities, a growing number of non-Chinese local students from various ethnic backgrounds, combined with a substantial increase in the number of international students over the past two decades, has begun to impact the Hong Kong tertiary-level linguistic landscape. As local universities continue to follow the global trend of internationalization of higher education, continued growth of student diversity is expected. Additionally, educational reforms in Hong Kong in 2012 replacing the three-year curriculum with a new four-year programme have resulted in most local students transitioning to university with one less year of exposure to English at secondary school, and an additional year of EMI at university. The chapter provides valuable information for EMI stakeholders with regard to pedagogical development and makes recommendations for further research on EMI praxis and policy in Hong Kong.