<![CDATA[The integration of 21st-century skills—critical thinking, collaboration, communication, and creativity—into English language education is essential for preparing health vocational students to meet the demands of a globalized healthcare industry. This systematic review examined how these skills are embedded within English language teaching for health vocational students and evaluates the effectiveness of innovative pedagogical approaches, including Project-Based Learning (PJBL) and Problem-Based Learning (PBL). Using the PRISMA framework, the study reviewed peer-reviewed articles published between 2012 and 2024 from PubMed, ERIC, and Google Schoolar. Inclusion criteria focused on studies addressing the application of 21st-century skills in English for Specific Purposes (ESP) within health vocational contexts. A total of 35 studies met the inclusion criteria and were analyzed to identify themes, methodologies, and outcomes. Key findings indicated that embedding 21st-century skills in English education significantly enhances students' preparedness for workplace communication in healthcare settings. PJ BL fosters critical thinking and collaboration through real-world healthcare scenarios, while Problem-Based Learning enhances problem-solving and contextual language use. However, challenges include limited access to resources, lack of teacher training, and cultural barriers in implementing innovative teaching methods. The study concluded that integrating 21st-century skills into English language education was vital for developing well-rounded health professionals. It recommended incorporating blended learning models, increasing teacher training in innovative pedagogies, and leveraging digital tools to support skill development]]>
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