Assessing learners’ present and real life language needs can contribute to learners’ active participation in learning processes. , Assessing learners’ task-based needs and aligning them with pedagogical tasks are significant in English for medical purpose (EMS) courses. The main objectives of the present study were to assess learners’ needs and to determine whether they are practiced in EMS courses. In this study, pedagogical tasks practiced in EMS courses at universities of medical sciences in Iran were identified and the task-based language learners practiced by stakeholders in real life situations were assessed. The results showed that some of the pedagogical tasks were not aligned with the real life task-based needs. Moreover, the pedagogical tasks and task-based needs were not aligned in terms of mode, channel and degree of interaction. The results can be applied by EMS teachers and material developers for meeting the learners’ specific needs.