This study employed a blended learning approach to investigate 98 medical university EFL students' perceptions and analyzed the learning trajectory of their LMOOCs in formal education. Meanwhile, Byram's (1997) intercultural communicative competence (ICC) model was adopted to explore if students' English proficiency and ICC abilities could enhance or hinder their LMOOCs. Participants of this elective two-credit course, "English Presentation Skills," were all required to complete one LMOOCs course to earn official certificates for the credits. Questionnaires about self-learning background and intercultural communicative competence, weekly reflections on self-learning, assistant-student interviews, and personal presentations at the final stage are conducted to test the consistency between student self-evaluation and class performance. The rubric of the TOEFL iBT Test was adopted to evaluate students' oral expression. Video clips collected in class were analyzed to track the differences in students' target skills. Findings revealed that before integrating LMOOCs in formal education, it is essential for instructors to equip students with enough self-learning skills through orientations and stress time management in MOOCs learning strategies, and scaffold sufficient English communication skills before students are thrown to sink or swim on their won. A revised version of the ICC model was proposed at the end (the context may vary) in the hope of drawing more attention and voice to this research area. The integration of LMOOCs in formal education, be it for language teaching or self-learning, should be directed toward the level of "precision instruction" in the future.