The classroom is considered a social institution in which the social interaction that happens between students and professors in a university setting is of prime importance. Accordingly, classroom participation as an important variable in this setting and pros and cons to grading the students' class participation have been considered to be researched further to answer four research questions regarding EFL students' perception toward: (1) their class participation; (2) the common factors that hinder or encourage their participation; (3) grading or not grading class participation; and finally (4) positive and negative effects of grading class participation. To answer these questions, this study applied a qualitative descriptive research method using a case study to collect data first from 120 medical students through four close and open- ended questions and then through interview with 10 students. The results showed that majority of the students (85%) do not consider themselves as active participants in their English classes, and psychological, physical and teacher factors are regarded as intensives for their class participation while cultural norms, textbook and teacher factors are among the factors that prohibit students' class participation. Furthermore, about half of the students reported that they are indifferent about whether class participation is graded or not because they are not intrinsically motivated to even study English. Pedagogical implications based on the above mentioned findings have been provided for teachers in this article.