This study aims to investigate development of middle school pre-service mathematics teachers' mathematical literacy through teacher education program on some PISA items. Participants of this qualitative study were 22 pre-service teachers who were at fourth or sixth term. In first section, a test consisted of 5 PISA items was carried out with participants. In second section, clinical interviews with same PISA items lasted approximately ninety minutes were conducted with selected five participants via criterion sampling from 22 graduated participants. Data from test and clinical interviews were analysed by qualitative methods. According to the results of first section, participants had difficulties in mathematization, especially making relations between variables in the problem, interpreting graphics and participants' mathematical literacy was not desirable. Participants could not progress in mathematical literacy from fourth term to graduation, had still difficulties in mathematization. Besides, participants assessed aims of items in the context of concept knowledge, mathematical abilities related to items not in the context of attaching importance to mathematical literacy. Participants could assess appropriateness of items for middle grades except difficult items for them.