Aim: The aim of the research was to identify modifiable factors which affect learning experiences and outcomes for international medical students. Based on the results of the study, recommendations for improving the learning environment and student support services are made.Background: Previous studies have considered the economic and educational benefits of hosting international students on New Zealand institutions and ways to promote the frequency and quality of intercultural contact in universities. Little research has specifically investigated international medical students' educational expectations, experiences and needs. There is anecdotal evidence to suggest that international students face special challenges pursuing medical education at Otago University and have unmet learning and educational needs. Proportionately more international students' names appear than domestic students at the Student Progress Academic Committee meetings, which discuss how to help students who are struggling or failing assessments. The reasons for this over-representation are complex and relate to a combination of communication difficulties, learning styles and attitudinal issues. The research explores some of the challenges faced by international medical students to provide insight into factors which enhance and inhibit learning in order to recommend measures to improve the learning environment.Methods: Data for the study were collected at the University of Otago in 2009 on the experiences of international medical students. Funding came from two research grants. After obtaining ethical approval from the University and review by the Māori Ngai Tahu Committee, study participants were recruited by email, word of mouth and written information. Anonymity was assured. Questions in the semi-structured interview covered: factors that inhibited and enhanced learning, students' experiences of accessing University support services, and students' suggestions for improving the learning environment and support services to meet learning needs. Each interview was taped and transcribed. Thematic analysis of the data collected was initially undertaken using a software programme (Atlas-ti). Manual categorisation and coding of the thirty-one interviews was also carried out by the principal investigator to reveal common themes that were interpreted using both an inductive and deductive approach. Fifty-five students from nine different countries were interviewed at the Dunedin and Wellington campuses. There was a mix of group and individual interviews with students from Years 2-6 of the medical course. Results: International students were generally appreciative of the learning experience in New Zealand. Few instances of racism were reported within the University, but marginalisation by staff and students in learning and social contexts was reported. The more interactive learning style in New Zealand was contrasted to didactic teaching in many of the students' home countries. Social events involving alcohol excluded many international students and inhibited integration with domestic students.Conclusion: Participants' recommendations for improving the learning environment included: proof reading of written work, mentoring in years two and three, coaching for objective structured clinical examinations (OSCEs), and the organisation of social events without alcohol to facilitate socialisation with domestic students. There were also suggestions about preparing overseas students better for studying in New Zealand.