This study was conducted to identify key issues for students in an undergraduate medical course with cross border delivery and the impact of these issues on the students' ability to learn. Data relating to the student experience and perceived student needs were collected from transnational students and teaching staff from Australia and Malaysia. The results highlight the complexities of migration from one learning environment to another and suggest the need for a cohesive institutional approach to support medical student movement between culturally diverse settings as well as the translation of medical curriculum from one cultural context to another. We describe how the particular needs of transnational students moving across borders align with Maslow's hierarchy of unmet needs and can be met through low cost, long reach institutional initiatives. These must be supplemented by interpersonal approaches in which institutions can also foster. The outcomes will benefit local as well as transnational students and staff. (Contains 4 tables and 1 figure.)