This study utilises [1993. "Leaving College: Rethinking the Causes and Cures of Student Attrition." 2nd ed. Chicago: University of Chicago Press] theoretical framework, known as the Model of Longitudinal Departure, to investigate success and failure in foundation year medical school in a Middle Eastern transnational location. This article arises from the qualitative stage (N = 13) of a mixed methods research project. The research investigates the student and staff perspectives of academic success and failure, and identifies factors that influence student academic transition in foundation year medical school. The research constructs a notion termed the 'state of realisation', this is the point at which students recognise and implement learning strategies associated with third-level learning success. The research refines Tinto's 1993 model into an appropriate framework for this transnational setting named the Model of Academic Success and Failure in a Transnational Context. It is within this framework that the constructed notion of the 'state of realisation' is situated.