Background: Penang Medical College is a joint Ireland-Malaysia project in which Malaysian students spend their initial 3 years in Ireland and complete their clinical training in Penang and receive Irish qualifications and registration. The educational foundations for such a program, particularly in general practice/primary care, are complex. Objectives: To explore the experiences of current students undertaking clinical training at Penang. Methods: All students were invited to complete an anonymous, confidential questionnaire dealing with foundation course availability and participation, the perceived value of such courses and suggestions for change. Results: Two thirds of all students responded. Attendance at foundation courses varied greatly as did the perceived value of such courses for clinical training. Early patient contact and communications skills courses scored most highly. More 'hands-on' clinical skills training was requested. No student raised ethical, legal or economic issues although these areas include very significant differences between the countries. Discussion: Educational bridges which link the learning and healthcare environments in which students work are crucial in this novel undergraduate setting. Conventional educational structures have value for students but access and relevance can be improved. Students are highly conscious of the differences between these environments but prize familiar themes such as clinical skills training over less tangible areas such as ethical or social structures.