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The medical course has always been regarded as highly stressful. Excessive stress causes physical and mental health problems. Persistent stress will impair students' academic achievement, personal and professional development. As the prevalence of psychological distress is rising rapidly among the medical student community, it is important to understand their stressors and coping strategies for creating a psychological-friendly environment for the students in the future. A multi-center cross- sectional study involving four Malaysian public universities was done. The prevalence of psychological distress among first year medical students in the four public universities was high. Academic related problems were the major stressor among the medical students across the four universities. The main coping strategies across the universities were religion, active coping, and positive reinterpretation. The factors most significantly contributed to the students' psychological distress were university, parent income group, and perception toward stressors related to academic, group activities, and drive and desire to study medicine.