Background: Papua New Guinea, a lower middle income country with a population of around 8.5 million, the majority of whom live in rural areas, produces far fewer than the number of medical graduates required to meet the WHO-recommended doctor/population ratio. The School of Medicine and Health Sciences is under pressure to increase its output and ensure the graduates are able to function in rural settings. Through two studies, we aimed to determine the predictors of student performance and their socioeconomic and educational background to assist in determining admission policies and improve completion rates. Methods: A retrospective study analysed data relating to student performance from six annual cohorts. A cross-sectional study among currently enrolled students sought information about their socioeconomic and educational background. Results: Of the 300 students enrolled in the six cohorts, 176 (59%) completed the programme in the scheduled 4 years. There were no differences in completion rates by gender or route of entry to the programme. Grade point average at medical school entry predicted academic performance. Sixty-four per cent of the students who failed to complete in four years attributed their poor academic performance to social issues. Overall attrition was only 8%. Seventy-six per cent (162/214) of the enrolled students completed the cross-sectional survey. Most (79%) of students' fathers and 58% of mothers had postsecondary education. Seventy-three per cent of respondents indicated that they had been to preschool or elementary school. Thirty-six per cent had attended primary school in a village or government/ mission station. Just over half (53%) of the students indicated that English had been the language most used in primary school. Males were more likely to have made a specific career choice than females. The majority (141/162, 88%) of the students indicated that they had experienced some academic difficulty during the years. Conclusion: Prior academic performance predicted timely completion of the MBBS programme. Just over a third of students had attended rural village primary schools. Social and domestic issues were common and adversely affected academic performance.