Background <p>International medical students experience diverse stressors that extend beyond academic demands to include challenges of cultural adaptation, institutional management, and experiences of discrimination. Understanding the structure of these interrelated stress domains is essential for developing effective educational and support strategies. This study examined the multidimensional structure of stress among international medical students using a construct-based analytical approach grounded in the Transactional Model of Stress and Coping.</p> Methods <p>A cross-sectional survey was conducted with 322 international students enrolled in the English-language medical program at the Medical University of Varna, Bulgaria. Participants completed a self-report questionnaire informed by standardized instruments, including the University Stress Scale and the Academic Stress Scale. Confirmatory factor analysis (CFA) was used to test a four-factor model comprising academic, adaptation, management, and discrimination-related stress.</p> Results <p>The proposed model demonstrated good fit to the data (χ²(48) = 70.08, <i>p</i> = .020; CFI = 0.941; TLI = 0.918; RMSEA = 0.047; SRMR = 0.060), supporting the conceptualization of stress among international medical students as a multidimensional construct. Academic stress emerged as the strongest factor, while strong correlations were observed among the stress domains, particularly between adaptation and management stress, indicating that adjustment difficulties and institutional challenges are closely interconnected.</p> Conclusions <p>The findings underscore the need for comprehensive institutional strategies that address multiple dimensions of student well-being. Implementing culturally responsive counseling, peer mentoring, and transparent administrative communication may reduce overall stress and enhance adaptation and resilience among international medical students.</p>