Background <p>China has become a major destination for international medical students, supported in part by English-taught Bachelor of Medicine and Bachelor of Surgery (MBBS) programmes. Existing research has tended to examine study motivations and learning outcomes separately, providing limited insight into how motivations are formed and how perceptions of academic and career returns evolve over the extended course of medical training. This study examines the formation of international MBBS students’ motivations to study clinical medicine in China and explores changes in their perceptions of academic and career returns over time.</p> Methods <p>A qualitative design was employed. Semi-structured interviews were conducted between June and November 2025 with 17 international medical students enrolled in MBBS programmes at two public universities in China. Participants were purposively sampled across different years of study and were mainly from Asian and African countries. Interviews were conducted in English or Chinese, audio-recorded, and transcribed verbatim. Data were analysed using thematic analysis supported by NVivo 12 software. The analysis was guided by push–pull theory, expectancy-value theory, and professional identity theory, with rigor enhanced through member checking and peer review.</p> Results <p>Two overarching themes, four subthemes, and fifteen specific categories emerged. Students’ motivations reflected push factors in their home countries, including limited access to medical education, high costs, and perceived shortcomings in training quality, alongside pull factors related to China, such as curriculum structure, affordability, degree recognition, safety, and exposure to a high volume of clinical cases. Perceptions of academic and career returns changed over time. Some students perceived higher-than-expected academic and career returns, reflected in shifts in learning approaches, increased professional confidence, and stronger identification with the doctor role. Others perceived expected or lower-than-expected academic and career returns, mainly associated with limited hands-on clinical experience, language-related communication challenges, and uncertainty regarding future career pathways.</p> Conclusions <p>Motivations to study clinical medicine in China were not static, and perceptions of academic and career returns evolved throughout training. Greater attention to students’ learning trajectories, including opportunities for clinical participation, language support, and career guidance, may enhance learning experiences and contribute to longer-term professional development.</p>