The Covid-19 pandemic imposes global disruption. Closing of medical schools including all teaching activities and clinical placement is mandatory to reduce the risk of spreading the disease. These sudden changes may have a significant effect on medical students’ well-being. This study aims to explore the challenges faced and coping strategies used by preclinical year medical students during a pandemic. This is a qualitative study involving 11 preclinical year medical students; four international and seven local students. The study, conducted between August 2020 and September 2020 at an international medical university in Malaysia, explored the mental health and well-being challenges the students faced during the pandemic, and their coping strategies. The data were analyzed through thematic analysis to assist in answering the research questions. Multiple challenges contributing to the medical students’ mental health were identified. These included the psychosocial impact of quarantine, significant lifestyle changes, and impact of skills competency and professional progression during a pandemic. The students used behavioral strategies, re-appraised the uncertainties of situation, applied active coping mechanism, and regulated their emotion with coping reserve to manage the challenges during a pandemic. There are indications of personality traits underlying the way medical students choose to cope with challenges faced during pandemic which may either lead to resilience building or experiencing burnout. The findings of the study highlighted the urgent need to develop preventive measures and intervention strategies to address the mental health of medical students to mitigate stress and promote positive well-being.