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The milieu of tertiary education has always been regarded as a highly stressful environment for students especially for medical students. The study aims to explore the stress level, stressors, and coping strategies among first year medical students in Malaysian public universities and factors contributed to the stress at the end of year. A multicenter cross-sectional study involving four Malaysian public universities. The 12-item General Health Questionnaire (GHQ-12), Medical Student Stressor Questionnaire (MSSQ) and Brief COPE inventory were self-administered to measure stress level, sources of stress and coping strategies respectively among the participants. Calculated sample size was 387. Out of 387 selected participants, 359 (92.7%) responded to this survey. This study found that the prevalence (at the end of the year) of distressed first year medical students was 50%. The major stressors across the universities were academic-related issues. The top five coping strategies were religion, active coping, positive reinterpretation, acceptance and planning. University, parent income, academic activities, group activities, and desire related stressors were significant factors contributing to the students’ stress (p-value< 0.05). This study found that there was a high prevalence of distressed among first year medical students at the end of year, the major stressors were related to academic and contributing factors of stress were related to university, coping strategy, types of stressor and parent income status. Training first year medical students on adaptive coping strategies, managing stressors, and improving …