BACKGROUND No country, least of all poorly resourced countries such as India, can afford to lose too many medical students in their undergraduate years. It would be useful to have an instrument to identify those students who are vulnerable to academic failure at this level of training and to identify the features of the educational environment that they perceive differently from students who are succeeding academically in order to design intervention strategies. Gender differences in perceptions of the educational environment might well emerge in particular academic or cultural contexts, with particular curricula. The present study was motivated by this concern and focused on comparisons between academic achievers and under-achievers and male and female students of Kasturba Medical College, India. OBJECTIVE (1) To compare the perceptions of the educational environment of academic achievers and under-achievers and to identify problem areas that should be remediated. (2) To identify whether there is any gender difference in the perceptions. METHODS The Dundee Ready Educational Environment Measure (DREEM) was administered to 508 medical students studying in the clinical years at the Kasturba Medical College in India. Item as well as scale scores were compared between academic achievers and under-achievers. RESULTS Overall sample of the present study rated educational environment in this institution as average. The overall mean DREEM score was significantly higher for academic achievers. Compared to under-achievers, academic achievers scored significantly higher on perceptions regarding teachers, academic atmosphere and social self-perceptions. In addition to this, the overall rating (total DREEM score) of female students was significantly less compared to males in the academically vulnerable group. CONCLUSIONS Perceptions of poor performers are significantly different from those of better performers in the same institution. More importance should be given to the perceptions of students to improve the educational environment, as perceptions are associated positively with learning outcome, learning approach and attitude toward studying. Use of the DREEM as a monitoring tool might permit timely interventions to remediate problematic educational environments.