The graduation of the first class of medical students in May 2008 from the Weill Cornell Medical College in Qatar (WCMC-Q), Cornell University's branch campus in the Middle East, was the first time that an M.D. degree from an American university was awarded abroad. It marked a milestone in American higher education. The establishment of WCMC-Q is part of a larger strategy to promote education and develop science policies in Qatar and other areas of the Gulf Arab States. Development of WCMC-Q has proceeded according to our institution's tripartite mission of fostering excellence in medical education, research, and clinical care. The focus of this article is the development of the educational program in Qatar since its inception, and it reviews critical success factors, the policies aimed at achieving our tripartite mission, and the challenges facing the promotion of medical education in the Gulf region. Critical factors in the success of this project include clearly defined educational objectives, a focus on academic quality and guaranteed academic freedom. Challenges include: 1) faculty recruitment and retention, 2) the integration of local high school students into a competitive science program, 3) the distance separating WCMC-Q from New York City where Weill Cornell Medical College-NY (WCMC) resides. As WCMC-Q continues to grow and expand its long-term mission, it may serve as a model for American universities seeking to establish branch campuses abroad for educational and medical training purposes.