BACKGROUND: Feedback is crucial in medical education for developing communication skills and fostering comprehensive learning. Despite its importance, medical students often face challenges in effectively leveraging feedback. This study investigates how students perceive and make sense of internal and external feedback in a 2nd language (L2) medical Dutch course. METHODS: Sixteen third-year international medical students (mean age = 23) participated in a medical Dutch course that included six structured sessions. Each session encompassed a briefing, simulated patient consultations (SPCs), and a debriefing. The curriculum integrated internal feedback from self-reflections and external feedback from peers, teachers, and simulated patients. Data were gathered through a students' feedback perception survey and semi-structured interviews and analyzed via inductive thematic analysis. RESULTS: Survey data indicated a trend where the preference, satisfaction, and trust in external feedback were higher than those for internal feedback. However, both types of feedback were regarded as equally effective in facilitating learning progress. Through thematic analysis, we identified five crucial themes that show how students perceive and make sense of various forms of feedback: proactive engagement with feedback, critically analyzing and utilizing the exchange in dialogues and discussions, self-reflection and progress tracking, value from diverse perspectives, and moment-specific and actionable feedback. CONCLUSIONS: This study emphasizes the vital roles of internal and external feedback in enhancing medical Dutch communication skills among medical students. Internal feedback encourages self-reflection and growth, essential for complex medical communications, while external feedback provides clear, specific and supportive guidance and experience from teachers, simulated patients and peers. These feedback mechanisms together improve students' skills in medical Dutch communication, leading to better doctor-patient interactions. Future research should focus on adapting these feedback strategies across diverse educational settings to further support the development of medical L2 communication skills in global medical contexts.