This within subjects study assessed the effectiveness of a previously published vignettes approach to the teaching of suicide risk factors in a cohort of students in an Omani medical school. As part of their learning, students were asked to rank four case descriptions for suicide risk, after which there was a specific discussion of the cases and of suicide risk assessment. A previous study had shown significant and dramatic improvement in students from a US university. However the students in this study showed a very different profile of learning about suicide risk from this activity. They had particular difficulty in weighing risk and protective factors when determining relative risk. The impact of cultural and religious context on the effectiveness of this learning activity is discussed. It is clear that there is a continuing need for evaluation and research as to the efficacy of developments in medical education as they are applied in international medical schools with students of different cultural and religious backgrounds.