This study investigated the medical students’ English language learning needs and their perceptions of ESP courses in an academic environment. To do this, 100 medical students studying medical sciences in the faculty of medicine in Mashhad, Iran, were selected as the participants. Hutchinson and Waters’ target language needs analysis framework was drawn on as the analytic model guiding the study. A needs analysis questionnaire was used for data collection. The questionnaire designed to identify the learners’ perceptions of the frequency of English language skills/sub-skills use, the importance of English language learning, their ability in using language skills, their needs of language learning and their preferences of an English language course. After gathering and analyzing the data, it was found that reading skill is given priority by the students in terms of frequency of use, importance and proficiency. It also revealed that students need and prefer training in speaking, listening and communication skills. Considering the students’ perceptions of the current ESP course, the findings implied that the English language skills incorporated in the current ESP book for the medical students and the allocated time for this course are not compatible with the English language learning needs and wants of the students.