In Ethiopia, the University Entrance Exam (UEE) score is the only criteria for selecting prospective medical students entering the university system, disregarding their career choice motivation. A cross-sectional study design was conducted to identify medical students career choice motivation and predictors of college academic achievement at Gondar university, Ethiopia. The study was conducted on 222 medical students enrolled at Gondar University in 2016. A self-administered questionnaire was used to collect data on study participants demographic characteristics, career choice motivation, and informed career choice. Data on the UEE score and student's college academic achievement were collected from the university registrar. Descriptive statistics and regression analysis were used to analyze the data. Desire to help others as a medical doctor and prevent and cure diseases were mentioned as the first important career choice reasons by 147 (68.2%) and 135 (64.0%) study participants, respectively. The results of regression analysis showed that the UEE score was significantly associated with pre-clinical cumulative GPA (R2=.327, p<.05) and 5th year cumulative GPA (R2=.244, p<.05) respectively. The stepwise multiple regression revealed that UEE score, having prior knowledge about medical profession, positive experience in the medical school, and intrinsic career choice motivation significantly predicted 5th year cumulative GPA (p<.05). The high beta weight of 0.254 and 0.202 confirmed the strongest prediction to come from prior knowledge about the medical profession and positive experience in medical school, respectively. The UEE score is a significant predictor for medical students' academic achievement, but it should not be the sole admission criterion. We suggest that comprehensive admissions criteria covering both cognitive and non-cognitive factors, as well as informed career choice, be developed to select the best applicants in the future.