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Academic advising is pivotal for student success, satisfaction, and personal development in higher education. However, the effectiveness of advising systems can vary, underscoring the need to understand student perspectives for continuous improvement. This study aimed to examine satisfaction levels and attitudes toward academic advisors among students at Ardabil University of Medical Sciences (ARUMS), Iran, and to investigate factors influencing these perceptions. A descriptive-survey, cross-sectional study was conducted during the 2023–2024 academic year. A total of 314 undergraduate and postgraduate students from five medical science faculties (Medicine, Public Health, Paramedical Sciences, Pharmacy, Dentistry) at ARUMS, selected via proportional stratified sampling, completed a validated, self-administered questionnaire. The instrument gathered data on demographics, attitudes towards the advising system (5-point Likert scale), and satisfaction with assigned advisors (17 items, 5-point Likert scale, total score 0–85). Data were analyzed using descriptive (means, SD, percentages) and inferential statistics (t-tests, ANOVA). Overall, 68.8% of students reported satisfaction with their assigned advisor, with a mean satisfaction score of 53.3 ± 15.3 (out of 85). Students were most satisfied with advisors’ polite and respectful behavior (68% satisfaction) and reliability (51%). Conversely, dissatisfaction was highest concerning help with personal/family issues and guidance on course selection and dropping. Regarding attitudes towards the advising system, students highly valued advisors’ ethical conduct in communication (72% positive) and their role in academic guidance (68% positive), but expressed lower confidence in advisors’ effectiveness in solving personal problems (43% positive) or their overall capability and qualification (52% positive). A significant difference in satisfaction was observed by academic year, with second-year students reporting the highest (57.1 ± 15.1) and fifth-year and above students the lowest (48.2 ± 13.7) satisfaction (p < 0.05). Multiple linear regression analysis revealed that the total attitude score toward the advising system was the only significant predictor of student satisfaction (), accounting for 18.7% of the variance. Students at ARUMS generally acknowledge the importance of academic advising and appreciate respectful interactions with advisors. However, moderate overall satisfaction levels and specific areas of concern regarding advisor competence in non-academic support and core academic functions like course guidance highlight a significant opportunity for improvement. Programs should routinely assess student expectations, clarify the advisor role, and provide targeted training and institutional support for advisors to improve student satisfaction.