Medicanes are cyclones over the Mediterranean Sea having a tropical-like structure but a rather small size, that can produce significant damage due to the combination of intense winds and heavy precipitation. Future climate projections, performed generally with individual atmospheric climate models, indicate that the intensity of the medicanes could increase under climate change conditions. The availability of large ensembles of high resolution and ocean–atmosphere coupled regional climate model (RCM) simulations, performed in MedCORDEX and EURO-CORDEX projects, represents an opportunity to improve the assessment of the impact of climate change on medicanes. As a first step towards such an improved assessment, we analyze the ability of the RCMs used in these projects to reproduce the observed characteristics of medicanes, and the impact of increased resolution and air-sea coupling on their simulation. In these storms, air-sea interaction plays a fundamental role in their formation and intensification, a different mechanism from that of extra-tropical cyclones, where the baroclinic instability mechanism prevails. An observational database, based on satellite images combined with high resolution simulations (Miglietta et al. in Geophys Res Lett 40:2400–2405, 2013), is used as a reference for evaluating the simulations. In general, the simulated medicanes do not coincide on a case-by-case basis with the observed medicanes. However, observed medicanes with a high intensity and relatively long duration of tropical characteristics are better replicated in simulations. The observed spatial distribution of medicanes is generally well simulated, while the monthly distribution reveals the difficulty of simulating the medicanes that first appear in September after the summer minimum in occurrence. Increasing the horizontal resolution has a systematic and generally positive impact on the frequency of simulated medicanes, while the general underestimation of their intensity is not corrected in most cases. The capacity of a few models to better simulate the medicane intensity suggests that the model formulation is more important than reducing the grid spacing alone. A negative intensity feedback is frequently the result of air-sea interaction for tropical cyclones in other basins. The introduction of air-sea coupling in the present simulations has an overall limited impact on medicane frequency and intensity, but it produces an interesting seasonal shift of the simulated medicanes from autumn to winter. This fact, together with the analysis of two contrasting particular cases, indicates that the negative feedback could be limited or even absent in certain situations. We suggest that the effects of air-sea interaction on medicanes may depend on the oceanic mixed layer depth, thus increasing the applicability of ocean–atmosphere coupled RCMs for climate change analysis of this kind of cyclones.