Academic satisfaction (AS)-the extent to which people enjoy their role or experiences as medical students-has important implications for well-being and career development. This study explores the relationships between social cognitive factors and AS in a Chinese medical education context. The social cognitive model of academic satisfaction (SCMAS) was adopted as the theoretical framework. Within this model, AS is assumed to be related to social cognitive factors-environmental supports, outcome expectations, perceived goal progress and self-efficacy. Demographic variables, financial pressure, college entrance examination scores and social cognitive constructs in SCMAS were collected. To explore the relationships between medical students' social cognitive factors and AS, hierarchical multiple regression analyses were performed. The final sampled data consisted of 127 042 medical students from 119 medical institutions. Demographic variables, financial pressure and college entrance examination scores were first entered in Model 1, explaining 4% of the variance in AS. Social cognitive factors were entered in Model 2, explaining an additional 39% of the variance. Medical students would report higher levels of AS when they (a) held strong confidence in their skills needed for success in studying medicine (β = 0.20, p < 0.05), (b) had optimistic beliefs about the outcome of studying medicine (β = 0.40, p < 0.05), (c) felt that they were making good progress in studying medicine (β = 0.06, p < 0.05) and (d) believed that they received adequate environmental support (β = 0.25, p < 0.05). The outcome expectations showed the strongest correlation with AS, and each 1-point increase was associated with 0.39 points on the AS score, controlling for all other factors in the model. Social cognitive factors play an important role in medical students' AS. Intervention programmes or courses aiming to improve medical students' AS are advised to consider social cognitive factors.