ABSTRACT: PURPOSE:To investigate the contributions of psychological needs (autonomy, competence, and relatedness) and coping strategies (self-compassion, leisure-time exercise, and achievement goals) to engagement and exhaustion in Canadian medical students. METHODS:This was an observational study. Two hundred undergraduate medical students participated in the study: 60.4% were female, 95.4% were 20-29 years old, and 23.0% were in year 1, 30.0% in year 2, 21.0% in year 3, and 26.0% in year 4. Students completed an online survey with measures of engagement and exhaustion from the Oldenburg Burnout Inventory-student version; autonomy, competence, and relatedness from the Basic Psychological Needs Scale; self-compassion from the Self-Compassion Scale-short form; leisure-time exercise from the Godin Leisure-Time Exercise Questionnaire; and mastery approach, mastery avoidance, performance approach, and performance avoidance goals from the Achievement Goals Instrument. Descriptive and inferential analyses were performed. RESULTS:The need for competence was the strongest predictor of student engagement (?= 0.35, P= 0.000) and exhaustion (?= -0.33, P= 0.000). Students who endorsed mastery approach goals (?= 0.21, P= 0.005) and who were more self-compassionate (?= 0.13, P= 0.050) reported greater engagement with their medical studies. Students who were less self-compassionate (?= -0.32, P= 0.000), who exercised less (?= -0.12, P= 0.044), and who endorsed mastery avoidance goals (?= 0.22, P= 0.003) reported greater exhaustion from their studies. Students' gender (?= 0.18, P= 0.005) and year in medical school (?= -0.18, P= 0.004) were related to engagement, but not to exhaustion. CONCLUSION:Supporting students' need for competence and raising students' awareness of self-compassion, leisure-time exercise, and mastery approach goals may help protect students from burnout-related exhaustion and enhance their engagement with their medical school studies.