Programs designed to assist medical students in academic difficulty typically fail to consider the importance of such factors as academic anxiety and the individual's mechanisms for coping with stress. The authors have addressed this issue by examining relationships among prior achievement, academic anxiety, locus of control, and performance in the first year of medical school. Academic anxiety not only was found to be significantly related to first year performance, but also, when combined with a measure of prior achievement, resulted in a significant increase in prediction. Additional evidence is presented which suggests that the relationship between academic anxiety and achievement may be curvilinear. Locus of control was found to correlate significantly with academic anxiety and tended to shift in a direction of greater externality during the first year of medical school. Findings are discussed within the framework of existing psychological research, and implications are presented for medical admissions, curricula, and counseling.