Introduction The effectiveness of medical school efforts in addressing suboptimal student wellbeing rests, in part, on how students perceive their learning environment. The study aim was to determine whether students’ sport background was a contributing factor in students’ perceptions of the medical program as supportive of their basic psychological needs for autonomy, competence, and relatedness. We also examined the relationship between sport background and students’ leisure-time exercise in medical school.

Methods Using an online questionnaire, quantitative data were collected from students enrolled in the 4‑year medical program at a large Canadian university. Two hundred (n = 200) students had complete responses on the measures used in the study. Analysis of variance and correlational analysis were used to examine the relationships between students’ sport background, their perceptions of the learning environment, and leisure-time exercise in medical school.

Results Compared with students with no sport background, students with a team sport background perceived their need for relatedness to be satisfied to a greater degree in the medical program. Students who pursued sports at higher levels of involvement (competitively) perceived the medical program as more autonomy-supportive than students who pursued sports at lower levels of involvement (recreationally). Irrespective of their sport background, students’ involvement in leisure-time exercise decreased over the years in the medical program. However, students with a sport background engaged in leisure-time exercise in medical school to a greater extent than students with no sport background.