Aim <p>By investigating the current state of online learning environments in medical education and students’ academic emotions, this study aims to further understand the association between online learning environments and academic emotions, thereby providing insights for optimizing the online learning environment in medical education.</p> Design <p>A cross-sectional study.</p> Settings and participants <p>The study employed a convenience sampling method to select participants from a sample of 317 medical school students at a university in China.</p> Methods <p>The study was conducted from September to November 2023. Data was collected using General Information Questionnaire, Online Learning Environment Assessment Scale, and College Students’ General Academic Emotions Questionnaire. Pearson’s correlation coefficient was used to examine the association between the online learning environment and academic emotions. And the ENTER method was chosen for multiple linear regression analysis.</p> Results <p>The results showed that content design had a significant positive association on positive activating emotions. Learning assessment had significant negative association on negative activating emotions and negative deactivating emotions. Website design had a significant positive association on negative deactivating emotions.</p> Conclusions <p>In order to increase positive academic emotions and decrease negative emotions among medical students in online learning, improvements can be made in the areas of content design, learning assessment, and website design, which in turn will improve the effectiveness of online learning.</p>