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This study applies Reeve's four-dimensional student engagement framework to a medical education context to elucidate the relationship between behavioral, affective, cognitive, and agentic engagement and learning outcomes. We used the China Medical Student Survey to investigate student engagement, and combined it with the Clinical Medicine Proficiency Test for Medical Schools results as a standardized measurement of learning outcomes. We performed multivariate regression analyses to investigate the effectiveness of different types of student engagement, and evaluated the moderating roles of gender and the National College Entrance Examination (NCEE). We observed that emotional and cognitive engagement could effectively contribute to learning outcomes, while behavioral and agentic engagement negatively affected learning outcomes. Besides, the NCEE played a positive moderating role.