The concept of competition has implications for educational contexts, as hormonal and emotional changes under competitive stress can modulate learning and memory processes. This study examined the impact of a competitive learning environment and associated hormonal and emotional responses on skill acquisition and expression in a medical domain. Using a cross-over design, sixteen male medical students participated in a competitive (in pairs facing each other) and non-competitive (alone) learning situation. In each treatment, an instructional video was followed by a timed straight-line suture evaluation with anxiety and competitiveness recorded. Salivary testosterone (T) and cortisol (C) were assessed at rest, before and after evaluation to quantify changes in T (ΔT) and C (ΔC). These procedures were followed by two sessions of self-directed training before retesting. Paired learning produced a larger positive ΔT (5.9–7.8% vs. 2.0–5.3%) and ΔC (7.6% vs. 3.3%), which was accompanied by more anxiety and elevated competitiveness (p <.01). Anxiety declined and suturing abilities improved over time (p <.001), irrespective of the learning approach, with resting C concentrations decreasing when learning alone (p <.05). Some ΔT and ΔC measures correlated (r = 0.40 to 0.65) with anxiety and competitive desire with paired learning only, whereas the ΔC was linked to suturing performance (r = −0.35) when learning alone. In summary, a tacit competition in a natural learning situation promoted more pronounced hormonal and emotional responses. However, skill acquisition and its expression improved to a similar extent in both situations of competitive and non-competitive assessment. Different adaptive pathways for skill expression and development emerged from this work.