Background: The outbreak of 2019 coronavirus disease (COVID-19) could increase the risk of academic anxiety among medical students. Research has revealed that academic anxiety was a risk factor for self-handicapping, however, little is known about the underlying mechanisms that may mediate or moderate this association. This study examined the mediating role of procrastination and moderating role of hardiness in the association between academic anxiety and self-handicapping during the COVID-19 pandemic.Methods: This study measured academic anxiety, self-handicapping, procrastination and hardiness in a sample of 320 Chinese medical students, and explored the relationship between variables.Results: Results showed that academic anxiety was positively correlated with procrastination and self-handicapping, and negatively correctly with hardiness; procrastination was positively correlated with self-handicapping, and negatively correctly with hardiness; hardiness was negatively correctly with self-handicapping. Furthermore, procrastination partially mediated the relationship between academic anxiety and self-handicapping, and both the effects academic anxiety on self-handicapping and the mediating effect of procrastination were moderated by hardiness. The direct effect was stronger for medical students with lower hardiness, and the indirect effect was potent for medical students with both levels of hardiness.Conclusion: During the COVID-19 outbreak, the effect of academic anxiety on self-handicapping of medical students was affected by procrastination and hardiness. These findings suggest that we need to pay attention to the academic anxiety and procrastination of medical students during the COVID-19 pandemic, and we can intervene in self-handicapping by cultivating hardiness in the future.