Background <p>Situational judgment tests (SJTs) are becoming more widely accepted for assessing medical students’ behavioral (non-cognitive) competencies. However, the correlation between behavioral and clinical competencies is under-explored, particularly in sub-Saharan Africa. Using a validated SJT questionnaire, this study examined the association between SJT and the academic performance of clinical medical undergraduates in Enugu state, Nigeria.</p> Method <p>This was a cross-sectional study of 279 clinical medical students at the Enugu State University of Science, Management and Technology (ESUT), Nigeria. The results of the SJT of behavioral competencies were collected using a pre-tested, validated, and self-administered questionnaire. Cronbach’s alpha for SJT competencies was below 0.7, which reflects domain heterogeneity rather than poor tool precision. The association between the dependent variable (SJT performance) and individual-level predictors was assessed using both bivariate and multivariate linear regressions. Statistical significance was set at <i>p</i> &lt; 0.01.</p> Results <p>An increase in students’ academic performance predicted a decrease in their SJT performance by 3% (β= -0.03; <i>p</i> = 0.21), but this finding was not statistically significant. Having a grade of A or B in chemistry, compared to a grade of C4 or below, predicted a statistically significant increase in SJT performance by 15% (β = 0.15; <i>p</i> = 0.01). Being a male student predicted a decrease in the SJT score by 8% (β= -0.08; <i>p</i> = 0.09). The results also showed that students’ state of origin (β = 0.28; <i>p</i> = 0.04) correlated with their SJT performance.</p> Conclusion <p>Our study findings suggest that students who perform better clinically are less likely to have higher behavioral competence. However, the negative association between clinical performance and SJTs is not always statistically significant. This has implications for training and implies that excellent clinical education may not facilitate the production of better doctors, but this is not always the case. Hence, there may be a case for incorporating mechanisms to specifically build behavioral competencies in medical students being trained. There is a need for studies that examine these associations in other contexts and test the impact of trainings and other mechanisms in building behavioral competencies in medical professionals.</p> Clinical trial registration <p>Not applicable.</p>