Abstract: Objective Investigate the academic performance of medical students in rural and remote discipline rotations by rurality of placement. Design A retrospective cohort study. Setting Rural and remote clinical placement locations in Queensland, Australia. Participants University of Queensland third-year medical students. Main outcome measures In this study, student results for a range of assessments are the main outcome measures with rural area of student placement locations as categorised by the Australian Standard Geographical Classification – Remoteness Areas system the independent variable of interest. Results There was a significant effect of Australian Standard Geographical Classification – Remoteness Areas of placement on the health project, clinical case presentation, clinical participation assessment and overall grade, after controlling for the potential confounding impact of sex, age, students who attended the rural clinical school, cohort year, rotation during the year and type of health service where students were placed. No significant effect of rural placement level was identified for the written examination, poster or journal of achievement assessments. Conclusion Medical students’ academic achievement is associated with many factors, but this study shows that being placed in remote areas is one factor that either does not impede or can positively influence the learning and academic performance of medical students.