Abstract: On the threshold of a new era of consequences, it seems the evidence of climate change is not speaking to medical education and training, and vice versa. What competencies will Australia’s rural and remote general practitioners need in a climate-changing world? How should Australian rural and remote medical education and training adapt to meet the challenges of climate change? How is Australia placed relative to the world in meeting such challenges and what does this suggest about our global responsibilities? This paper aims to explore what Australia should do locally, nationally, and internationally to help ensure rural and remote general practitioners are prepared for a climate-changing world. The paper draws on the results of 1. A study of the climate change literature as it relates to health: abstracts for 458 papers and 146 reviews were scanned in the database PUBMED using the terms “climate change” and “health” for the period 2003-2008 to locate papers useful to identifying the clinical and non-clinical knowledge and skills relevant to rural and remote regions. 2. A case study of Australian competencies for rural and remote general practice and related quality assurance systems, using documents obtained from the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP), and related national and international quality assurance documents, as well as Australian government department website searches useful to identifying Australian policy and research plans for climate change 3. An international study of key publicly available models of rural and remote competencies around the world: this study involved searches of the websites of relevant professional and government agencies and medical schools, as well as written requests for direction to publicly available documents. This part of the study also involved a literature search on best practice in developing competencies using Australian and international databases for the time period 2000 to 2008 (APAIS-Health, Australian Medical Index, Pubmed, as well as ERIC and ProQuest). The search terms included variations of the words “identifying competencies”, “writing competencies”, “evaluating competencies”, “developing competencies” and “medical competencies”. Almost 400 papers were identified and used to develop the author’s foundational understandings of what is best practice in developing rural and remote competencies and related quality assurance issues. Rural and remote competencies have been defined in this paper as any explicit statement of the knowledge, skills and attributes required for rural medical education and training.