The Middle East comprises of approximately 15 nations and refers to the area between Arabia and India, mainly the nations of the Persian Gulf. Although a form of competency-based medical education was present centuries ago in this region, this discussion will cover recent information about modern physiology and medicine in this region. The oldest centre for modern medical training in the Middle East was started in 1867 in Lebanon, and this is now known as the American University of Beirut. Within the six Gulf Cooperative Council (GCC) states, Saudi Arabia has the oldest medical college, King Saud University (KSU, 1967). The current levels of competency-based physiology education in the curricula at KSU and the Arabian Gulf University; a regional GCC university based which started in Bahrain in 1982, and other universities in the Middle East will be presented. Around 2002, the Accreditation Council for Graduate Medical Education (ACGME) in the USA identified six general competencies to assess resident competence. The World Federation for Medical Education endorsed these. The World Federation for Medical Education has produced a document ‘Basic Medical Education WFME Global Standards for Quality Improvement’. It was produced in 2003 and revised in 2012, with an aim to set international standards to all medical schools and also encourage reform. The present state of physiology education will be discussed in the light of these standards. More specific to the Middle East, the Arab Knowledge Report 2009, although positively showing a consistent decline in illiteracy in the region, also paints a worrying picture for universities in the region. This report was co-produced by the Mohammed bin Rashid Al Maktoum Foundation and the United Nations Development Programme/Regional Bureau for Arab States. Whether competency-based education (CBE) in physiology and other medical sciences will improve or worsen the situation described by the Arab Knowledge Report 2009 will be discussed. This matter is also complicated by the fact there has been an exponential establishment and growth by 400 % of Departments of Physiology in the Middle Eastern region over the last 2 decades. Due to this expansion, CBE has taken a back seat in terms of present teaching priorities for physiologists and administrators in the region. Eventually, physiologists have to match student competencies with the needs of patients and stakeholders, in a new era of globalization and interdependence.