NZREX Preparation Guide: Step-by-Step Tips for International Doctors

For many internationally trained doctors, gaining registration to practice in New Zealand represents both a dream and a career milestone. However, this journey isn’t without challenges—especially when facing the New Zealand Registration Examination (NZREX Clinical). This guide is crafted to demystify the NZREX process, offering actionable advice, step-by-step preparation strategies, and insider tips to help you pass the exam confidently and earn your place in New Zealand’s dynamic healthcare system.

What Is the NZREX?

The NZREX Clinical is a high-stakes clinical exam administered by the Medical Council of New Zealand (MCNZ). It is designed for international medical graduates (IMGs) who have completed their basic medical qualification and wish to gain provisional registration in New Zealand.

Unlike multiple-choice written exams like the USMLE or PLAB, NZREX is a clinical OSCE-style (Objective Structured Clinical Examination) that tests real-world practical skills such as communication, clinical reasoning, diagnosis, and patient interaction. It mirrors the final year clinical exam in New Zealand medical schools.

Eligibility Criteria for NZREX

Before you can apply for NZREX, you must meet several stringent requirements:

1. Medical Qualification Recognition

Your medical degree must be from a university listed in the World Directory of Medical Schools and recognized by the MCNZ.

2. English Proficiency

You must demonstrate English language proficiency through:

• IELTS Academic with a minimum score of 7.5 overall and no band less than 7.0, or
• OET with a minimum B grade in each band.

3. Pass the AMC MCQ Exam

This often surprises candidates: you must pass the Australian Medical Council (AMC) MCQ Exam, a computer-based multiple-choice test focusing on clinical knowledge. This acts as a gateway to the NZREX Clinical.

Structure of the NZREX Clinical

The NZREX is a one-day clinical examination comprising 12 stations, each lasting 8 minutes (plus 2 minutes of reading time). Stations cover:

• History taking
• Physical examination
• Diagnosis and clinical reasoning
• Management planning
• Patient communication
• Cultural sensitivity (Māori health may be emphasized)

Every station is marked independently, and passing requires demonstrating both clinical competence and communication skills.

Step-by-Step Guide to Passing the NZREX

Step 1: Understand the NZREX Format Inside Out

Before diving into prep materials, grasp what’s being tested:

• Familiarize yourself with station types.
• Watch sample OSCE videos.
• Read the NZREX Candidate Handbook published by the MCNZ.

Step 2: Enroll in an OSCE Training Course

Self-study might not be enough. Consider:

• NZREX-specific OSCE workshops in Australia or New Zealand.
• Online OSCE practice groups (Telegram, Facebook, Reddit).
• Courses like Dr. Najib’s or PassGAMSAT for applied clinical reasoning.

Step 3: Practice, Practice, Practice

• Partner with fellow candidates to practice stations.
• Time your stations strictly.
• Record yourself to evaluate posture, tone, and empathy.
• Incorporate culturally appropriate phrases (e.g., acknowledging whānau in Māori culture).

Step 4: Master AMC MCQ Knowledge

While NZREX isn’t an MCQ test, the AMC exam content is foundational.

• Use AMC Handbook of Multiple Choice Questions.
• Practice diagnosis, red flags, and emergency scenarios.

Step 5: Develop Communication Skills

Communication can make or break your performance.

• Practice breaking bad news (SPIKES protocol).
• Use layman’s terms.
• Always check patient understanding.

Step 6: Mock Exams Are Gold

• Simulate the full 12-station exam with peers.
• Have assessors or mentors provide feedback.
• Replicate exam stress and fatigue.

What Is the Pass Rate for NZREX?

The pass rate varies but tends to hover around 30–50%, indicating the high level of competition and stringent assessment criteria. Your preparation must be holistic and focused—not just knowledge-based but also emotionally intelligent.

Common Challenges and How to Overcome Them

1. Time Management

• Strictly time yourself in every practice.
• Use the 2-minute reading time wisely to form a plan.

2. Cultural Competence

• Learn about New Zealand’s healthcare system, the Treaty of Waitangi, and Māori health principles.
• Include cultural respect in your station answers.

3. Visa and Travel Issues

Since the exam is only conducted in New Zealand:

• Plan well in advance for visas.
• Ensure passport validity.
• Secure funding for travel and accommodation.

Life After Passing NZREX

Passing the NZREX doesn’t immediately make you a fully registered doctor. Here's what happens next:

1. Provisional Registration

You must secure a PGY1-equivalent internship, usually a 12-month supervised position, which can be hard to find due to competition with local graduates.

2. General Registration

After successfully completing your internship, you’re eligible for full general registration.

NZREX vs. PLAB vs. AMC: A Quick Comparison

Feature

NZREX

PLAB (UK)

AMC (Australia)

Entry Exam

AMC MCQ required

PLAB 1

AMC MCQ

Clinical Test

NZREX OSCE-style

PLAB 2

AMC Clinical OSCE

Recognition

New Zealand

United Kingdom

Australia

Internships

Harder to secure

Structured FY1/FY2 system

More structured system

Is NZREX Worth It?

Yes—if you're determined to practice medicine in New Zealand, love the country's lifestyle, and are prepared for the challenges. The healthcare system is among the best in the world, and physicians are well-respected.

However, prepare for:

• Delays (booking slots, finding jobs)
• Financial strain
• Intensive competition

Final Tips from Past Candidates

• Don’t underestimate the importance of eye contact and empathy.
• Use the ISBAR framework for presenting to examiners.
• Be humble—acknowledge uncertainty when appropriate.
• Stay up-to-date with New Zealand medical guidelines (use HealthPathways or the NZ Formulary).