NZREX Clinical Exam: Format, Strategy, and 2025 Updates for IMGs

The NZREX Clinical Exam is the gateway for international medical graduates (IMGs) who want to practise medicine in New Zealand. For many, it’s the final hurdle before gaining provisional registration with the Medical Council of New Zealand (MCNZ).

But the exam is known to be tough - not because the content is obscure, but because the communication standards, clinical logic, and pacing are unfamiliar to many candidates.

According to A/Prof George Eskander, PassGP Chief Examiner and former AMC National Examiner:

“NZREX tests what kind of doctor you are, not just what you know. It’s about structure, rapport, and prioritising what matters in 8 minutes.”

Let’s break down the format, key strategies, and how you can succeed in 2025.

What Is the NZREX Clinical Exam?

The NZREX Clinical is a 12-station OSCE-style exam that assesses your ability to work safely and effectively in the New Zealand health system.

Format Overview:

• 12 OSCE stations
• 8 minutes per station (+ 2 min reading time)
• Role-played by actors or examiners
• Covers a broad range of general medicine, surgery, psychiatry, paediatrics, obstetrics & gynaecology

You are expected to:

• Take a history
• Perform focused examinations
• Explain diagnoses and management
• Demonstrate empathy and cultural safety

 Key Focus Areas in 2025

1. Communication and Cultural Competence
   • NZ places strong emphasis on the Treaty of Waitangi, health equity, and respect for Māori health perspectives.
   • You must show sensitivity, not just clarity.
2. Clinical Reasoning
   • The right answer is not enough - your thought process 
   • You’ll be marked on what you rule out, not just what you name.
3. System Familiarity
   • Know common local pathways (e.g., ED triage, primary care referral)
   • Avoid suggesting unrealistic or unavailable resources

 How NZREX Differs from AMC Clinical

Both exams are difficult - but with the right communication strategies and pacing, IMGs can thrive in either.

How to Prepare for NZREX

Practise with Realistic OSCE Scenarios

• Use video-style cases that mirror real station timing
• Simulate pressured speaking and quick reading time

Get Feedback on Communication

• Work with local mentors or use structured feedback platforms like PassGP
• Focus on tone, pacing, and structure

Know Your NZ System

• Learn the structure of the NZ health system, including triage, community care, referrals, and emergency protocols

Embrace Cultural Safety

• Include cultural context in your management plans
• Always acknowledge patient values and background

How PassGP Supports NZREX Candidates

Although PassGP was born from the Australian exam system, its OSCE-style platform and expert clinical coaching are fully applicable to NZREX:

• 100+ OSCE scenarios for practice
• Tailored feedback on structure, cultural safety, and clarity
• 1:1 support from clinicians like A/Prof Eskander, who understand what examiners want
• NZREX-focused tutorials and prep sessions launching in 2025

 Join our waiting list for NZREX-specific content at PassGP.au - and in the meantime, start building confidence with our clinical case bank.