Updated 2026

Your Complete Guide to the
NZREX Clinical Exam

A comprehensive, free resource for international medical graduates preparing for the New Zealand Registration Examination. We are not associated with any organisation mentioned on this website. Please do your due diligence.

Start Reading Practice Questions
12
OSCE Stations
1
Exam Days
12 min
per case, includes 2 mins pre-reading
~$4,900
NZD Fee
Overview

What is the NZREX Clinical?

The New Zealand Registration Examination (NZREX) is the registration examination established by Te Kaunihera Rata o Aotearoa | The Medical Council of New Zealand (MCNZ). It is designed for doctors who don't come from a "comparable healthcare system" and need to demonstrate they are ready to practice safely here.

The exam assesses whether candidates have the necessary clinical knowledge, skills, and professional attributes required to practice safely and competently at the level of a New Zealand graduate. It is conducted in an OSCE (Objective Structured Clinical Examination) format.

Administered by MCNZ

Medical Council of New Zealand oversees the exam

For International Medical Graduates

Designed for doctors who trained outside NZ/Australia

OSCE Format

Practical clinical exam with simulated patients

Medical professionals studying

Exam Format at a Glance

Understanding the structure of the NZREX Clinical examination

12 Stations

12 stations with patients/cases, covering various clinical scenarios + 2-4 rest stations.

12 Minutes Each

Each station allows 12 minutes: 2 minutes reading + 10 minutes with the patient.

Simulated Patients

Actors portray patients, and examiners assess your clinical and communication skills.

Pass Marks

Must pass a minimum number of stations AND achieve an overall aggregate pass.

Requirements

Eligibility Criteria

Before you can sit the NZREX, you must meet several requirements set by the MCNZ. Please verify directly on the MCNZ website.

1

Primary Medical Qualification

You must hold a primary medical qualification from a recognised institution outside New Zealand or Australia. Your qualification must be verified through the EPIC system.

  • Medical degree from WHO-listed school
  • EPIC verification completed
  • Original transcripts available
2

English Language Proficiency

You must demonstrate English language proficiency through an approved test. Scores must meet minimum requirements.

  • IELTS: Overall 7.5 (min 7.0 each band)
  • OET: Grade B in all sections
  • Test within last 2 years
3

Clinical Experience

You need relevant clinical experience and must not have been out of clinical practice for an extended period.

  • At least 12 months post-graduation
  • Recent clinical practice (within 3 years)
  • Good standing certificates
4

Source Pathway Verification

Your application will be assessed under one of the source pathway categories defined by MCNZ.

  • Comparable health system assessment
  • Registration history review
  • Source pathway determination
5

Documentation

Complete documentation must be submitted including identification, qualifications, and references.

  • Passport or national ID
  • Certified copies of degrees
  • Three professional references
6

Application & Fee

Submit your application through the MCNZ portal and pay the required examination fee.

  • Online application via MCNZ
  • Examination fee: ~NZD $4,900
  • Closing dates apply

Important Note

Eligibility requirements may change. Always refer to the official MCNZ website for the most current and detailed information before applying. You can do a MCNZ self assessment to check your eligibility and best pathway forward.

Preparation

Study Guide

A structured approach to preparing for the NZREX Clinical examination

Recommended Study Timeline

3-6

Months Before: Foundation

Review clinical guidelines, brush up on examination skills, and understand the NZ healthcare system. Study clinical guidelines from BPAC, NZGG, and Best Practice Advocacy Centre.

2-3

Months Before: Active Study

Practice OSCE stations regularly. Focus on history-taking, physical examination, counselling, and emergency management scenarios. Join study groups if possible.

1

Month Before: Intensive Practice

Full mock exams, timed practice stations, and refinement of communication skills. Focus on time management and structured approaches.

1w

Week Before: Final Review

Light revision, rest, and logistics. Confirm exam venue, prepare ID and required documents. Focus on confidence and self-care.

Key Topics to Cover

Cardiology

Chest pain, hypertension, heart failure, arrhythmias

Neurology

Stroke, headaches, seizures, dementia

Paediatrics

Child development, immunisation, common childhood illnesses

Mental Health

Depression, anxiety, risk assessment, addiction

Emergency Medicine

Trauma, anaphylaxis, cardiac arrest, sepsis

General Medicine

Diabetes, respiratory, GI, endocrine conditions

Surgery

Pre-op assessment, post-op care, common surgical conditions

Women's Health

Antenatal care, contraception, menopause, cervical screening

Recommended Books

  • John Murtagh's General Practice
  • Clinical Examination (Talley & O'Connor) + Videos on Youtube
  • Bates' Guide to Physical Examination
  • AMC Clinical Handbook
  • Any other OSCE books eg. USMLE step 2CS, Katrina Hurley, etc

Online Resources

Study Tips

  • Practice with simulated patients
  • Record yourself for self-review
  • Use a structured approach (SEIPS)
  • Know NZ-specific guidelines
  • Join a study group
  • Join the NZREX Facebook and Whatsapp Groups
Practice

Mock Exam Questions

Sample OSCE stations to help you prepare. Click to reveal suggested approaches. (These are just sample questions)

CARDIOLOGY

Station 1: Chest Pain Assessment

A 55-year-old male presents to the emergency department with central chest pain for the past 2 hours. Take a focused history and explain your initial management plan.

PAEDIATRICS

Station 2: Child with Fever

A 3-year-old is brought in with a fever of 39°C for 24 hours and decreased appetite. Assess the child and counsel the parent.

MENTAL HEALTH

Station 3: Depression Assessment

A 28-year-old woman presents with low mood and fatigue for 6 weeks. Take a history and assess risk.

EMERGENCY

Station 4: Anaphylaxis Management

A patient in the waiting room suddenly develops lip swelling and difficulty breathing after eating. Manage the emergency.

WOMEN'S HEALTH

Station 5: Contraception Counselling

A 24-year-old woman requests contraception advice. Counsel her on the available options.

NEUROLOGY

Station 6: Headache History

A 35-year-old presents with recurrent headaches. Take a detailed history and discuss your differential diagnosis.

Want more practice? Check out additional resources below.

View All Resources
Next Steps

Post Exam Journey

What happens after you've completed the NZREX Clinical examination

Getting Your Results

Results are typically released within 4-6 weeks after the exam. You will be notified by email when results are available in your MCNZ online portal.

  • Results available in MCNZ portal
  • Pass/fail notification only (no detailed scores)
  • Feedback provided for unsuccessful candidates

If You Pass

Congratulations! You can now proceed with the registration process. Here's what comes next:

  • Apply for provisional general scope registration
  • Obtain a job offer (required for registration)
  • Complete IPC (Infection Prevention & Control) requirements
  • Apply for medical indemnity insurance
  • Work under supervision for 12-24 months

If You Don't Pass

Don't be discouraged. Many excellent doctors don't pass on their first attempt. Here's what to do:

  • Review feedback from MCNZ
  • Identify areas for improvement
  • You can attempt NZREX up to 3 times
  • Wait period applies before re-sitting
  • Consider additional practice or coaching

Registration Process

After passing, the registration process involves several steps:

1
Secure employment position
2
Apply for registration with MCNZ
3
Complete NZ Medical Council forms
4
Receive registration certificate

Typical Timeline After Passing

1-3 wks
Results released
3-18 mo
Job search & offer
4-8 wks
Registration processing
12-24 mo
Supervised practice
Clinical Experience

Observerships in NZ

Gaining clinical exposure through observerships can enhance your preparation and application

What is an Observership?

An observership is a period during which you shadow a doctor in a clinical setting. You observe clinical practice, attend ward rounds, and participate in teaching sessions - but you do not provide patient care. It's an excellent way to familiarise yourself with the NZ healthcare system.

How to Find Observerships

  • Contact DHBs directly: Email clinical directors or medical education officers at District Health Boards
  • University hospitals: Contact teaching hospitals affiliated with Otago and Auckland medical schools
  • General practices: Approach GP practices directly for primary care exposure
  • Professional networks: Use LinkedIn, medical forums, and NZ medical associations
  • NZ Doctor forums: Connect with other IMGs who may have contacts

Benefits of Observerships

Familiarity with NZ system
Clinical exposure
Networking opportunities
References for jobs
Understanding of guidelines
Cultural competence

Major NZ Hospitals

Auckland City Hospital

Largest hospital in NZ. Contact clinical education unit.

Middlemore Hospital

South Auckland. Busy clinical environment with diverse patient population.

Christchurch Hospital

Major South Island teaching hospital. Contact via CDHB.

Wellington Hospital

Capital city hospital. Contact via CCDHB medical staffing.

Dunedin Hospital

University of Otago affiliated teaching hospital.

Important Considerations

  • Observerships are unpaid and may require a visitor visa
  • You cannot have direct patient contact
  • Confidentiality and privacy requirements must be strictly followed
  • Not all hospitals accept observers - check beforehand
  • Typically lasts 2-8 weeks
Useful Links

Resources

Essential resources for your NZREX journey

MCNZ Official Website

The official Medical Council of New Zealand website with all official information.

Visit

BPAC NZ

Best Practice Advocacy Centre - NZ clinical guidelines and resources.

Visit

Ministry of Health

Official NZ Ministry of Health with health system information and policies.

Visit

NZ Medical Association

Professional body representing doctors in New Zealand.

Visit

RNZCGP

Royal NZ College of General Practitioners - useful for primary care guidelines.

Visit

Healthpoint

Directory of NZ health services, providers, and healthcare facilities.

Visit
Questions & Answers

Frequently Asked Questions

Common questions about the NZREX Clinical examination

Still have questions?

Visit MCNZ for Official Info
Essential Guides

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NZ Medical Roles Explained

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How to Introduce Yourself

Learn the proper way to introduce yourself in NZ clinical settings and the OSCE.

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IELTS & English Requirements

Everything about IELTS, OET, and meeting English language requirements.

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Mnemonics for NZREX

Essential mnemonics for history taking, examinations, and OSCE stations.

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NZREX Pilot Program

Learn about alternative pathways and pilot programs for NZ medical registration.

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NZREX vs USMLE

A detailed comparison of format, difficulty, recognition, and career pathways.

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OSCE Practice

Station types, structured approaches, and practical tips for OSCE success.

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Random Tips & Advice

Practical tips, common pitfalls, and insider advice for the NZREX journey.

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Visa for NZREX

Visa options, requirements, and immigration pathways for sitting the exam.

Learn more

Disclaimer

NZREXinfo is an independent information resource and is not affiliated with, endorsed by, or connected to the Medical Council of New Zealand (MCNZ). All information provided here is for general guidance only. Always refer to the official MCNZ website for the most current, accurate, and authoritative information regarding the NZREX examination and registration requirements.