Thank you for your effort to read this blog post. I highly appreciate it.

You might have read my other blog My NZREX journey, if you have not, please do as your question might be answered in that post or the comments sections below it.

I decided to write this post, as I realised that so many interest about NZREX and so many questions were asked on my previous blog post. I tried to answer all the questions on the comment section but sometimes they are repetitive, and as I become more busy will take sometimes for me to finally able to answer them. So I think this post will make it easier for people to find the information.

1. Where do I find information about NZREX
Please familiar your self with the eligibility requirements, how to apply and the NZREX schedule trough New Zealand Medical Council  website here. Most of the information can be found in the website.

2. I am a specialist in my home country, do I need to sit NZREX prior to work in NZ?
Not every IMG need to sit NZREX, there are several pathways for IMGs depend on where they trained and the degree of training they have. Please do the self assessment to find out if you need to go down the NZREX pathway. Click here to take the assessment.

3. How long do I need to prepare for NZREX?
The amount of time will be all depend on how familiar you are to New Zealand medical system. How confident you are practising medicine in English. How familiar you are with New Zealand culture. How long have you been practising medicine.

There are a lot to cover and prepare. You will need more time to practice if you have not been practising medicine for more than a year, as you will need to get your confident back and your train your speed on physical exam and history taking.

For people who less familiar with New Zealand culture and medical system will need time to research about them and familiar them self with these. 

How much time you have to practice every day prior to your exam.

For general example. My study buddy and I have not practising medicine for more than five years when we were taking the exam. We both have been living in NZ for more than five years and pretty much immerse with the culture. We are fluent in English but never practise medicine in English previously. We know very little about the New Zealand medical system. It took us a full six months to be confident to take the exam, and we were practising almost every day. Most people prepare for a year. Some only 4 months.

I suggest book your exam ASAP and start preparing.

4.  How long will it take from passing NZREX to getting a house officer job
Well this is the most difficult question, as there are no exact time and there is no guarantee for you to get a job after the exam. So people can get a job immediately (less than 4 months). Some take a few years (1-5 years) Some never getting a job and gave up.

It took me 1.5 years to secure a PGY1 position, after 5 interviews, 18 weeks of observerships in NZ hospitals, Many weeks of observership in the GP practises.

Please note, passing NZREX does not guarantee position as PGY1/HO.

5. Can you please add me to viber group?
Sure. However, the group sometimes reach the limit so I unable to add more people, I will keep trying at random time, but may take time. Please be patient.

Please make sure you have opened an account with viber and send me the right phone number - the one that registered with viber - prior to requesting to be added. This will safe my time and yours.

6. Can I prepare for NZREX from my home country?
Yes. However as this is an OSCE, please find someone that you can practise face to face in your home country on top of skype study partners.

I highly recommend to come to NZ and arrange for observership prior to the exam, so you can familiar your self with NZ culture and medical system if this possible for you.

If you are from non English speaking country and never been to NZ, I highly suggest to make a visit to NZ prior to your exam or deciding to migrate to NZ.

7. How to arrange for observership?
Please contact the hospital or DHBs directly. If you are not a NZ permanent resident or citizen please check with immigration NZ what kind of visa do you need.

I hope this blog post will help answer some of your questions, feel free to ask more questions if you have. I will try to keep updating this post as required. 

Three to four weeks before the exam
From my experience the last few weeks before the exam was the most difficult time during my exam preparation. As I felt so tired from rehearsing all the materials over and over again. I started loosing interest in my study and feeling anxious  because I was not ready yet for the exam. So my study partner and I decided to take a week break after the mock exam, and we promised that we will come back with fresh mind and give the best effort to pass the exam.

As the exam exam only a few weeks away, it is natural if you feel more anxious. You may feel that you have learned everything but you keep forgetting the important information for counselling stations or particular questions in history taking, or you keep running out of time when doing physical examinations. The good news is everyone experience the same thing, so you are not alone.

The key to survive the last few weeks before your exam is to organise your study schedule well. Below is some tips from me to help you planning your last several weeks.

1. Attend a mock exam
If you are studying in a group you can organise a mock exam. If you are not part of a study group, start asking around if there is any study group that will do a mock exam. In my experience, the mock exam was a crucial part of my preparation. The mock exam is usually design to mimic the real exam, so for the first timer, this is the best opportunity to experience the exam. You will get useful feedbacks on your performance from the past candidates who volunteer as examiners.

Mock exam is usually held at least four weeks from the real exam so you will know your weaknesses and will have time to make improvement. Cases on the mock exam are usually have high possibility to be in the real exam.

2. Make a list of cases that most likely will appear on your exam or make prediction
Predict and practice those cases. This is sound complicated and confusing but it is actually very easy. Find out what cases that have been in the previous exam up to a year back. Cases from the two previous exam are very unlikely to be on your exam so you can cross them out. Cases from a year ago, are more likely to be in your exam. Then check the remaining cases from the high yield case lists. Cases that are common in New Zealand are more likely to come than more rare cases, however in each exam usually there is one rare case. Remember that this is a prediction only, so there is no guarantee that your prediction will be 100% correct.

3. Recognise your weaknesses
Get honest feedback from your study partner or from someone who has passed the exam, look for your weaknesses and improve them.

4. Do what ever work for you
If you learn more by reading, then read your script again and again. If you learn better by practicing, then practice as much as you can with your study partner. I belief after a few months preparing for your exam, you will have an idea about the best study method that suitable for you.

5. Get in to the habit
You have accepted the allocation letter from the medical council, so you know which slot will you be in. Why this is important, because you want to start building some habits for your body to follow. For example, if you are in the morning slot, you will start your exam at 9 am. So wake up and get ready to start your practice at 9 am. Say "Good morning" when you introduce your self in every practice stations. Pace your self so you are able to last for 3.5hr in your optimal condition. Remember there is only one toilet break, so you will need to train your bladder as well. The same with the afternoon session, train your self to be able to maintain your optimum performance until around 4pm. That's means you need to have lunch before your exam. Use "Good afternoon" for every station when you practice. The main point is to get your self as comfortable as possible when you do your exam.

​6. Do your home work as early as possible
​Aim to reduce as much stress as possible near the day of your exam. Find out where you should go, choose your outfit in advance, book your ticket and accommodation for out of town candidates.
Avoid driving to the exam venue if you can. Organise for your family or friends to droop you off, or to hire a taxi. Public transport in Auckland sometimes can be a bit stressful, so avoid it if you can.

I wish you all the best with your preparation and exam. It is a tricky exam, but it is very possible to pass it with proper preparation. Good luck to all future candidates. Feel free to droop a comment or send me email if you have any questions.

Continuing from my last post, below is the list of high yield topics for counselling stations in NZREX:
1. Pre-eclamsia
2. PCOS
3. Lifestyle management (Diabetic and non diabetic)
4. Contraseption
5. AAA
6. Duodenal/gastric ulcer
7. Salmonella infection
8. Colon ca
9. Termination of pregnancy
10. Breast ca
11. Asthma
12. COPD
13. Gout
14. STI
15. Anxiety
16. Otitis media + Grommet
17. ADHD + Autistic spectrum disorder
18. Neonatal jaundice
19. Diabetes management/investigation
20. Male infertility
21. Down syndrome
22. Croup
23. Rashes in children
24. Smoking cessation
25. Drugs abuse
26. Nephrotic syndrome
27. PSGN
28. Alcohol withdrawn
29. Hypertension
30. Hypercalcemia
31. OCD
32. Pneumonia

How to prepare for counceling stations:
Counselling station test your communication skills, and your ability to deal with difficult questions or situations. Be prepared to answer any questions from the patients related to the station. However, some patients might not ask you anything. When this happens, explain everything that need to be explained according to the stations as if in real life. 

In general, you will be expected to explain the diagnosis to the patients. Diagnosis might be stated in the question paper, but most of the time you need to conclude the diagnosis from the history given or from the investigation results. If you are not sure about the diagnosis, take short history, or mention that you need to do more investigations to confirm the diagnosis.

You will be expected to address patients' concern, this is why it is important to ask if the patients have any questions or concerns. Look for verbal and non verbal clues. Get ready to handle resistance from patients, or denial. In some cases patients might be angry or crying. If this happens, do not panic, acknowledge patients emotion and react accordingly. Calm patient down by giving reassurance or explanation.

Prepare the management plans and know how to explain about investigations and treatments. Avoid using  medical terminology, if there is no other option, give short explanation about the terminology that you use, for example: if you mention cervix, then follow with explaining that it is the lower end of the womb.

Know about most common side effects of drugs and complication of procedures or the illness itself. Offer reading materials and supports. Mention about red flag signs or when to seek medical help.  Arrange follow up appointment if needed.

The proportion of integrated stations in the exam is increasing, so prepare to take focus history, do physical examination,  consul the patient about your diagnosis and explain about management plan, all in one station.

I hope that this post will be helpful for those who are preparing for the exam. Please comment below if you find it useful and would like me to post more articles about NZREX preparation. Also read my list of history taking stations on previous post.

Below is a list of history taking cases that you need to study as you prepare for NZREX
This list was compiled to give an idea about some of the cases that may be included in the NZREX. People who passed the exam before me wrote the original list and I just added some more cases.

History Taking

1. Chest Pain (Cardiac related, Anxiety, GORD, Pleuritic chest pain)
2. Ankle Pain
3. Loss of consciousness
4. Depression
5. Chronic cough (Adult)
6. Hearing loss + vertigo + tinnitus
7. Headache (SAH, temporal arteritis, Migraine, SOL)
8. Weight loss + vomiting + amenorrhoea
9. 1st trimester abdominal pain
10. Recurrent cough in children
11. Blurring of vision + carotid bruit
12. Sore throat
13. Jaundice (adult and children)
14. Hypertension
15. Knee pain
16. Anaemia
17. High blood pressure in pregnancy
18. Disruptif behaviour in children
19. Suicide / self harm
20. Vaginal discharge + lower abdominal pain
21. Shortness of breath (CHF, Pneumothorax, PE, Asthma, Pneumonia, COPD)
22. Bloody diarrhoea + abdominal cramping
23. Post menopausal bleeding
24. Abdominal pain in left illic fossa
25. Hyperthyroidism
26. Pre-op assessment
27. Epigastric pain
28. Abdominal pain + vaginal bleeding in pregnancy
29. RUQ pain in the last trimester of pregnancy
30. Lightheadedness + one sided weakness
31. Amenorrhoea (primary and secondary)
32. Hip pain
33. Red urine in children
34. Delirium post-op
35. Rashes in children
36. Child with edema and proteinuria

How to use the list above?

• Check all the differential diagnosis of each case in John Murtagh's.
• Check the management plan including therapy, more investigation and follow up plan in RMO book.
• Plan your list of questions, before approaching the patient.
• Make sure you do not forget questions that can eliminate your differential diagnosis or lead you to your primary diagnosis
• Prepare at least three differential diagnosis for each case
• Know your management plan according to your diagnosis or differentials

I purposely wrote the cases in random manner, as I like to have a mix in my study each day to avoid boredom and bias. I found it better than when I study one system at the time, especially for the beginning of my study. 

There might be some other cases that I have missed, please add in the comment section below if you know of  any. All the  cases in the NZREX are often found in New Zealand hospitals or GP clinics. Also read my post for counselling stations.

My NZREX journey started in February 2016. I studied blindly since there is not enough information about the exam itself. I started by reading John Murtagh's, since some people advised me to do so.

After a month reading John Murtagh's for the second time, (I read this book for my AMC-MCQ preparation in the previous year), I was invited to an NZREX vibre group, which changed my journey into a success story. This vibre group connects some doctors who have passed NZREX and who are still preparing for the exam, to share experience and help each other to pass the exam. There are also regular classes organised through this group to discuss common cases in NZREX. I met some wonderful people in this group and joined a smaller study group which I think is crucial for anyone preparing for NZREX. (Please leave me a message if you want me to invite you to this group).

I started in a study group of three, which later grew to six people and we met two times a week for role-play. I enjoyed practising with this group and learned a lot from more senior doctors in our group and from those who have more experience about NZREX it self. However, after a few weeks I felt that the study pace was not suitable for me, since I was very new to the exam format and need more repetition than the others. Apart from that, I also started an observer-ship in a GP clinic, that made me so busy and I felt tired during the practice time. After a lot of consideration, I decided to take a break from the study group.

In April 2016 I met a surgeon from Fiji that was also sitting her NZREX in November 2016, so we decided to be study buddies. I organised our study plan for the next few months and aimed to finish a month before our exam.

My study plan

• 1 month of reading John Murtagh
• 5 weeks history taking practice (aim to finish in 8min/case)
• 2 weeks counseling practice (aim to finish in 8 min/case)
• 2 weeks physical exm practice (aim to finish in 8 min/case)
• 6 weeks of systematic study 
• Random cases as long as possible
• Mock exam (4 weeks before the exam)
• continue with random cases

(read more about my study plan here).

We met twice a week during history taking practice, and three times a week for physical examination and counceling, and only on Saturday during the systematic study.

I was delighted to receive my result at the end of Novenber and to know that my study buddy also passed the exam. At the moment, I am tutoring another doctor to help her to pass the exam.

Insight to NZREX

NZREX is an OSCE, it is similar to all other OSCE but somehow also very different. It is designed to test wheather you are ready to work in New Zealand as a house officer. Some overseas graduates found it very difficult, as they are not familiar with NZ medical system and culture.

You can practice OSCE like you are preparing for AMC clinical or USMLE step 2 CS, since the cases are quite similar. However, do familiarise your self with the NZREX format and with New Zealand culture since in NZREX the way you communicate with patients is very important. I found that doing an observer-ship is the most effective way to get insight to NZ cultur and to polish-up your communication skills.

The exam consists of 16 stations: four history taking stations, four counceling stations, four physical examination and four static stations. Since 2015 there are some integrated stations included in the exam, which means you need to prepare to perform a focus history taking, focus physical exam and conseling in one station. Time management is key to successfully completing these stations.

Time allocated for each station is 10 minutes with two minutes reading time in between stations. There is a 15 minutes toilet break after the 8th station, and drinking water is provided in static stations without extra time for water break. (More information about the exam format can be found on MCNZ website).

The only way to pass this exam is to prepare well. The preparation time required will depend on your medical knowledge, your communication skills and how familiar yourself to New Zealand medical system. (read a more complete tips for NZREX here).

Thank you for reading my blog, I wish you well with your preparation. Do share your experiences, I would be happy to read them. If you want me to write in more detail about NZREX please let me know by writing a comment below.

Check out the list of high yield cases in NZREX history taking stations here.
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Hi, thank you for your interest to my story. Since I have been too busy lately it take me longer to reply to your comment. So I wrote some of the most common questions here please check it out.

​Please also read some comments attached to this post as your questions might have been answered there. I will try to reply to all your messages and emails, but may take me some time before I able to.

For those who requesting to be added to viber group please be aware that the group is fully saturated at times, I will try to add at random times, and please make a viber account and send me the right phone number so I can add you. This will save your time and mine.

Thank you for your understanding. I hope you find my blog is helpful and all the best with your own journey.