NRE Step 2 OSCE Stations 2026 β€” Complete List of All Stations with Tips
πŸ₯ NRE Step 2 β€” OSCE

NRE Step 2 OSCE Stations 2026 β€” Complete List of All Stations with Tips

Every station in the NRE Step 2 OSCE explained β€” what is tested, how it is marked, which stations are mandatory passes, and exactly how to prepare for each one.

✍️ Dr. Jawad Akram, MBBS, MS General Surgery πŸ“… Updated September 2026 ⏱️ 15-min read

Most NRE Step 2 candidates walk into the OSCE having prepared for Step 1. They have revised clinical knowledge, practiced MCQs, and studied subject-wise content. What they have not done is prepare for being watched performing a clinical skill in real time, with a structured mark sheet, a patient actor, and an examiner noting every step they skip.

NRE Step 2 is a different examination from Step 1. It does not test what you know β€” it tests what you can do. The OSCE (Objective Structured Clinical Examination) format means every candidate faces the same stations in a standardised sequence, marked against the same checklist. There is no partial credit for a good history if you forget to wash your hands. There is no recovery from failing a mandatory station even if you pass every other station perfectly.

This guide gives you the complete station list for NRE Step 2, what each station assesses, how marks are allocated, which stations carry mandatory pass requirements, and the specific preparation strategy for each one.

πŸ“Œ NRE Step 2 OSCE β€” Structure Overview
NRE Step 2 is conducted by PM&DC at designated examination centres in Pakistan. The OSCE consists of 20 stations, each lasting 5–7 minutes with a short rest/reading station between clinical stations. Total examination time is approximately 2.5–3 hours. Candidates rotate through stations in sequence. Mandatory stations must each be passed independently β€” a fail in any mandatory station results in overall exam failure regardless of performance in other stations.

Mandatory Stations β€” Must Pass Each One Independently

These are the stations where failure means overall exam failure β€” regardless of your total score across all other stations. They represent the absolute minimum clinical competencies PM&DC requires before licensing a doctor to practice in Pakistan. Prepare these stations first, prepare them to a higher standard than the others, and do not allow yourself to be underprepared for any of them on exam day.

M1 Basic Life Support (BLS / CPR) MANDATORY PASS

The examiner presents a collapsed, unresponsive patient (manikin). You must perform a complete BLS sequence including scene safety assessment, responsiveness check, calling for help, opening the airway, assessing breathing, starting chest compressions, and performing rescue breaths (or hands-only CPR if instructed).

What is marked: Correct compression depth (5–6 cm adults), correct compression rate (100–120/min), correct hand position (lower half of sternum), adequate chest recoil, airway opening technique (head-tilt chin-lift or jaw thrust), correct ratio (30:2), calling for help and AED, reassessment after 2 minutes.

Why candidates fail: Incorrect hand position, insufficient compression depth, forgetting to call for help before starting CPR, not reassessing after the first cycle, performing compressions too slowly or too fast.

Preparation: Practice on a manikin or firm surface until the compression rate and depth are automatic. Count out loud in practice β€” 100–120/min is faster than most candidates expect. Time yourself for 2-minute cycles. Learn the AED steps: power on β†’ attach pads β†’ analyse β†’ shock if advised β†’ resume CPR immediately.
M2 Abdominal Examination MANDATORY PASS

A standardised patient (real person or actor) is provided. You must perform a complete, systematic abdominal examination β€” inspection, auscultation, percussion, and palpation β€” in the correct sequence, with appropriate exposure, positioning, and patient communication throughout.

What is marked: Correct positioning (patient supine, one pillow), adequate exposure (nipple to groin), inspection from the end of the bed (scars, distension, visible peristalsis, hernias), auscultation before palpation (correct sequence β€” NRE-tested), light then deep palpation of all 9 regions, liver percussion and palpation (starting from RIF), spleen percussion and palpation (starting from RIF), kidney ballotement, checking for shifting dullness (ascites), hernial orifices, and asking to examine external genitalia.

Why candidates fail: Wrong examination sequence (palpation before auscultation), failure to start liver palpation from the RIF, not checking for shifting dullness, poor patient communication (not warning about pain before deep palpation), inadequate exposure.

Preparation: Practice the full abdominal examination sequence daily until it is automatic and fluid. The examiner’s mark sheet goes step by step β€” any step you skip loses a mark even if your findings are accurate. Film yourself performing the examination and review for missed steps.
M3 Paediatric Assessment MANDATORY PASS

A scenario involving a child (usually presented as a case history with a doll or actor parent) requiring assessment of developmental milestones, growth parameters, or an acute paediatric presentation. May involve calculation of a child’s nutritional status using weight-for-age or MUAC.

What is marked: Correct approach to the child (non-threatening, appropriate tone), accurate developmental milestone knowledge by age, correct growth chart interpretation, identification of acute danger signs (IMCI framework β€” not able to drink, convulsing, abnormally sleepy, persistent vomiting), correct triage decision.

IMCI danger signs to know cold: Not able to drink or breastfeed | Vomits everything | Convulsions (current or recent) | Abnormally sleepy or unconscious | Stridor in calm child | Severe acute malnutrition (visible wasting or oedema of both feet). Any danger sign = urgent referral.

Preparation: Know developmental milestones by age β€” 6 weeks (social smile), 3 months (head control), 6 months (sits with support, transfers objects), 9 months (pincer grip, stranger anxiety), 12 months (walks with support, 1–2 words), 18 months (walks alone, 10+ words), 2 years (runs, 2-word phrases), 3 years (rides tricycle, 3-word sentences). Practice with the IMCI chart β€” it is the framework PM&DC uses.

Clinical Examination Stations

These stations assess your ability to perform a focused or complete clinical examination of a body system β€” correctly sequenced, appropriately communicated, and clinically interpreted. You are marked on technique, sequence, communication, and interpretation of findings.

S1 Cardiovascular Examination STANDARD

Complete cardiovascular examination: general inspection (dyspnoea, cyanosis, pallor, malar flush), hands (clubbing, splinter haemorrhages, Osler’s nodes, Janeway lesions), pulse (rate, rhythm, character, volume, radio-radial and radio-femoral delay), BP, JVP, face (corneal arcus, xanthelasma), carotid pulse, precordium inspection and palpation (apex beat β€” position and character, heaves, thrills), auscultation of all 4 areas with radiation, lung bases, and sacral/ankle oedema.

Key NRE tip: Always count the pulse for a full 15 seconds (Γ—4) or 30 seconds (Γ—2) β€” never estimate. Report JVP height in cm above the sternal angle with patient at 45Β°. Know which murmurs radiate where: aortic stenosis β†’ carotid; mitral regurgitation β†’ axilla; tricuspid β†’ lower sternal edge.
S2 Respiratory Examination STANDARD

Complete respiratory examination: inspection (respiratory rate, pattern, use of accessory muscles, chest shape β€” barrel chest, pectus excavatum/carinatum, scoliosis, surgical scars), tracheal position, expansion (anterior and posterior), percussion (comparing zones), auscultation (breath sounds, added sounds β€” wheeze, crepitations, pleural rub), and vocal resonance / tactile fremitus.

Common station finding: Pleural effusion β€” dull to percussion, reduced breath sounds, reduced vocal resonance, tracheal deviation away (if large). Consolidation β€” dull, bronchial breathing, increased vocal resonance, whispering pectoriloquy. Practice explaining findings clearly: “There is stony dullness at the right base with absent breath sounds and reduced vocal resonance, consistent with a right-sided pleural effusion.”
S3 Neurological Examination β€” Upper Limb STANDARD

Upper limb neurological examination: inspection (wasting, fasciculations), tone (spasticity vs flaccidity vs rigidity), power (MRC grading 0–5 for each muscle group), reflexes (biceps C5/6, brachioradialis C5/6, triceps C7), coordination (finger-nose test, dysdiadochokinesia), and sensation (light touch, pinprick, proprioception, vibration).

UMN vs LMN: Upper motor neuron lesion β†’ spasticity, hyperreflexia, upgoing plantar. Lower motor neuron β†’ flaccidity, hyporeflexia, wasting, fasciculations. The examiner will ask you to localise the lesion β€” practice saying: “The findings of [UMN/LMN] pattern in the upper limb suggest a lesion at [cortex/cervical cord/brachial plexus/peripheral nerve].”
S4 Neurological Examination β€” Lower Limb STANDARD

Lower limb neurological examination: same sequence as upper limb β€” inspection, tone, power (hip flexion/extension, knee flexion/extension, ankle dorsiflexion/plantarflexion), reflexes (knee L3/4, ankle S1/2, plantar response), coordination (heel-shin test), and sensation. Romberg’s test and assessment of gait if time allows.

Gait patterns to recognise: Hemiplegic (circumduction β€” UMN); Steppage (foot drop β€” common peroneal nerve or L4/5); Waddling (proximal myopathy); Parkinsonian (festinating, stooped, reduced arm swing); Ataxic (broad-based, cerebellar). The examiner frequently asks “What does this gait pattern suggest?” immediately after the station.
S5 Thyroid Examination STANDARD

Examination of the thyroid gland and assessment of thyroid status: inspection of neck (swelling moving with swallowing), palpation from behind (size, consistency, tenderness, nodularity, movement on swallowing and tongue protrusion β€” moves with swallowing = thyroid or thyroglossal; moves with tongue protrusion = thyroglossal cyst), percussion for retrosternal extension, auscultation for bruit (hyperthyroid). Then systemic assessment: hands (tremor, sweating, acropachy β€” hyperthyroid; dry skin β€” hypothyroid), pulse, eyes (exophthalmos, lid lag, lid retraction β€” Graves’ specific), reflexes (brisk β€” hyperthyroid; slow-relaxing β€” hypothyroid), pretibial myxoedema.

Examiner’s common question: “What investigations would you request?” Answer in order: TFTs (TSH + FT4 first), then USS thyroid (if nodule suspected), then radionuclide scan (to characterise hot vs cold nodule), then FNAC (fine needle aspiration cytology β€” if suspicious nodule). Cold nodule = higher malignancy risk than hot nodule.
S6 Breast Examination STANDARD

Breast examination using a breast model or manikin: inspection in three positions (arms by side, arms raised, hands on hips), systematic palpation of all four quadrants and axillary tail, nipple assessment (discharge, retraction, Paget’s disease), and axillary lymph node examination (five groups β€” anterior, posterior, lateral, medial, apical).

Describing a lump: Site (clock position and distance from nipple) | Size (cm) | Shape | Surface (smooth/irregular) | Consistency (hard/soft/rubbery) | Margins (well/ill-defined) | Mobility (mobile/”breast mouse” = fibroadenoma; fixed = malignancy) | Skin changes (tethering, peau d’orange) | Tenderness. Practice this description sequence until automatic β€” examiners award marks for each descriptor.

History Taking Stations

History taking stations present a patient actor with a presenting complaint. You have 5–7 minutes to take a focused, structured history and reach a differential diagnosis. You are marked on structure, completeness, communication skills, and clinical reasoning.

H1 Chest Pain History STANDARD

Patient presents with chest pain. You must take a structured history using SOCRATES (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity) while screening for red flags and differentiating cardiac from non-cardiac causes.

Red flags that must not be missed: Central crushing pain radiating to arm/jaw + diaphoresis + nausea = ACS until proven otherwise. Tearing/ripping pain radiating to back = aortic dissection. Pleuritic pain + haemoptysis + leg swelling = PE. Positional pain relieved by sitting forward + recent viral illness = pericarditis.

Structure tip: After SOCRATES, always ask: cardiac risk factors (smoking, DM, HTN, hypercholesterolaemia, family history), past cardiac history, medications (GTN use), and functional impact. Close with: “Is there anything else you’d like to tell me?” β€” examiners award marks for this open-ended closing question.
H2 Shortness of Breath History STANDARD

Patient presents with breathlessness. History must differentiate cardiac (heart failure, ACS), respiratory (asthma, COPD, PE, pneumonia, pneumothorax), and non-respiratory causes (anaemia, anxiety). Key questions: onset (sudden vs gradual), orthopnoea and PND (heart failure), wheeze (asthma/COPD), sputum (colour, quantity β€” infection), haemoptysis (TB, malignancy, PE), exercise tolerance (NYHA class for heart failure), and occupational exposure.

NYHA classification: Class I β€” no symptoms on ordinary activity; Class II β€” mild symptoms on moderate exertion; Class III β€” symptoms on minimal exertion; Class IV β€” symptoms at rest. Examiners frequently ask you to classify the patient’s heart failure after the history.
H3 Abdominal Pain History STANDARD

Patient presents with abdominal pain. Use SOCRATES plus specific gastrointestinal questions: nausea/vomiting (content β€” bilious, blood, undigested food), bowel habits (constipation, diarrhoea, blood per rectum β€” fresh vs melaena), appetite and weight loss (malignancy red flag), jaundice and its features, urinary symptoms, menstrual history in women (last period, possibility of pregnancy), and alcohol/NSAID use.

Red flags that must not be missed in abdominal pain: Weight loss + change in bowel habit + age >50 = colorectal cancer until excluded. Jaundice + dark urine + pale stools + weight loss = pancreatic/biliary malignancy. Sudden severe abdominal pain in elderly with vascular disease = ruptured AAA. Missed period + abdominal pain + PV bleeding = ectopic pregnancy β€” Ξ²hCG is mandatory.
H4 Obstetric / Gynaecological History STANDARD

Patient presents with a gynaecological complaint β€” PV bleeding, vaginal discharge, pelvic pain, or a complication in pregnancy. History must include: LMP, cycle regularity, obstetric history (GPALD β€” Gravida, Para, Abortions, Living children, Deaths), contraceptive use, cervical smear history, and sexual history (sensitively approached).

PV bleeding in pregnancy β€” the key differentials by trimester: First trimester: threatened/inevitable/complete miscarriage, ectopic pregnancy, hydatidiform mole. Second trimester: placenta praevia (painless), placental abruption (painful, tender uterus), cervical incompetence. Third trimester: placenta praevia (painless), abruption (painful). Always establish gestational age and haemodynamic stability before anything else.

Communication & Counselling Stations

Communication stations are among the most feared in NRE Step 2 β€” and among the most predictable. The scenarios repeat consistently. You are not marked on clinical knowledge alone β€” you are marked on how you deliver information, how you respond to patient emotion, and whether your communication is structured, empathetic, and complete.

C1 Breaking Bad News STANDARD

You are asked to inform a patient or relative that a diagnosis of serious illness has been made (cancer, terminal condition, HIV, major organ failure). Use the SPIKES protocol: Setting up (private environment, sitting down, tissues available) β†’ Patient’s Perception (what do they already know?) β†’ Invitation (how much do they want to know?) β†’ Knowledge (give information in small chunks, avoid jargon) β†’ Emotions (respond to emotional reaction with empathy β€” “I can see this is very difficult news”) β†’ Strategy and Summary (next steps, support available, offer to repeat information).

Common mistake: Candidates deliver all clinical information correctly but fail to pause, acknowledge the patient’s emotional response, and offer support. The examiner specifically marks for empathetic responses. When the patient actor shows distress, stop giving information β€” acknowledge the emotion first: “I can see this has come as a shock. Take all the time you need.” Then continue only when they are ready.
C2 Informed Consent STANDARD

You must obtain informed consent from a patient for a common procedure (appendicectomy, cholecystectomy, coronary angiography, endoscopy). Informed consent requires: explaining the diagnosis, explaining the proposed procedure in lay terms, explaining the benefits, explaining the risks (common and serious), explaining alternatives (including no treatment), checking understanding, answering questions, and confirming the patient’s voluntary decision.

Legal requirements to cover: Capacity (is the patient able to understand, retain, weigh, and communicate a decision?), voluntariness (no coercion), and information (all material risks and benefits). For surgery: always mention general anaesthetic risks, bleeding, infection, organ damage specific to the procedure, and risk of conversion (laparoscopic to open). Close with: “Do you have any questions? Are you happy to proceed?”
C3 Counselling β€” Lifestyle / Chronic Disease STANDARD

A patient newly diagnosed with diabetes, hypertension, or obesity needs lifestyle counselling. Or a patient needs counselling on smoking cessation, alcohol reduction, or contraception. You are marked on structure, completeness, avoiding jargon, assessing motivation (motivational interviewing principles), and providing a clear, actionable plan.

Smoking cessation structure: Ask (smoking status), Advise (clear advice to stop β€” the single most effective intervention a doctor provides), Assess (readiness to quit β€” pre-contemplation, contemplation, preparation, action), Assist (NRT options: patch, gum, spray, inhaler; or varenicline; or bupropion), Arrange (follow-up, support group, quitline number). The 5 As framework β€” examiners recognise it immediately.
C4 Explaining a Diagnosis or Investigation STANDARD

You are asked to explain a diagnosis (diabetes, heart failure, asthma) or an investigation (colonoscopy, MRI, echocardiogram) to a patient who has no medical background. Marks are awarded for: using lay language (not medical jargon), checking understanding (teach-back technique), covering what it means for the patient’s daily life, and explaining next steps clearly.

Teach-back technique: After explaining, say: “I’ve covered quite a lot there β€” just to make sure I’ve explained it clearly, could you tell me in your own words what you understand about your condition?” This is a highly marked communication skill. It demonstrates patient-centred communication and is frequently on the mark sheet.

Procedural & Practical Stations

P1 Venepuncture & IV Cannulation STANDARD

On a manikin arm: perform hand hygiene β†’ explain procedure and obtain verbal consent β†’ apply tourniquet β†’ identify vein (antecubital fossa preferred) β†’ clean site with alcohol swab (30 seconds, allow to dry) β†’ insert needle at 15–30Β° bevel up β†’ confirm flashback β†’ advance catheter β†’ release tourniquet β†’ withdraw stylet β†’ connect giving set or flush β†’ secure cannula β†’ label with date and time β†’ dispose of sharps safely.

Never miss: Hand hygiene before AND after (examiner marks both). Sharps disposal β€” needle directly into sharps bin without resheathing. Labelling the cannula with date (required to know when to replace at 72–96 hours). These three steps are frequently missed by candidates who are focused on the technical insertion.
P2 Prescription Writing STANDARD

A clinical scenario is given and you must write a correct drug prescription. Marks are awarded for: correct drug name (generic, not brand), correct dose, correct route, correct frequency, correct duration, allergy check documentation, legible handwriting, and signature with date.

Common prescription scenarios: Community pneumonia (amoxicillin 500mg TDS oral 5 days), UTI (trimethoprim 200mg BD oral 7 days), acute gout attack (colchicine 500mcg BD or naproxen), post-MI prescription (aspirin + beta-blocker + ACE inhibitor + statin), DKA fluid and insulin prescription.

Common errors: Writing brand names instead of generic (Brufen instead of ibuprofen); omitting route of administration; not checking/documenting allergies; unclear abbreviations (write “three times daily” not “TID”). Write clearly β€” illegible prescriptions are a patient safety issue and examiners penalise them.
P3 ECG Interpretation STANDARD

A printed ECG is provided with a brief clinical scenario. You must interpret it systematically β€” rate, rhythm, axis, P waves, PR interval, QRS duration, ST segment, T waves β€” and reach a clinical conclusion with immediate management recommendation.

ECGs most commonly provided in NRE Step 2: STEMI (with territory localisation), AF, complete heart block, SVT, VT, LBBB, hyperkalaemia (peaked T waves β†’ wide QRS β†’ sine wave), and digoxin effect (reverse tick ST depression).

Systematic approach every time: Rate (count large squares between R waves: 300Γ·number = rate) β†’ Rhythm (regular/irregular; P before every QRS?) β†’ Axis (leads I and aVF: both up = normal axis) β†’ P wave β†’ PR interval β†’ QRS width β†’ ST segment β†’ T waves β†’ Conclusion + management. State your findings out loud β€” examiners mark your verbal presentation, not just your conclusion.
P4 Urine Dipstick Interpretation STANDARD

A urine dipstick result is given alongside a clinical scenario. You must interpret each component (blood, protein, leucocytes, nitrites, glucose, ketones, bilirubin, urobilinogen, pH, specific gravity) and reach a diagnosis with management plan.

Key interpretation patterns: Leucocytes + nitrites + protein = UTI β†’ urine MC&S + antibiotics. Blood alone (no infection markers) = haematuria β†’ exclude malignancy, stones, glomerulonephritis. Glucose + ketones = DKA β†’ check blood glucose + ABG. Protein alone (heavy) = nephrotic syndrome β†’ 24-hr urine protein + renal USS. Bilirubin without urobilinogen = obstructive jaundice.

Remember: Nitrites are produced by gram-negative bacteria (E. coli, Klebsiella) that convert urinary nitrates. Gram-positive bacteria (Staph. saprophyticus in young women) do NOT produce nitrites β€” so nitrite-negative UTI is possible. A negative dipstick does not exclude UTI if the pre-test probability is high β€” send urine MC&S regardless.

Data Interpretation Stations

D1 Blood Test Interpretation STANDARD

A set of blood results is provided β€” FBC, U&E, LFTs, TFTs, or coagulation screen β€” with a clinical context. You must identify the abnormalities, interpret them in context, reach a diagnosis, and suggest further investigations and management.

FBC patterns to recognise immediately: Microcytic hypochromic anaemia (iron deficiency, thalassaemia, anaemia of chronic disease β€” check ferritin); Macrocytic anaemia (B12/folate deficiency, hypothyroidism, alcohol, liver disease); Normocytic anaemia (ACD, haemolysis, acute blood loss); Pancytopenia (bone marrow failure, hypersplenism, aplastic anaemia).

U&E pattern β€” AKI: Rising creatinine + rising urea + hyperkalaemia β†’ AKI. Classify as pre-renal (low BP, dehydration, poor urine output), intrinsic (ATN, glomerulonephritis), or post-renal (obstruction β€” distended bladder, hydronephrosis on USS). Immediate steps: IV fluids + catheterise + treat hyperkalaemia + stop nephrotoxic drugs + renal USS.
D2 Imaging Interpretation (X-ray / USS) STANDARD

A chest X-ray, abdominal X-ray, or USS report is provided. You must interpret it systematically and clinically. CXR: use ABCDE β€” Airway (tracheal position), Breathing (lung fields, infiltrates, consolidation, effusions), Cardiac (size β€” CTR >0.5 = cardiomegaly), Diaphragm (free air beneath = perforation), Everything else (bones, soft tissue, lines, tubes).

Most common CXRs provided in NRE Step 2: Lobar consolidation (pneumonia), cardiomegaly with pulmonary oedema (heart failure), pleural effusion, tension pneumothorax, widened mediastinum (aortic dissection), free air under diaphragm (perforation), bilateral interstitial infiltrates (PCP, pulmonary fibrosis, ARDS).

Systematic approach to CXR: Always start with: patient name, date, projection (PA vs AP β€” AP magnifies the heart), rotation (clavicle heads equidistant from spine?), and penetration (vertebrae just visible behind heart = correct). Then ABCDE. Examiners mark for systematic approach even if the interpretation is incomplete.

NRE Step 2 OSCE β€” Strategy for Exam Day

At Every StationWhy It Matters
Read the instruction card for the full 1-minute reading timeEvery station has a reading card outside. Use all of the time β€” candidates who rush miss key information that changes their entire approach.
Introduce yourself and confirm the patient’s nameProfessional communication is marked from the first 10 seconds. “My name is Dr. Akram. May I confirm your name please?” opens every station correctly.
Perform hand hygiene visibly before touching the patientHand hygiene is on the mark sheet of virtually every clinical station. Do it slowly and visibly β€” examiners must see it to mark it.
Narrate what you are doing“I am now palpating the liver, starting from the right iliac fossa…” Narration helps examiners follow your examination and mark steps correctly even if they cannot see your hands clearly.
Thank the patient and offer to help them re-dressProfessional closing is marked. Candidates who finish an examination and step back without acknowledging the patient lose marks for communication.
If you make an error, acknowledge it and continueExaminers do not penalise candidates for acknowledging a mistake and correcting it. Panicking and freezing loses more marks than the original error.
⚠️ The Three Most Common Reasons for NRE Step 2 Failure
  1. Failing a mandatory station β€” especially BLS. Candidates who have never practiced CPR on a manikin consistently fail on compression rate, depth, or sequence. This single station has ended more NRE Step 2 attempts than any other.
  2. Skipping hand hygiene β€” it is on the mark sheet of almost every clinical and procedural station. Missing it repeatedly compounds across the entire exam.
  3. Poor time management β€” spending too long on history-taking stations and not reaching the summary or differential diagnosis. Practice each station type within the time limit. 7 minutes is shorter than it feels.

Also on Multipotent Medverse

NRE Step 2 β€” Complete Preparation Guide How to Apply for NRE Step 2 NRE Step 1 β€” Complete Preparation Guide Top 100 High-Yield Topics for NRE Step 1

Frequently Asked Questions

How many stations are in NRE Step 2 OSCE and how long is each?
NRE Step 2 consists of 20 OSCE stations. Each clinical station lasts 5–7 minutes, with a 1-minute reading station before each clinical station where you review the instruction card. Rest stations (without a task) are also included to allow candidates to move between areas of the examination centre. Total examination time is approximately 2.5 to 3 hours. PM&DC publishes the official structure on their website, and the format may be updated β€” always check the official NRE Step 2 guidelines before your exam date.
Which stations are mandatory pass stations in NRE Step 2?
The mandatory pass stations in NRE Step 2 are BLS/CPR, abdominal examination, and the paediatric assessment station. These stations must each be passed independently β€” a failure in any one of them results in overall exam failure regardless of your performance in all other stations. PM&DC introduced mandatory stations because these competencies represent the absolute minimum clinical standard required before independent medical practice. We recommend spending at least 40% of your OSCE preparation time on these three stations specifically.
I studied in China β€” how do I prepare for OSCE when my university exams were MCQ-based?
This is the most common challenge for China-trained graduates facing NRE Step 2. Chinese MBBS examinations are predominantly written β€” MCQs, short answers, and OSPEs (observed structured practical examinations) that focus on procedure demonstration rather than integrated clinical communication. NRE Step 2 OSCE adds the communication and reasoning layer on top. The preparation strategy is: first, learn the examination sequences for each system until they are completely automatic (so you can perform them while simultaneously communicating with the patient). Second, practice each station type with a timer. Third, get someone to watch you and give feedback β€” you cannot identify your own gaps in real-time performance. Our NRE Step 2 live sessions specifically address the China-trained graduate’s OSCE preparation gap.
Is there a pass mark for each station in NRE Step 2?
Each station in NRE Step 2 has its own mark sheet with individual criteria. For standard stations, there is an overall pass mark for the exam (typically around 60% of total marks), and candidates who achieve this pass mark across all stations overall pass the exam β€” with the exception of mandatory stations, which must be passed at the station level regardless of overall score. PM&DC does not publish the exact pass mark percentage for each non-mandatory station β€” it is determined using the Angoff method by the examining committee for each sitting.
πŸ‘¨β€βš•οΈ

Dr. Jawad Akram β€” MBBS, MS General Surgery

NRE course instructor at Multipotent Medverse Academy. Based in Henan, China. Teaches NRE Step 1 and Step 2 preparation for Pakistani MBBS graduates from China, Central Asia, and Russia via live online sessions.

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