NRE Step-2 — Clinical Skills Examination
Pass NRE Step‑2 CSE —
Master Every OSCE Station
Complete preparation for Pakistani MBBS graduates from China, Central Asia & Russia — covering all 20 stations with checklists, procedures, and communication skills.
20
OSCE Stations
8
Minutes Per Station
60%
Passing Score
3
Mandatory Stations
Overview
What Is NRE Step‑2 (CSE)?
Congratulations on clearing NRE Step‑1. You have already proven your theoretical knowledge. Now NRE Step‑2 — officially called the Clinical Skills Examination (CSE) — tests what matters most in real practice: your ability to assess, diagnose, and communicate with patients safely and systematically.
The exam uses an OSCE format (Objective Structured Clinical Examination) — multiple timed stations, each testing a specific clinical skill in front of an examiner. There are no MCQs. Everything is practical and observed.
20
Clinical OSCE stations
8 min
Per station + 2 min changeover
60%
Minimum overall pass mark
3
Mandatory stations — must pass individually
~3.5h
Total exam duration
⚠️ Critical Rule — Mandatory Stations
The mandatory stations are Basic Life Support (BLS), Abdominal Examination, and Paediatrics–Medicine. Candidates must pass all three mandatory stations individually in addition to achieving the overall passing score. Failing even one mandatory station means failing the entire CSE — regardless of your total percentage. Always confirm which stations are mandatory before your exam date via the official PM&DC website.
Why It Matters
What Step‑2 Unlocks for You
Full PM&DC Registration
Passing both Step-1 and Step-2 gives you complete, permanent medical registration in Pakistan.
House Job & Residency
Required to start house job placements and apply for residency or specialty training in Pakistan.
Recognition of Foreign MBBS
Confirms that your MBBS from China, Central Asia, or Russia meets Pakistan’s clinical standards.
Independent Practice
Required before you can practise as an independent doctor anywhere in Pakistan.
All 20 OSCE Stations
Complete Station-by-Station Breakdown
Each station is 8 minutes long. Below are all 20 stations with what is tested and tips for each. Stations marked in red are mandatory — you must pass them individually.
Mandatory station
Clinical discipline
Procedure
Communication
1
Basic Life Support (BLS)
Adult CPR, airway management, chest compressions, rescue breathing, AED application, and emergency response according to current resuscitation guidelines.
⚠️ Mandatory
2
Abdominal Examination
Comprehensive abdominal examination including inspection, palpation, percussion, auscultation, identification of organomegaly, ascites, masses, and formulation of differential diagnoses.
⚠️ Mandatory
3
Paediatrics – Medicine
Assessment of common paediatric medical conditions including developmental milestones, growth assessment, child examination techniques,EPI Schedule and clinical reasoning.
⚠️ Mandatory
4
Cardiovascular Examination
Systematic cardiovascular examination including pulse assessment, JVP evaluation, precordial examination, heart sounds, murmurs, and clinical interpretation.
Clinical Examination5
Communication & Counselling
Patient counselling, informed consent, explaining diagnoses, discussing treatment options, breaking bad news, and demonstrating professional communication skills.
Communication6
Respiratory Examination
Complete respiratory system examination including inspection, palpation, percussion, auscultation, and identification of common pulmonary abnormalities.
Clinical Examination7
Neurological Examination
Focused neurological assessment covering cranial nerves, motor and sensory systems, reflexes, coordination, gait, and localisation of lesions.
Clinical Examination8
Paediatrics – History Taking
Structured paediatric history taking from parents or guardians including presenting complaints, birth history, immunisation status, nutrition, and developmental milestones.
History Taking9
Obstetrics
Assessment of antenatal, intrapartum, and postnatal scenarios including obstetric history, pregnancy-related complications, and clinical decision making.
Women’s Health10
Gynaecology
Evaluation of common gynaecological complaints, menstrual disorders, infertility issues, and women’s reproductive health scenarios.
Women’s Health11
Ophthalmology
Recognition of common ophthalmic conditions, visual assessment techniques, ocular examination findings, and interpretation of eye-related clinical scenarios.
Specialty Station12
ENT Examination
Examination of the ear, nose, and throat with identification of common ENT disorders and relevant clinical findings.
Specialty Station13
History Taking / Diagnosis – Medicine
Focused medical history taking followed by differential diagnosis formulation, clinical reasoning, and discussion of appropriate investigations.
Clinical Reasoning14
Data Interpretation – ECG
Interpretation of ECG tracings including arrhythmias, ischemic changes, conduction abnormalities, and clinically significant findings.
Interpretation15
Picture Diagnosis – Medicine
Identification and interpretation of common internal medicine conditions like Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Image Interpretation16
Instrument Identification
Recognition of commonly used medical and surgical instruments, their indications, functions, handling principles, and clinical applications.
Practical Skills17
Image Diagnosis – Surgery
Interpretation of surgical imaging including fractures,Chest X-Ray, CT/MRI Brain, abdominal pathologies, trauma findings, and common surgical conditions.
Image Interpretation18
Surgery Case Scenario
Presenting any clinical case to which the examiner will ask questions to assess knowledge about diagnosis, investigations, management principles, operative indications, and complications.
Viva Station19
Medicine Case Scenario
Examiner-will ask questions while giving lab report to assess clinical knowledge, diagnostic approach, treatment planning, and evidence-based patient management.
Viva Station20
Diagnostic Imaging Station
Comprehensive interpretation of any diagnostic image including X-ray, CT, MRI, ultrasound, pathology images, or clinically relevant visual findings.
Image Interpretation📌 Note on Station Numbers
The exact 20 stations and which three are mandatory can vary slightly between exam sessions. Always verify with the official PM&DC notification for your specific exam date. The stations above reflect the most consistently reported format from recent NRE Step-2 sittings.
Rules You Must Know
Critical Rules Before You Sit Step‑2
Step-1 must be passed first. You cannot sit for Step-2 until you have a valid Step-1 pass certificate from PM&DC.
Step-1 pass is valid for 5 years. You must complete Step-2 within this window. If it expires, you must re-sit Step-1 before attempting Step-2 again.
3 consecutive CSE failures = restart from Step-1. If you fail Step-2 three times in a row, PM&DC requires you to resit the complete NRE — both steps — on the next attempt.
No limit on total attempts. There is no cap on how many times you can attempt the NRE overall. However, each failure delays your career by months — structured preparation is essential.
Always check PM&DC announcements. Exam dates, centres, format details, and fee structures can be updated at any time. Verify before registering for each attempt.
Preparation Strategy
How to Prepare for NRE Step‑2 Effectively
1. Learn the Structure of Every Station First
Before practising any station, memorise its structure — the opening, the core task, and the closing. Examiners mark against a fixed checklist. A structured candidate who is calm and methodical scores higher than a knowledgeable candidate who is disorganised.
2. Practise with a Partner — Not Just in Your Head
OSCE skills cannot be revised by reading. You must physically practise history taking, examination, and procedures out loud with another person playing the patient. Time yourself to 8 minutes for every station from day one.
3. Prioritise the 3 Mandatory Stations
BLS, Abdominal Examination and Peadiatrics must be practised until they are automatic. Failing any one of these fails the entire exam. Practise BLS on a mannequin if possible — correct rate (100–120/min) and depth (5–6cm) must be muscle memory, not recalled under pressure.
4. Use Station Checklists for Every Practice Session
Each OSCE station has an examiner’s marking checklist. Practise with the checklist in front of you so you know what is being scored. After each session, tick what you covered and identify what you missed. Close the gaps systematically.
5. Run Full Mock CSE Sessions Under Timed Conditions
At least 2 weeks before the exam, run complete mock sessions — all 20 stations timed at 8 minutes each with 2-minute changeovers. This builds stamina and removes the time-shock on exam day. Ask for honest feedback after each station.
FAQs
NRE Step‑2 Frequently Asked Questions
What is the format of NRE Step-2 CSE?
NRE Step-2 is an OSCE-style clinical skills exam with 20 timed stations. Each station is 8 minutes with a 2-minute changeover. You are assessed by an examiner against a fixed marking checklist at each station. There are no MCQs — every station is practical and observed.
Which stations are mandatory in NRE Step-2?
Three stations are designated mandatory — typically BLS, Abdominal Examination and Peadiatrics. You must pass all three individually. Failing even one mandatory station means failing the entire CSE, regardless of your total score across all other stations.
How can I practise NRE Step-2 OSCE stations at home?
Practise with a study partner or group using printed station checklists. One person plays the patient, the other the candidate. Time every station to exactly 8 minutes. Focus on your opening (introduce yourself, wash hands, confirm patient name), your structure, and your closing (summarise and thank the patient).
Which clinical skills are most important for NRE Step-2?
BLS is the most critical — it is mandatory and non-negotiable. After that, focused history taking, cardiovascular and respiratory examination, and communication skills (breaking bad news, counselling) carry the most marks across stations.
How long should I prepare for NRE Step-2?
4 to 6 weeks of dedicated daily OSCE practice is sufficient for most candidates who have strong theoretical knowledge from Step-1. The first 2 weeks should focus on learning station structures. Week 3 should focus on practising each station with a partner. The final weeks should be full mock CSE sessions.
Ready to Master NRE Step‑2 OSCE?
These station guides give you the foundation. For complete OSCE practice sessions, station checklists, mock CSE coaching, and personalised feedback — join our private Telegram group.
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