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.
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.
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.
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 (5β6 cm adults), correct compression rate (100β120/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.
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.
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.
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.
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.
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.
Upper limb neurological examination: inspection (wasting, fasciculations), tone (spasticity vs flaccidity vs rigidity), power (MRC grading 0β5 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).
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.
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.
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).
History Taking Stations
History taking stations present a patient actor with a presenting complaint. You have 5β7 minutes to take a focused, structured history and reach a differential diagnosis. You are marked on structure, completeness, communication skills, and clinical reasoning.
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.
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.
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.
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).
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.
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).
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.
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.
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.
Procedural & Practical Stations
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 15β30Β° 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.
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.
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).
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.
Data Interpretation Stations
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).
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).
NRE Step 2 OSCE β Strategy for Exam Day
| At Every Station | Why It Matters |
|---|---|
| Read the instruction card for the full 1-minute reading time | Every 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 name | Professional 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 patient | Hand 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-dress | Professional 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 continue | Examiners do not penalise candidates for acknowledging a mistake and correcting it. Panicking and freezing loses more marks than the original error. |
- 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.
- 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.
- 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.
Frequently Asked Questions
How many stations are in NRE Step 2 OSCE and how long is each?
Which stations are mandatory pass stations in NRE Step 2?
I studied in China β how do I prepare for OSCE when my university exams were MCQ-based?
Is there a pass mark for each station in NRE Step 2?
Preparing for NRE Step 2 OSCE from Abroad?
Our live NRE Step 2 sessions cover every OSCE station β BLS, clinical examinations, history taking, communication skills, and procedural stations β in real-time practice format with feedback. Message us to join the next cohort.
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