Qualifying in New Zealand: a system built on borrowed exams

Medical and health education in New Zealand

Medicine is taught at two schools: the University of Auckland and the University of Otago. The MBChB is a six-year programme, entered after a competitive first-year health science course. The sixth year is spent as a trainee intern. Medical Council of New Zealand (MCNZ) and the Australian Medical Council accredit the programmes together, so New Zealand and Australian training are formally aligned. Teaching is in English.

After graduating, doctors apply to MCNZ for provisional general registration and complete two years of supervised prevocational training (PGY1 and PGY2) before moving into specialist training. The first of those years is the house officer year.

Nursing is a three-year Bachelor of Nursing regulated by the Nursing Council of New Zealand. Pharmacy is a four-year degree followed by a supervised internship before registration with the Pharmacy Council. Dentistry is a five-year Bachelor of Dental Surgery at Otago, accredited with the Dental Council of New Zealand. English and te reo Māori are both official languages, and Māori health content is part of every curriculum.

A small country that imports its exams

New Zealand is a small country, and the result is a distinctive system. For doctors, dentists and pharmacists, the written component is bought in from a larger country, and the local examination is the clinical or practical stage. That shapes how you prepare: for a New Zealand registration, much of your study is for someone else's exam.

It also makes New Zealand an unusually efficient second destination. A candidate who has passed the AMC MCQ for Australia, the MCCQE Part I for Canada, PLAB 1 for the UK or USMLE for the US already holds a New Zealand prerequisite. The same logic applies to dentists, where one exam sequence serves Canada and New Zealand.

Who needs a licensing exam in New Zealand

Doctors: NZREX Clinical

The Medical Council of New Zealand (MCNZ) runs NZREX Clinical for international medical graduates who are not eligible for another registration pathway. It is an OSCE of 12 stations lasting three hours. The Council publishes a dashboard of candidate numbers, and over the last five years the average pass rate has been 66%. That means roughly one in three candidates does not pass on a given attempt, so the clinical exam deserves more than a few weeks of preparation.

NZREX Clinical has no written paper of its own. To be eligible, you must first pass one of the following within the last five years:

• PLAB 1 (UK)
• MCCQE Part I (Canada)
• AMC MCQ (Australia)
• USMLE Step 1 and Step 2 CK (United States)

The choice should depend on where else you might apply. PLAB 1 is also accepted in Ireland, the AMC MCQ leads to Australian registration, and the USMLE steps lead to US residency. The five-year clock is easy to overlook: a result that is older than five years will not count.

Because NZREX has no written paper, TriagePass practice questions will not prepare you for the clinical stage itself. They help with the written prerequisite, whichever of the four you choose. For the OSCE, practise timed stations with a partner, rehearse structured history taking and examination, and learn New Zealand practice such as Te Tiriti o Waitangi obligations and Pacific and Maori health context, since cultural safety is part of New Zealand clinical practice.

1. Check the Council's pathway page to confirm you need NZREX rather than another route.
2. Pass a qualifying written exam and keep the result within the five-year window.
3. Apply to sit NZREX Clinical and prepare for 12 stations in 3 hours.
4. Follow the Council's remaining registration steps after you pass, as listed on its site.

Choosing the written exam for NZREX

Four exams qualify, and they are not interchangeable in cost, location or reach. A short comparison helps.

Pick the exam that matches your second-choice country. If New Zealand is the only goal, the shortest sequence is usually a single exam, not the two-step USMLE pairing. Note, though, that the Council decides eligibility, and the list of qualifying exams can change.

Nurses: the NCNZ competence assessment

The Nursing Council of New Zealand (NCNZ) assesses internationally qualified registered nurses who do not meet its exemption criteria, and all enrolled nurses, with a competence assessment made up of a theory exam and an OSCE. Documents are first verified by TruMerit (formerly CGFNS), and the Council requires 1,800 hours of post-registration practice.

Exemptions matter here. Registered nurses from the United States, the UK, Ireland, Singapore and some Canadian provinces are often exempt, so the first task is to read the criteria and find out whether you need the assessment at all. We have not confirmed the format of the NCNZ State Final Examination that New Zealand graduates sit, so this page does not describe it.

Midwives: a competence programme

Internationally qualified midwives are assessed against New Zealand standards by the Midwifery Council. For overseas-registered midwives, the Council describes an overseas competence programme, completed within 24 months of the first practising certificate. It covers a Te Tiriti o Waitangi workshop, a cultural competence course, a course on the New Zealand maternity and midwifery system, pharmacology and prescribing, a newborn examination with theory and practical parts, and Growth Assessment Protocol education. For at least the first 12 months of practice you work under a Council-appointed supervisor. The Council's programme page does not describe a licensing exam, and you should confirm the details with the Council. It also lists a National Midwifery Examination for New Zealand graduates, but we have not confirmed its format.

Pharmacists: NZ OPRA and the Assessment Centre

The Pharmacy Council of New Zealand registers pharmacists from countries without a comparable route through a sequence of three stages. First comes the New Zealand OPRA, a computer-based multiple-choice assessment delivered by the Australian Pharmacy Council, with a limit of two attempts. Second is the New Zealand Pharmacy Legislation course. You must pass both within two years of the preliminary review. Third is the Assessment Centre, an OSCE-style assessment at the end of the intern year. New Zealand graduates complete the intern programme and the same Assessment Centre.

Pharmacists from the UK, Ireland, the US, Canada and Australia have separate routes, so check the Council's page before assuming you need OPRA.

Dentists: NZDREX through the NDEB

The Dental Council of New Zealand (DCNZ) uses the Canadian NDEB Equivalency Process as its registration examination. It is made up of the AFK and ACJ computer-based exams at Prometric centres and the NDECC practical exam in Ottawa. Passing the Canadian process counts as NZDREX. The AFK and ACJ banks therefore serve two countries.

Physiotherapists: no licensing exam

The Physiotherapy Board of New Zealand assesses overseas physiotherapists on their qualification and experience. An express path exists for those registered in the UK, Ireland, Canada and South Africa, following changes in 2022. We have not confirmed the exact current requirements, so use the Board's registration page.

Exams compared

Language and recognition

New Zealand exams and assessments are in English, and the councils require English language evidence from applicants who did not train in English. The recognition picture is the most layered on this site: doctors qualify via another country's written exam, dentists via Canada's, pharmacists via Australia's, and nurses and physiotherapists via exemptions for named countries. Always check whether your country appears on an exemption or express list before booking an exam.

The practical rule is to decide which written exam to sit and where. A single choice can open two or three countries, but only if you keep the result valid, and the five-year window for NZREX is the clearest example.

TriagePass is independent of the MCNZ, NCNZ, Midwifery Council, Pharmacy Council and DCNZ. Our questions are original.

Last reviewed October 2026