NRE Step I is the written (theory) half of the National Registration Examination that Pakistani citizens with a foreign MBBS must pass before they can hold a full PM&DC licence. It is 200 computer-based MCQs, 70% clinical (140) and 30% basic sciences (60), with a 60% pass mark and no negative marking. The next sitting is Sunday 8 November 2026, moved from 11 October; registration for it was extended to 15 September. In the December 2025 sitting only about one candidate in five passed. Step II, the OSCE-style clinical skills exam, opens only after you pass Step I, and the Step I pass stays valid for five years. Dates, fees and eligibility rules change by notice, so confirm each one on pmdc.pk before you pay anything.
What the exam is and who sits it
The National Registration Examination (NRE) is set under Section 18 of the PM&DC Act 2022. The Pakistan Medical and Dental Council (PM&DC) owns the policy. The National University of Medical Sciences (NUMS) in Rawalpindi conducts the paper. The exam applies to doctors and dentists who qualified outside Pakistan. This page covers the medical (MBBS) track.
PM&DC's own 2024 syllabus document calls the two parts "Theory" and "Clinical Skills Examination (CSE)". Notices, newspapers and candidates call them Step I (NRE-I) and Step II (NRE-II). They mean the same two papers. Step I is the MCQ paper. Step II is the OSCE-style clinical exam.
Most candidates are Pakistani nationals who went abroad for MBBS: Kyrgyzstan, China, Kazakhstan, Uzbekistan, Tajikistan, Russia, Iran, Ukraine and a long tail of smaller countries. In the December 2025 sitting, Kyrgyzstan alone supplied about 4,300 of roughly 7,000 candidates, and China about 2,150. If you studied somewhere else, the exam is the same. Only the odds differ by country (see pass rates by country of graduation).
Without passing both parts you cannot obtain a full licence or practise independently in Pakistan. A degree from a PM&DC-recognised foreign college can earn you provisional registration so that you can start a house job, but the NRE is still required for full registration. The route you are on depends on whether your college is recognised. We explain that in what PM&DC needs from a foreign MBBS graduate.
Eligibility and booking
PM&DC's 2024 syllabus states that candidates must hold an MBBS, MD or equivalent from a PM&DC-approved foreign medical college and hold a PM&DC provisional licence. A September 2025 PM&DC press release adds that only graduates of institutions on the ECFMG-accredited lists may appear, and that graduates from the earlier PM&DC or PMC period whose colleges are not yet recognised receive provisional registration once they qualify through the NRE. These statements do not read identically, and the position has moved since 2023. Treat the notice for your own sitting as the final word.
The booking process below follows PM&DC's notices. The portal screens change between sittings, so the order can differ slightly.
- Check the notice. Read the public notice for the sitting on pmdc.pk: dates, deadline, fee, eligibility and any document changes. Do not rely on a forwarded screenshot.
- Create your profile on the NRE portal. Use the same name, spelling and CNIC details that appear on your degree and passport. A mismatch between documents is an avoidable problem, so fix it before you submit.
- Upload documents. Degree, provisional licence where required, identity documents and photographs, in the formats the portal asks for.
- Generate the challan and pay. The fee is paid by bank challan through banking channels. The November 2024 notice set PKR 20,000 for Step I. The 2026 notices say "prescribed fee" without a figure, so read the amount from the challan itself.
- Submit before the deadline. PM&DC states that late applications are not entertained. Submit days early, not hours.
- Download your roll number slip. Check your centre (Islamabad/Rawalpindi, Lahore, Karachi or Peshawar), reporting time and the items you may bring.
Fees, dates and the per-sitting deadlines have their own page: booking, fees and dates for NRE Step I.
Registration for the 8 November 2026 sitting had a deadline of 15 September 2026 after an extension, and the exam itself was moved from 11 October. If you missed it, plan for the next announced sitting. PM&DC holds the NRE at least twice a year, but it has not published 2027 dates at the time of writing.
Format and scoring
Step I is 200 computer-based multiple-choice questions. PM&DC describes them as objective questions aimed at higher cognition, which in practice means clinical vignettes rather than single-fact recall. Seventy per cent (140 items) test clinical sciences and thirty per cent (60 items) test basic sciences.
| Feature | What PM&DC states | Status |
|---|---|---|
| Number of questions | 200 computer-based MCQs | Stated in the 2024 syllabus |
| Clinical / basic split | 140 clinical (70%), 60 basic (30%) | Stated in the 2024 syllabus |
| Time | 3 hours 30 minutes (210 minutes) | Reported in the June 2025 press release; not in the syllabus |
| Options per question | Not stated | Expect single best answer with five options; this is our working assumption |
| Pass mark | 60% | Stated; it was 70% in 2023 |
| Negative marking | None | Stated |
| Standard setting | Angoff method | Stated |
| Attempts | No limit on attempts at the full NRE | Stated |
| Validity of a Step I pass | 5 years for sitting Step II | Stated |
Because there is no negative marking, answer every question. Because the Angoff method sets the standard from expert judgement of how a minimally competent candidate would perform, the pass mark is a fixed 60% of marks, not a rank. You are not competing with the rest of the room. Details are in pass mark and scoring.
Try PMDC NRE Step I practice questions free
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Blueprint by domain
PM&DC's published blueprint table is partly unreadable in the scan. Clinical figures are legible: Medicine and allied 52, Surgery and allied 48, Obstetrics and gynaecology 14, Paediatrics 14, Ophthalmology 6, ENT 6. For basic sciences the legible figures sum to 56, so four items cannot be assigned from the scan. We scaled the basic-science figures to the stated 60 items and merged ophthalmology with ENT. Treat any single basic-science number as accurate to within one or two items.
| Domain | Weight | Approx. items of 200 | Page |
|---|---|---|---|
| Medicine and Allied (incl. psychiatry, dermatology, neurology) | 26% | 52 | Medicine |
| Surgery and Allied (incl. orthopaedics, urology, anaesthesia) | 24% | 48 | Surgery |
| Obstetrics and Gynaecology | 7% | 14 | Obs and gynae |
| Paediatrics | 7% | 14 | Paediatrics |
| Ophthalmology and ENT | 6% | 12 | Eye and ENT |
| Applied Anatomy (incl. embryology, neuroanatomy) | 6% | 12 | Anatomy |
| Applied Pathology (incl. microbiology, haematology, immunology) | 6% | 12 | Pathology |
| Applied Physiology | 5.5% | 11 | Physiology |
| Clinical Pharmacology | 4.5% | 9 | Pharmacology |
| Applied Biochemistry | 3% | 6 | Biochemistry |
| Community Medicine and Public Health (Pakistan) | 3% | 6 | Community medicine |
| Forensic Medicine and Toxicology (Pakistan law) | 2% | 4 | Forensic medicine |
Two things follow from this table. First, medicine and surgery together are half the paper (100 items), so a clinical weakness there cannot be rescued by strong basics. Second, the 60 basic-science items are spread over seven subjects, and PM&DC asks them as clinical correlations. A candidate who learned anatomy as labelled diagrams and physiology as definitions will find these items hard. For the full ranking of what to revise first, see high-yield topics.
How to prepare: a four-phase plan
Most failed attempts in this exam are not failures of intelligence. They come from preparing for the wrong exam: a university-style written paper, or an international exam such as USMLE, or a theory test built on your own country's guidelines. The plan below assumes you have 12 weeks. Shorter and longer versions are in the 8, 12 and 16-week study plan.
| Phase | Weeks | What you do | Output |
|---|---|---|---|
| 1. Baseline and map | 1 | Sit a 100-question timed mixed test. Download the 2024 syllabus. Mark each domain red, amber or green. | A one-page weakness map |
| 2. Clinical core | 2 to 6 | Medicine, surgery, obstetrics and gynaecology, paediatrics by system. Twenty questions a day on the same system. Learn Pakistani first-line management, not only textbook options. | Error log by topic |
| 3. Basics as clinical correlation and local content | 7 to 9 | Anatomy, physiology, pathology, pharmacology, biochemistry through clinical cases. Community medicine and forensic medicine against Pakistani programmes and law. | Revised map; local-guideline sheet |
| 4. Exam conditions | 10 to 12 | Two full 200-question papers under 210-minute conditions. Review every error. Last week: error log only, no new topics. | Stable mock score above 65% |
The 65% target is deliberate. The pass mark is 60%, and mock questions from any source will differ from the real paper. A margin of five marks absorbs that difference. It is a planning target we set, not a PM&DC figure.
Three habits matter more than the resource you choose. Do questions by system, not by random, until your accuracy in a system is stable. Keep an error log in your own words: the fact you missed and the reasoning step that failed. And practise in 50-question blocks of 52 minutes so that the pace of about 63 seconds a question becomes automatic.
Do not memorise recalled questions. PM&DC items are written afresh and the pool changes. Recalled-question groups circulate in WhatsApp and Facebook, and they teach you answers without the reasoning the exam asks for. Our bank is original and does not copy any exam content.
What the questions look like, and how to pace them
PM&DC does not publish past papers and we do not reproduce any, so we describe the style only from the syllabus wording: objective, computer-based items aimed at higher cognition. In practice that means a short clinical vignette (age, sex, presenting complaint, key findings, sometimes a laboratory or imaging result), a question such as the most likely diagnosis, the next best step or the first-line drug, and a list of options. Basic-science items are built the same way: the stem describes a patient, and the answer tests the underlying anatomy, physiology or pathology.
The reported 210 minutes for 200 items gives an average of 63 seconds. A workable pacing rule is to reach item 50 by minute 52, item 100 by minute 105 and item 150 by minute 157, which leaves about 53 minutes for the final 50 items and a review of flagged questions. Read the last sentence of the stem first, so you know what is being asked, then read the stem for the facts that decide it. Eliminate options you can prove wrong. If two remain, choose the one that fits the patient described, not the one that is true in general.
- Do not change an answer without a specific reason. First instincts are not always right, but changes made from anxiety lose marks more often than they gain them.
- Do not spend more than two minutes on any item on the first pass. Flag it and move on.
- If the exam software offers a flag or review function, learn how it works before the timer starts.
- Answer all 200. There is no negative marking.
Are you ready to book? A checklist
Booking a sitting before you are ready costs the fee, travel and months. Book when most of the following are true.
| Check | Ready when |
|---|---|
| Documents | Degree, transcript, provisional licence (where required) and identity documents are scanned and match one another |
| Eligibility | You have read the notice for the sitting and know whether your college is recognised |
| Mock performance | Two timed papers at 65% or more on original questions |
| Weak domains | No domain in medicine or surgery below 55% on recent blocks |
| Local content | You can state the EPI schedule, first-line TB, malaria and dengue management, PPH and eclampsia drugs without notes |
| Logistics | You can reach a PM&DC centre the day before and have money set aside for a second attempt if needed |
The mock and domain thresholds are our planning rules. They are not PM&DC requirements, and a candidate who is a few marks short may still pass. They exist because the real exam has a margin of error you cannot see.
Common reasons candidates fail
PM&DC has not published a failure analysis, so the points below are our inference from the published pass rates, the syllabus, and the content gaps we see between foreign curricula and the Pakistani blueprint. They are guidance, not findings.
- Weak applied basic sciences. Sixty items test anatomy, physiology, pathology, pharmacology, biochemistry, community medicine and forensic medicine as clinical problems. Memorising lists without correlation loses marks here.
- Pakistan-specific content. The Expanded Programme on Immunization schedule, the National TB Control Programme, the Lady Health Worker Programme, XDR typhoid and typhoid conjugate vaccine, hepatitis C control, polio surveillance and Pakistani medicolegal law are examinable. A programme in Bishkek or Wuhan may not have taught them. See local guidelines you must know.
- Local disease burden in vignettes. Typhoid, malaria (mostly vivax), dengue, Crimean-Congo haemorrhagic fever, tuberculosis, hepatitis B and C, organophosphate poisoning and leishmaniasis appear far more often than in curricula built for colder climates.
- Clinical knowledge learned a long time ago. Many candidates sit the exam two to five years after their final-year exams. Medicine and surgery, half the paper, need active recall again.
- Late preparation after a bad attempt. There is no limit on attempts, but each attempt costs the fee and several months. A first attempt prepared properly is cheaper than three half-prepared ones.
- Time management. Two hundred items in 210 minutes leaves little room for stuck questions. Flag and move on.
Pass rates give context. In the June 2025 sitting the medical pass rate was 25.26%. In December 2025, 21.17% of medical candidates passed (1,467 candidates), by the figures reported from PM&DC. The country breakdown for December 2025 ranges from about 15.5% for China to about 31% for Kazakhstan among the larger groups.
Sit a timed PMDC NRE Step I mock exam
Blueprint-weighted questions under exam timing, then a breakdown of your result by domain.
After the exam
PM&DC publishes Step I results on pmdc.pk, with detailed marks through the online portal, about three to five weeks after the paper in recent sittings. You can request re-totalling through PM&DC.
If you pass, you may register for Step II, the Clinical Skills Examination. It is OSCE-style: 20 stations, each 8 minutes with 2 minutes for changeover, about 3 hours 30 minutes in all. The stations are Medicine 7, Surgery 7, Obstetrics and gynaecology 2, Paediatrics 2, Ophthalmology 1 and ENT 1. You need 60% in aggregate and must clear all three mandatory stations. The Step I pass is valid for five years, and Step II must be passed within that window. After three consecutive Step II failures you re-sit the full NRE. Our Step II OSCE guide covers the station mix and how to practise.
If you do not pass, you may re-sit with no cap on attempts. The after-the-exam page sets out results, re-totalling, the Step II timeline and what comes next for registration: provisional registration, the one-year house job in four three-month modules, Basic Life Support certification, and full registration. The house job and registration rules come from the PM&DC Registration Regulations 2023. Confirm any later changes on pmdc.pk.
Choose a pass for PMDC NRE Step I
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Where to go next
Read the guide that matches your next decision. If you are choosing a date, go to booking and fees. If you are unsure whether you are eligible, read what PM&DC needs from you. If you have started revising and want to rank subjects, use the domain pages linked in the blueprint table above and the high-yield topics guide.
TriagePass is independent of PM&DC and NUMS. Nothing on this page is endorsed by either body. Every number in this guide is dated and traceable to a PM&DC document, or labelled as our estimate.