Step II OSCE: 20 stations, three mandatory, and how to prepare for it

What Step II is, in PM&DC's words

The 2024 NRE syllabus describes the Clinical Skills Examination as "similar to" an Objective Structured Clinical Examination. It says the exam aims to assess your ability to interpret clinical and diagnostic data, formulate a diagnosis, develop a management plan, perform clinical examination and carry out key procedural skills. The syllabus lists an appendix of the skills and competencies expected of an MBBS graduate and a house officer. Read that appendix in the PDF itself, because it is the nearest thing to a published checklist.

Step II is not a second theory paper. A candidate who passed Step I by a small margin and prepared for Step II only by reading will struggle, because OSCE marks are given for observable actions: the question you ask, the way you position the patient, the order of examination steps, the dose you write, the sentence you use to explain a result. None of that can be learned from a question bank alone.

The station map

Medicine and surgery make up 14 of 20 stations. That is the same emphasis as Step I, where they carry half of the paper. "Allied" matters: medicine and allied is likely to include psychiatry, dermatology and neurology, and surgery and allied is likely to include orthopaedics, urology and anaesthesia, because PM&DC's Step I blueprint groups them that way. PM&DC does not say how those are split across stations, so prepare for a station in any of them.

The arithmetic is simple. Twenty stations at 10 minutes each is 200 minutes. The stated duration of about 3 hours 30 minutes (210 minutes) "including the initial briefing" leaves roughly 10 minutes for briefing. In practice candidates are rotated in groups, and the exact flow is decided by the centre. Follow the invigilators.

How you pass: two gates, not one

The pass rule has two parts and you must satisfy both.

1. Aggregate of 60% or more. Your marks across the 20 stations are totalled. PM&DC uses the Angoff method for standard setting and states there is no negative marking.
2. All three mandatory stations cleared. If you reach 60% or more in aggregate but fail any one mandatory station, the syllabus states you are declared to have failed the entire CSE.

The syllabus does not say which three stations are mandatory or what "clear" means for a single station. You cannot game this. Because the identity is not published, treat every station as a potential mandatory one. A weak station in a small discipline (ophthalmology, ENT, a paediatric emergency) is more dangerous than it looks, because a single failed mandatory station voids a good aggregate.

Attempts, validity and the three-failure rule

These rules come from the 2024 syllabus.

• Only candidates who passed Step I may sit Step II.
• A Step I pass is valid for five years. Step II has to be passed within five years of the theory pass.
• If you pass Step I and fail Step II, you re-register for Step II only. You do not repeat the theory.
• After three consecutive Step II failures, the fourth attempt is the complete NRE: theory and clinical skills together.
• There is no bar on the number of times you may attempt the complete NRE.

A December 2025 PM&DC notice allowed a single additional attempt to candidates who had exhausted three chances "under the 70% passing requirement". That was a one-off decision connected to the earlier, higher pass mark. It does not change the standing three-failure rule.

Dates and booking

Recent Step II sittings give a pattern, not a promise.

Registration is through the PM&DC online portal. The January 2026 window was about ten days, so a candidate who learns about the sitting late may not have time to collect documents. Keep your Step I result, degree, provisional licence and identity documents scanned and ready. The notices we found do not state the Step II fee, the centres or the document list. Do not pay any agent or group a sum that you cannot match to a PM&DC challan.

How to prepare: a six-week OSCE plan

PM&DC publishes no station list, and we do not claim to know the content of any sitting. What follows is a preparation method built on the syllabus statements above and on how OSCEs work in general. It is our advice, not a PM&DC specification.

A routine for any eight-minute station

Spend the first 30 seconds reading the instruction outside the door. Decide what the examiner wants: history, examination, procedure, interpretation or explanation. Then:

• Introduce yourself, confirm the patient's name, explain what you will do and ask permission.
• Wash or sanitise your hands where it applies and say so aloud.
• Follow a fixed sequence. A fixed sequence is faster and leaves fewer gaps.
• Narrate findings and reasoning. The examiner cannot award marks for what you think silently.
• Finish with a summary, a working diagnosis, the next investigation and the first-line treatment, then thank the patient.

Keep the last 60 seconds for the close. Candidates who run out of time before they state a diagnosis or plan lose the marks that discriminate best.

Where foreign graduates lose marks

These are common patterns across OSCE-style exams for overseas graduates, not PM&DC findings.

• Little hands-on practice. Some programmes give limited bedside examination time, or teach in a second language. If you have not examined a real abdomen in two years, do it again with supervision before the exam.
• Management that does not match local practice. A station may expect first-line treatment as used in Pakistani hospitals: oral rehydration and zinc for diarrhoea, magnesium sulphate for eclampsia, oxytocin for postpartum haemorrhage prevention, directly observed therapy for tuberculosis. See local guidelines you must know.
• Communication that is too brief or too long. Open questions first, then closed ones. Avoid jargon when explaining to a patient. A patient is a person, not a case.
• Skipping safety steps. Consent, privacy, hand hygiene, checking allergies before prescribing and double-checking a drug name and dose are all observable.
• Freezing on a blank station. If you cannot recall the next step, say what you would do in an emergency (ABC), then order the safest investigation. Do not stay silent.

How Step II connects with the rest of the pathway

Step II is the last exam before full registration. It does not replace the one-year house job or the other requirements listed in the PM&DC Registration Regulations 2023. See after the exam for the sequence and what PM&DC needs from you for the document side. If your Step I pass is already two or three years old, start Step II preparation early, because the five-year validity clock runs from the date you passed theory.

TriagePass prepares you for the Step I theory paper. We do not run Step II stations. Our domain pages, for example Medicine and allied and Surgery and allied, help you keep the clinical knowledge that Step II assumes.