NRE Step 1: the complete guide
The National Registration Examination is the PM&DC exam foreign medical graduates must pass to register and work in Pakistan. Step 1 is a 200-question computer-based MCQ paper; Step 2 is a clinical OSCE.
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What the NRE is
The National Registration Examination (NRE) is run by the Pakistan Medical and Dental Council (PM&DC) under the PM&DC Act 2022. It replaced the older National Licensing Examination (NLE). Pakistani doctors and dentists who studied abroad must pass it before they can be registered and practise in Pakistan, including starting a house job.
Graduates of Pakistani medical colleges don't sit the NRE. PMDC said in July 2025 it would bring back a licensing exam (NLE) for all graduates; see NLE in Pakistan: current status. For this cycle's dates, see NRE exam 2026 dates.
Rules and dates change. Always confirm the current notification on the official portal at nre.pmdc.pk before you apply or plan your preparation around a date.
Who is eligible
- A primary medical (MBBS or equivalent) or dental (BDS or equivalent) qualification from a foreign institution recognised by PM&DC.
- In 2026 PM&DC notices, recognition has been linked to the institution being on the ECFMG-recognised list. PM&DC has also said that graduates of institutions in Afghanistan cannot sit the NRE.
- A PM&DC provisional licence or approval first. Document verification can take weeks, so start early; candidates have missed a whole session waiting for it.
Structure
The NRE has two steps:
| Step | What it is |
|---|---|
| Step 1 (theory) | 200 single-best-answer MCQs, computer-based |
| Step 2 (Clinical Skills Examination) | An OSCE of about 20 stations |
You must pass Step 1 before you can sit Step 2.
Step 1 subject weightage
PM&DC's published structure gives about 70% clinical sciences and 30% applied basic sciences:
| Area | Approximate MCQs |
|---|---|
| Medicine and allied | 52 |
| Surgery and allied | 48 |
| Obstetrics and gynaecology | 14 |
| Paediatrics | 14 |
| Ophthalmology | 6 |
| ENT | 6 |
| Applied basic sciences (pathology, anatomy, physiology, pharmacology, biochemistry, community medicine, forensic medicine) | About 60 |
The paper is clinically oriented. Basic sciences are tested through clinical scenarios, not isolated facts.
Pass mark and marking
- Pass mark: 60% for Step 1, as summarised from PM&DC's structure in 2026.
- No negative marking: answer every question.
- A Step 1 pass has been reported as valid for 5 years, within which Step 2 must be cleared.
How to apply
- Get your PM&DC provisional licence or approval.
- Create an account on nre.pmdc.pk.
- Apply when a session is announced.
- Upload your degree, transcripts, CNIC or passport and photographs.
- Pay the fee online.
- Download your roll number slip before the exam.
How to prepare
Most candidates need 2 to 4 months of steady preparation. The exam rewards clinical reasoning: "What is the next best step?", "What is the most likely diagnosis?", "Which drug?"
- Learn the pattern: do timed blocks of 50 questions early, not just at the end.
- Master the big four: medicine, surgery, gynaecology and paediatrics carry most of the marks.
- Learn Pakistani practice: local guidelines and local diseases (typhoid, TB, dengue, malaria, hepatitis, snakebite, organophosphate poisoning) appear often.
- Review every explanation, including for questions you got right.
- Do full mocks in the last two to three weeks.
See our 12-week study plan and the syllabus breakdown.
Practise with the NRE-1 Prep question bank, which explains every option, and use the clinical guides to learn how Pakistani wards actually manage common problems.
Common mistakes
- Waiting for the provisional licence before starting to study.
- Memorising foreign guidelines that don't match local practice.
- Only reading, never doing timed questions.
- Ignoring small subjects: eye, ENT and forensic questions are easy marks.
- Leaving questions blank when there is no negative marking.
More NRE guides
High-yield subjects and weightage · Step 1 vs Step 2 · Preparing while working · 12-week study plan
Frequently asked questions
Who has to take the NRE in Pakistan?
Pakistani citizens and others with a medical or dental degree from a foreign institution, who want to register with PM&DC and work in Pakistan.
How many MCQs are in NRE Step 1?
200 single-best-answer MCQs, taken on a computer.
What is the passing score for NRE Step 1?
60%, according to PM&DC's published structure summarised in 2026. Confirm in the current notification.
Is there negative marking in the NRE?
No. Answer every question.
Do graduates of Pakistani medical colleges need to pass the NRE?
No. The NRE is for foreign graduates. A separate licensing exam (NLE) for all graduates was announced in July 2025; see its current status.