Dear Health New Zealand,

Tēnā koutou,

I am writing to request information under the Official Information Act 1982 regarding the NZREX Clinical Examination process, marking methodology, outcomes data, and the integrity of the overall assessment process.

Background and Context:

Publicly available data on the Medical Council website shows that between 2021 and 2026, 394 candidates sat the NZREX Clinical Exam. The overall pass rate across this period is 65.5%, with significant variation between sittings, ranging from 56.7% to 77.8%. Of those who passed, only 67.4% subsequently gained provisional general registration.

Since late 2023, I have been independently speaking with NZREX Clinical candidates approximately 15 days following their examination sittings to understand their results in the context of their preparation, study group feedback, and their own performance expectations on the day. I have gathered a substantial number of testimonials from candidates. The pattern emerging from these conversations is deeply concerning and points to serious questions about the integrity of the marking and assessment process.

Candidates with significant overseas clinical experience, strong preparation histories, and positive performance expectations on the day are consistently receiving failing results. What makes this more alarming is that in several cases, candidates who passed the examination have also expressed genuine shock at their result, again raising serious questions about the consistency and reliability of the marking process. I have at least three such candidates who are willing to come forward with their accounts. These individuals are no longer residing in New Zealand, which is itself a reflection of the broader problem this examination is creating for the country's healthcare workforce.

I am now in the process of bringing these testimonials and this data to media outlets and community groups to raise public awareness of what I believe to be a systemic failure, and potentially corrupt practices, within the NZREX Clinical examination and assessment process. New Zealand is already facing a well-documented GP shortage. A significant number of internationally qualified doctors who fail NZREX subsequently emigrate to Australia or the United Kingdom, representing a direct and ongoing loss to the New Zealand healthcare workforce. This is not an abstract issue. People across New Zealand are experiencing longer wait times and reduced access to healthcare as a direct consequence.

The cost of sitting the examination is also substantial, and the recount process, which consistently returns the same result, raises further questions about whether the recount serves as a genuine review mechanism or simply as an additional fee collected from already frustrated candidates.

I am making this OIA request as part of a broader effort to hold the Medical Council publicly accountable and to ensure that the examination process is transparent, fair, and free from any form of bias, whether based on country of origin, gender, ethnicity, or any other characteristic.

I request the following information:

1. The full marking and assessment criteria used in NZREX Clinical examinations, including how individual station scores are weighted and aggregated to determine a pass or fail outcome.

2. The process by which the cut score (pass mark) is determined for each sitting, including who is involved in setting it and whether it varies between sittings.

3. The qualifications, selection criteria, and training requirements for NZREX Clinical examiners and assessors, including any conflicts of interest policy applicable to them.

4. Any internal audits, quality assurance reviews, or external reviews of the NZREX Clinical examination marking process conducted in the past five years, and the outcomes of those reviews.

5. The number of recount requests received for each NZREX Clinical sitting from 2021 to present, the number where the result changed following recount, and the number where it did not change.

6. Data on pass rates broken down by candidate country of origin, gender, and ethnicity for NZREX Clinical sittings from 2021 to present, to the extent this information is held.

7. Any complaints received regarding the NZREX Clinical examination marking or assessment process in the past five years, and how those complaints were handled, in aggregated and de-identified form if necessary.

8. The Medical Council's policy on providing detailed feedback to unsuccessful candidates, including what specific information is and is not shared, and the reasoning behind any limitations on feedback.

9. Any correspondence, reports, or internal communications regarding concerns raised about pass rate variability, marking consistency, or the integrity of the assessment process across NZREX Clinical sittings.

10. Whether the Medical Council has conducted or commissioned any analysis of the downstream impact of NZREX outcomes on New Zealand's healthcare workforce supply, including the emigration of unsuccessful candidates.

11. Whether any formal complaints or concerns have been raised internally or externally regarding potential bias, whether based on country of origin, gender, ethnicity, or any other protected characteristic, in the NZREX Clinical examination or marking process, and how those were addressed.

12. Any policies, procedures, or correspondence relating to the conduct and independence of examiners involved in NZREX Clinical assessments, including any investigations into examiner conduct.

If any part of this request is refused, I ask that you specify the grounds under the OIA for doing so.

I am making this request in the public interest. The integrity of this examination process has direct consequences for New Zealand's healthcare system, for the doctors who have invested years preparing for it, and for the patients waiting for care.

Yours faithfully,
Lee