NZREX Clinical common mistakes
NZREX Clinical · Understand the traps and how to avoid them.
Taking a history as a checklist interview, firing closed questions and never letting the patient tell their story, so the examiner cannot credit communication or the key discriminating symptom is missed.
Candidates practise under time pressure and default to a systems-review script; anxiety about finishing in the station time rewards rapid-fire questioning.
What to do instead
Open with a broad invitation, use two or three open questions before narrowing, and signpost transitions ('Now I'd like to ask some specific questions'). Practise with a timer and a peer who scores whether you used open questions in the first 90 seconds.
Presenting a disorganised summary to the examiner: chronological rambling that buries the diagnosis, with no problem list, no differential, and no management plan.
Candidates rehearse data gathering but not synthesis, so under pressure they simply replay the history in the order it was collected.
What to do instead
Use a fixed structure every time: one-line summary, key positives and negatives, differential with the most likely first, then investigations and immediate management. Rehearse the summary aloud in under 60 seconds for every practice station.
Examining without a running commentary, so the examiner cannot tell whether a finding was elicited or assumed, and skipping the general inspection and vital-sign review at the bedside.
Candidates focus on completing the physical sequence and forget that the mark scheme rewards demonstrated technique and interpretation, not just completion.
What to do instead
Narrate what you are doing and what you find ('I am palpating the left iliac fossa; it is non-tender'), always start with exposure, general inspection and any available observations, and finish with a summary of positive and negative findings.
Failing to obtain valid informed consent and to introduce yourself, confirm identity, and explain the procedure before starting an examination or practical skill.
In OSCE-style practice, candidates treat the manikin or actor as a task rather than a patient, and time pressure pushes the opening formalities out.
What to do instead
Build a fixed opening script: wash hands, introduce role, confirm patient identity and date of birth, explain what you will do and why, gain consent, offer a chaperone. Rehearse it until it is automatic in every station.
Managing a surgical presentation without a structured resuscitation-first approach, jumping to a definitive diagnosis and operation while ignoring airway, breathing, circulation and analgesia.
Candidates study conditions as diagnoses rather than as emergencies, and station prompts about abdominal pain invite pattern-matching to a named disease.
What to do instead
For every acute abdomen or trauma station, verbalise A to E first, state the need for IV access, fluids, analgesia, catheter and nasogastric tube as indicated, and only then give the differential and definitive plan.
Interpreting a CTG or obstetric emergency without stating the need for maternal assessment and immediate escalation, and delaying definitive action while continuing to observe.
Candidates are unsure of the threshold for escalation and fear being seen as over-reacting, so they keep monitoring rather than calling for senior help.
What to do instead
Learn and rehearse a fixed phrase for escalation ('This is abnormal; I would call the registrar and anaesthetist now and prepare for category 1 caesarean section'). Practise categorising CTG traces aloud and stating the action and timeframe for each category.
In a postpartum haemorrhage or pre-eclampsia station, giving a single drug or fluid bolus and stopping, rather than running a simultaneous sequence of resuscitation, uterine massage, uterotonics, blood products and theatre.
Candidates learn individual drug doses but not the parallel structure of an obstetric emergency drill, so they deliver interventions one at a time.
What to do instead
Rehearse the emergency sequence as a timed drill with a peer: call for help, left lateral or tilt, oxygen, two large-bore cannulae, bloods and crossmatch, fluids, then the drug sequence in order with doses stated. Time yourself and repeat until the whole sequence takes under three minutes to verbalise.
Assessing a febrile or unwell child without systematically checking weight-based drug doses, hydration status, and red-flag features such as lethargy, poor perfusion, or grunting.
Candidates transfer adult assessment habits to children and are unfamiliar with weight-based prescribing and paediatric early-warning thresholds.
What to do instead
For every paediatric station, state the child's weight, calculate paracetamol, ibuprofen, and antibiotic doses aloud, and explicitly screen for red flags. Use a paediatric observation chart in practice so the thresholds become familiar.
In a paediatric history, directing all questions to the parent and not engaging the child at an age-appropriate level, and omitting the developmental, feeding, and immunisation history.
Candidates are anxious about the child's cooperation and default to the adult history template, which has no developmental or feeding components.
What to do instead
Practise a child-specific history template: birth and pregnancy, feeding and growth, development and milestones, immunisations, school and behaviour. Address the child first with an age-appropriate greeting and explain what you are doing to both child and parent.
In a psychiatric station, failing to complete a structured risk assessment covering self-harm, suicide, and risk to others, and not documenting the mental state examination in a recognised sequence.
Candidates are uncomfortable asking directly about suicide and fear that asking will damage rapport, so they leave risk out or bury it in vague language.
What to do instead
Learn a direct risk script ('Have you had thoughts of ending your life? Have you made plans? Have you acted on them?') and rehearse the mental state examination in order: appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight. State risk formulation and management explicitly in every summary.