PESCI Exam Guide for IMGs Seeking AMC Registration in Australia

Conquering The PESCI Exam: Your Comprehensive Guide To Success In Australia

For International Medical Graduates (IMGs) aiming to practice medicine in Australia, the Pre-Employment Structured Clinical Interview (PESCI exam) is a key hurdle on the road to AMC registration and medical practice. This structured interview evaluates far more than your factual knowledge. It probes your clinical reasoning, communication, professionalism, and your readiness to work safely in the Australian healthcare system.

Because the PESCI exam is position-specific and high stakes, many IMGs find it stressful. With a clear understanding of how the assessment works and a deliberate preparation plan, you can turn it into an opportunity to show that you are ready for supervised practice in Australia.

This guide explains what the PESCI exam is, how it fits into AMC registration pathways, common reasons IMGs struggle, and practical preparation strategies to help you approach your interview with confidence.

Understanding The PESCI Exam: More Than Just A Medical Test

The PESCI exam is not a traditional written or clinical exam. It is a structured clinical interview linked to a specific job offer, usually in general practice. The interviewing panel uses standardized questions and scenarios to judge whether you are suitable for that particular position, under the proposed level of supervision.

The PESCI report and recommendation are sent to the Medical Board of Australia (through Ahpra) and become one of several components the Board considers when deciding whether to grant registration.

What The PESCI Exam Assesses

Interviewers assess a broad set of competencies, including:

• Clinical Knowledge And Skills
  Your ability to apply medical knowledge to real-world clinical scenarios; develop focused differential diagnoses; choose appropriate investigations; and outline safe, evidence-based management plans within the scope of general practice in Australia.

• Clinical Reasoning And Decision-Making
  How you gather information, prioritize problems, recognize red flags, balance risk, and justify your choices. The panel wants to hear your thinking, not just your final answer.

• Communication Skills
  Your capacity to:

  • Explain complex medical information in plain language

  • Build rapport and show empathy

  • Explore patient concerns and expectations

  • Check understanding and gain informed consent

  This also includes how well you work with nurses, practice staff, and other health professionals.

• Professionalism And Ethical Understanding
  Your awareness of professional boundaries, confidentiality, consent, conflicts of interest, and your responsibilities under Australian codes such as Good medical practice: a code of conduct for doctors in Australia. The panel will often explore how you handle complaints, errors, and difficult colleagues.

• Understanding Of The Australian Healthcare System
  Your familiarity with:

  • Medicare and the Medicare Benefits Schedule (MBS)

  • The Pharmaceutical Benefits Scheme (PBS)

  • Referral pathways to public and private services

  • The role of allied health and community services

  You are expected to adapt your practice to this context, not simply transplant habits from your home country.

• Cultural Safety And Awareness
  Your ability to provide respectful care to people from different cultural and language backgrounds, including Aboriginal and Torres Strait Islander peoples, and to recognize social determinants of health.

• Time Management And Organization
  How you prioritize tasks, keep consultations focused, and work safely within time limits.

Understanding these domains is the first step in building a focused **PESCI exam preparation plan**. To put the PESCI exam in context, it can help to compare it briefly with other assessments:

Aspect	PESCI Exam	AMC Clinical Examination
Main Purpose	Suitability for a specific job under supervision	Assessment of general clinical competence
Format	Structured interview with scenarios and discussion	Objective structured clinical examination (OSCE)
Context Considered	Practice setting, supervision, local resources	Broad hospital and community scenarios
Outcome	“Suitable” or “Not suitable” for that particular role	Pass / Fail

A common comment from PESCI assessors is: “We are asking ourselves whether you would be a safe doctor to have in our community, with the supervision that has been proposed.”

Where The PESCI Exam Fits In AMC Registration Pathways

The PESCI exam does not exist in isolation. It sits within the broader system of AMC registration and Ahpra medical registration pathways.

The Main AMC / Ahpra Pathways For IMGs

The four principal pathways for IMGs are:

• Standard Pathway
  For IMGs seeking registration pathways who have an eligible primary medical degree from a recognized medical school. This usually involves:

  • AMC CAT MCQ Examination

  • AMC Clinical Examination or an AMC-accredited workplace-based assessment (WBA)

  After this, IMGs typically apply for provisional registration and a supervised position. For many general practice roles, a PESCI exam is required before the Board will grant registration.

• Competent Authority Pathway
  For IMGs whose primary medical qualification and training are from a recognized “competent authority” country (for example, the United States, United Kingdom, Canada, New Zealand, or Republic of Ireland), and who meet specific criteria.
  These IMGs are usually exempt from AMC exams, but when they apply for provisional or limited registration in general practice, they are often still required to pass a PESCI exam for that role.

• Specialist Pathway
  For overseas-trained specialists applying for specialist recognition or an Area of Need specialist position. Assessment is handled by the relevant Australian specialist college.
  Specialist Pathway candidates do not normally undertake a PESCI exam, because the college assessment already addresses their suitability.

• Short-Term Training In A Medical Specialty Pathway
  For overseas-trained specialists or trainees coming to Australia for time-limited, supervised training (usually up to two years). A PESCI exam is generally not part of this pathway.

Who Actually Needs A PESCI Exam?

You are usually required to complete a **PESCI exam** if you are:

• An IMG applying for limited registration in general practice (often in an Area of Need position), or

• An IMG applying for provisional registration to work in general practice after completing AMC exams or as part of the Competent Authority Pathway.

A PESCI exam is **position-specific**:

• It relates only to the job listed in your application.

• The outcome cannot be transferred to another position.

• If you apply for a different role, you must undertake a new PESCI exam tailored to that job.

Area Of Need (AoN) Positions And The Three-Year Experience Rule

For **Limited Registration for Area of Need** in general practice, there is an additional requirement:

• You must show at least three years of full-time equivalent experience in general practice or primary care.

For these AoN GP roles, the Medical Board of Australia advises IMGs to:

1. Apply for registration first so the Board can assess your evidence of three years’ experience.

2. Wait for the Board’s direction:

   • If you meet the experience requirement, the Board will ask you to arrange a PESCI exam.

   • If you do not meet it, you will be considered ineligible for that role and will not need a PESCI exam for that position.

If your general practice experience has already been formally assessed by **RACGP** or **ACRRM** for another purpose (for example, General Practice Experience assessment), you can usually provide that report instead of undergoing a separate experience assessment.

PESCI Exam Application Process: Step-By-Step For IMGs

Once you understand that you need a **PESCI exam**, the next step is to get the application process right. Missing documents or incorrect sequencing can cause delays.

Step 1: Secure A Job Offer

You cannot sit a “general” PESCI exam. The assessment must be linked to a **specific position** in an Australian general practice. Work with potential employers to:

• Clarify your duties and scope of practice

• Confirm the supervision plan and who will be your principal supervisor

• Obtain a detailed position description

Step 2: Complete Primary Source Verification And AMC Registration

Before most PESCI providers will accept your application, you must:

• Create an account with EPIC (Electronic Portfolio of International Credentials) through ECFMG.

• Submit your medical degree and any required documents for primary source verification.

• Establish an AMC portfolio, after which you’ll receive an AMC candidate number. This number links your PESCI exam to your broader AMC registration process.

Step 3: Gather Applicant-Specific Documentation

Each AMC-accredited PESCI provider (**RACGP**, **ACRRM**, **IME**) has its own forms and templates, but you will usually need:

• Curriculum vitae (CV) on the provider’s official template

• Proof of passing the AMC CAT MCQ Examination

• For provisional registration applicants: proof of passing the AMC Clinical Examination or evidence of eligibility under the Competent Authority Pathway

• A signed PESCI applicant declaration

• Certified copies of your passport and any name change documents

• Certified English translations for any non-English documents

Check your provider’s handbook carefully so you do not miss any item.

Step 4: Coordinate Practice-Specific Documentation

Your prospective employer or practice is usually responsible for:

• Completing the position description on the provider’s template

• Preparing an Ahpra Supervised Practice Plan and Supervisor’s Agreement (Form SPPA‑30), which explains:

  • Levels of supervision

  • How feedback will be given

  • How your performance will be monitored and reported

This information shapes the panel’s expectations during the **PESCI exam**, so make sure it accurately reflects the role.

Step 5: Submit The PESCI Exam Application And Pay Fees

Once all documents are complete:

• Submit your application through the provider’s online portal.

• Pay the required fee.

• Keep copies of everything you upload.

You will receive confirmation and, later, a scheduled interview date and time, along with instructions (for example, online platform details if your PESCI exam is conducted via videoconference).

Step 6: Begin Focused Preparation

Do not wait until the interview date is set to begin studying. As soon as you commit to a position and provider:

• Review Australian general practice guidelines

• Study the practice’s patient population, remoteness, and available support

• Start rehearsing PESCI-style scenarios under timed conditions (see the strategy section below)

• Consider structured preparation, such as mock interviews or coaching programs, for example through LearnMedicine.com.au, if you prefer guided practice

Navigating The Challenges: Common Reasons For PESCI Exam Failure

Many IMGs with strong knowledge do not achieve a “suitable” outcome on their first **PESCI exam**. Understanding common problems helps you prepare more effectively.

As one experienced PESCI interviewer tells candidates, “Knowledge is essential, but what we really see on the day is how you think, how you speak, and how you keep patients safe.”

Communication Difficulties

For IMGs, communication strategies is often the biggest challenge. Problems may include:

• Overly technical language with little explanation

• Long, unfocused answers

• Not checking patient understanding

• Limited empathy or lack of acknowledgment of emotions

• Difficulty adjusting communication style for different health literacy levels

During preparation:

• Practice explaining diagnoses and management plans to non-medical friends in plain English.

• Use structured phrases such as, “What worries you most about this problem?” or “Can you tell me in your own words what you understand so far?”

• Pause regularly to check understanding and invite questions.

Unstructured History Taking

A disorganized history suggests weak clinical reasoning. Common errors include:

• Asking every question you can think of instead of focusing on likely diagnoses

• Missing key “must not miss” questions for serious conditions

• Failing to clarify red-flag symptoms early

Use structured formats (for example, SOCRATES for pain, or a systems-based screen) and always keep your working differential in mind as you ask questions.

Limited Understanding Of The Australian Healthcare Context

Many scenarios in the PESCI exam assume:

• Knowledge of local screening recommendations

• Familiarity with MBS and PBS

• Awareness of rural vs metropolitan resource differences

If you propose investigations or referrals that are unrealistic for the working in Australia, the panel may question your suitability. During preparation, read:

• RACGP guidelines (for example, Red Book, Green Book)

• State or territory referral guidelines

• Local health service websites for the region where you will work

Inadequate Clinical Reasoning

Some candidates know the “right” investigation or treatment but cannot explain why. The PESCI exam panel wants to hear:

• How you interpret the information you have gathered

• How you compare and prioritize different diagnoses

• Why your management plan is safe and appropriate

Practice “thinking aloud” as you work through cases, so you become comfortable verbalizing your reasoning step by step.

Poor Time Management

The PESCI exam is timed. Common problems include:

• Spending too long on history and leaving no time for management

• Giving overly detailed answers that don’t address the question

• Getting stuck on low-yield details

Use a watch or timer while practicing. Aim for concise, structured answers, with clear headings in your mind such as:

• History

• Examination

• Differential diagnoses

• Investigations

• Management

• Safety netting and follow-up

Professionalism Concerns

Unprofessional behavior will almost always lead to an unfavorable outcome. Risky behaviors include:

• Being defensive when questioned

• Minimizing patient concerns

• Ignoring guidelines or safety issues

• Blaming colleagues instead of focusing on patient safety

In your answers, show that you:

• Take responsibility for your actions

• Are open to feedback and supervision

• Put patient welfare and safety first

Inside The PESCI Exam Interview: Structure, Scenarios, And Assessment

Understanding what happens on the day removes much of the anxiety around the PESCI exam.

Panel Composition

Most PESCI exam providers follow similar standards:

• At least three panel members, usually:

  • Minimum two registered medical practitioners (often experienced GPs)

  • One additional member who may be:

    • Another doctor

    • A different health professional

    • A lay person representing the community perspective

Each panelist brings a slightly different lens (clinical, systems, patient experience) to your performance.

Interview Format

While details vary by provider, the PESCI exam commonly includes:

• An introduction and explanation of the process

• Several structured clinical scenarios, each with:

  • A brief written or spoken case stem

  • Questions exploring your approach to history, examination, investigation, and management

• Questions targeting:

  • Communication (for example, breaking bad news, dealing with a distressed or angry patient)

  • Professionalism and ethics (for example, confidentiality, prescribing boundaries, impaired colleagues)

  • Australian system knowledge (for example, billing, referrals, follow-up, rural challenges)

  • Cultural safety, especially when caring for Aboriginal and Torres Strait Islander patients or other cultural groups

Every candidate for the same position is asked similar core questions to support fairness.

How Your Responses Are Judged

Panelists typically rate you against defined criteria, such as:

• Clinical safety and awareness of red flags

• Appropriateness to the practice setting and level of supervision

• Communication and rapport

• Respect for cultural and social factors

• Professional behavior and insight

The assessment is contextual. A candidate may be “suitable” for a well-supported metropolitan practice but “not suitable” for an isolated rural clinic with limited onsite supervision.

Strategies For Success: Mastering The PESCI Exam

Once you understand the structure and expectations of the PESCI exam, you can design a smart preparation plan.

Deepen Your Knowledge Of The Australian Healthcare System

Focus on:

• Medicare and MBS: common item numbers for GP consultations, chronic disease management plans, and mental health treatment plans

• PBS: first-line medications commonly used in Australian primary care, subsidy rules, and safety issues

• Referral pathways: how to access emergency services, outpatient clinics, allied health, and community services in the region where you will work

• Public health priorities: common local conditions (for example, skin cancer, cardiovascular disease, diabetes, mental health, Indigenous health issues)

Use reputable sources such as:

• Australian Institute of Health and Welfare (AIHW)

• RACGP Historical timeline and current guidelines

• State health department websites

Sharpen Your Communication Skills

Treat communication practice as seriously as clinical study:

• Record yourself answering PESCI preparation guide; review for clarity and pace.

• Practice summarizing complex explanations in one to two sentences first, then expand as needed.

• Work with native or near-native English speakers who can give honest feedback on:

  • Accent intelligibility

  • Grammar that affects clarity

  • Overuse of jargon

Consider structured role-play sessions where you:

• Break bad news

• Explain uncertainty

• Manage expectations when resources are limited

Master Structured History Taking And Examination

Use frameworks to keep your history targeted and efficient:

• Presenting complaint: onset, course, severity, associated symptoms, red flags

• Past medical history, medications, allergies

• Family and social history, occupational factors

• Risk factors and screening relevant to the case

For each common GP presentation (for example, chest pain, abdominal pain, headache, shortness of breath, mood symptoms), write out:

• Essential questions you must ask

• Warning features you must not miss

• Key examinations you would perform (even if you just describe them verbally in the interview)

Strengthen Clinical Reasoning

Instead of memorizing lists, focus on how you think:

• Practice case discussions with colleagues, mentors, or study groups.

• For each case, explicitly state:

  • Most likely diagnosis and alternatives

  • What would change your mind

  • Why you chose one investigation or treatment over another

• Link your reasoning to Australian guidelines whenever possible.

This habit will help you explain your decisions clearly in the PESCI exam.

Use Australian Clinical Guidelines And Resources

Demonstrating familiarity with Australian standards reassures panelists that you are ready to adapt your practice. Prioritize:

• Australian Medicines Handbook (AMH)

• RACGP guidelines and handbooks

• Specialty-specific Australian guidelines relevant to primary care (for example, diabetes, asthma, cardiovascular risk)

Refer to them by name in your answers when appropriate:
“For a new diagnosis of hypertension in this patient, I would follow current Australian recommendations and start with…”

Practice Under Simulated Exam Conditions

Create or join practice groups and simulate the real experience:

• Use real timing (for example, 8–10 minutes per scenario).

• Rotate roles: candidate, panelist, and observer.

• After each mock PESCI exam:

  • Ask for clear, specific feedback.

  • Identify one or two concrete goals for your next attempt (for example, “state a differential diagnosis within the first two minutes,” “summarize at the end of each case”).

Over time, this reduces anxiety and makes the format feel familiar long before the actual PESCI exam date.

You can do this informally with colleagues or through structured programs such as those offered by LearnMedicine.com.au, which provide PESCI-style cases, timed practice, and targeted feedback.

Reinforce Professionalism And Ethics

Review:

• Good medical practice: a code of conduct for doctors in Australia

• Ahpra’s codes and guidelines on:

  • Advertising

  • Prescribing

  • Mandatory reporting of impaired colleagues

• Local legislation relevant to your practice (for example, child protection reporting requirements in your state or territory)

Prepare brief, clear ways to express your ethical approach, such as:

“My priority is always patient safety. If I discover a significant error, I would disclose it honestly, explain what happened, correct the issue, and discuss how we will prevent it in future.”

After The PESCI Exam: Outcomes, Providers, And Ahpra Requirements

Your work does not end when the interview finishes. Understanding what happens next helps you plan your next steps toward AMC registration and medical practice in Australia.

Understanding Your PESCI Exam Result

The PESCI provider prepares a written report and sends it to:

• You (the candidate)

• The Medical Board of Australia (through Ahpra)

Key features of the outcome:

• Timeframe: Many providers aim to release the report within about 15 business days.

• Validity: The PESCI report is usually valid for 12 calendar months from the date of issue.

• Outcome options:

  • Suitable: You are considered suitable for the specific position, under defined supervision.

  • Not suitable: You are not considered suitable for that particular role, given its demands and support level.

The Board then considers this report alongside other registration standards.

Interpreting A “Suitable” Outcome

A “suitable” result often includes recommendations, such as:

• Level of supervision (Ahpra Levels 1–4) appropriate for your current experience

• Areas where further education or upskilling would be helpful (for example, communication skills, cultural safety, Australian prescribing)

Next steps typically include:

1. Finalizing your registration application with Ahpra, including all required documents.

2. Confirming professional indemnity insurance (often through your employer or medical defense organization).

3. Preparing for your landing your first doctor job using the feedback from the PESCI exam as a development plan.

Moving Forward After A “Not Suitable” Outcome

A “not suitable” outcome can be disappointing, but it is:

• Specific to that position – it does not mean you will be unsuitable for every role in Australia.

• Valuable feedback – the report often explains which domains need more work: clinical knowledge, system understanding, communication, or professionalism.

Use the feedback to:

• Target your learning and supervised experience.

• Seek roles with stronger support or a different clinical scope.

• When you secure a new job offer, apply for a new PESCI exam tailored to that position.

AMC-Accredited PESCI Exam Providers

The Australian Medical Council (AMC) accredits three organizations to conduct PESCI exams across all states and territories:

• Royal Australian College of General Practitioners (RACGP)
  The main professional body for general practitioners, offering PESCIs closely aligned with contemporary general practice standards.

• Australian College of Rural and Remote Medicine (ACRRM)
  Focused on the demands of rural and remote practice, often emphasizing broader scope and independent decision-making.

• Institute of Medical Education (IME) (trading as METC Institute Pty Ltd)
  An independent provider following AMC accreditation standards, offering an alternative to college-based PESCIs.

You may choose any accredited provider whose PESCI exam covers the type of position you are applying for, taking into account availability, fees, and their specific processes.

Other Ahpra Registration Requirements Beyond The PESCI Exam

Even with a successful PESCI exam, IMGs must still meet all other Ahpra and Medical Board of Australia registration standards, including:

• English Language Skills
  You must show adequate English proficiency, usually through one of the approved tests (for example, IELTS, OET, PTE Academic, or TOEFL iBT) unless you qualify for an exemption based on your education and training history.

• Recency Of Practice
  You need to demonstrate that your AHPRA CPD requirements, based on minimum recent practice hours defined by the Board. Long gaps in practice may lead to conditions such as higher supervision levels or refresher requirements.

• Professional Indemnity Insurance (PII)
  All registered doctors in Australia must hold appropriate PII. This is often arranged by your employer, but you are responsible for confirming that you are covered.

• Criminal History Checks
  Ahpra conducts checks in Australia and in any country where you have lived for six months or more since turning 18. The Board considers whether any history is relevant to patient safety.

• Certificates Of Good Standing / Professional Status
  You must provide certificates from every medical regulatory authority where you have been registered in the last ten years, confirming that you are (or were) in good standing.

The PESCI exam result is one important piece in a larger picture that the Board reviews before granting registration.

LearnMedicine.com.au: Your Partner In PESCI Exam Success

At LearnMedicine.com.au, we understand the specific challenges IMGs face when preparing for the PESCI exam and pursuing AMC registration in Australia. PESCI online courses are designed to help you build confidence in exactly the areas the interview panel will assess.

We offer:

• Targeted Content Aligned With The PESCI Format And Australian Standards
  Study materials and sessions focus on common PESCI exam scenarios, Australian guidelines, and real-world primary care practice.

• Interactive Case Studies And Simulated Interview Scenarios
  You will practice full-length PESCI-style interviews, refine your clinical reasoning, and strengthen your ability to explain your thinking clearly under time pressure.

• Expert Guidance And Feedback From Experienced Medical Educators
  Our educators understand how panels think. They provide specific, constructive feedback on your communication, reasoning, and professionalism so you can steadily improve.

• Resources To Help You Understand The Australian Healthcare System And Clinical Guidelines
  We direct you to the most relevant guidelines, referral resources, and practical tools for safe general practice in Australia.

While this article gives you a broad overview of the PESCI exam, the structured courses at LearnMedicine.com.au offer the depth, repetition, and personalized feedback that many IMGs need to perform at their best on the day.

Conclusion: Moving Closer To Medical Practice In Australia

The PESCI exam is a major step between being an overseas-trained doctor and working safely in Australian general practice. When you understand:

• How the PESCI exam fits within AMC registration pathways

• Who needs to sit the interview and why it is position-specific

• The common pitfalls that lead IMGs to an unfavorable outcome

• How to prepare systematically for communication, clinical reasoning, and the Australian healthcare context

—you put yourself in a much stronger position to succeed.

Combine a clear understanding of the process with focused practice, feedback from experienced educators, and a realistic appreciation of your future role. With steady preparation and the right support, you can approach your PESCI exam with confidence and move closer to your goal of practicing medicine in Australia.

If you are ready to take your preparation further, consider the structured PESCI-focused learning and support available through LearnMedicine.com.au as you plan your next steps.