New Zealand Registration

Examination (NZREX) Bridging

Programme

Provided by the Waitematā, Counties Manukau and Te Toka

Tumai - Auckland Districts for New Zealand
Curriculum The NZREX bridging programme is a ready
to work programme for clinicians who
have passed the NZREX examination.

Professionalism
The curriculum covers the 5 key
competencies of pre-vocational training,
within the context of the New Zealand
Health System. The curriculum will
therefore include training on Te Tiriti o
Waitangi and the important role this plays
in improving health outcomes for Māori, as
Procedures and
Interventions
Communication well as training on the dynamics of the
multidisciplinary team, Pacific health and
New Zealand Māori health models and New Zealand
Health System medico-legal information.
context
The curriculum will focus on the application
of clinical skills/knowledge and
demonstration of professional behaviours.

The curriculum is broken down into two

parts:
Clinical Clinical
Management Problems 1. 6 week orientation
2. 13 week clinical period
6 Week Orientation Programme
Overview:
• The 6 week orientation programme will largely be delivered from one hospital site across the
Waitematā, Counties Manukau or Te Toka Tumai - Auckland Districts. Participants may have
set days where they are allocated to other hospitals across Auckland to maximise exposure
to a variety of clinical settings.

• The 6 week clinical orientation will incorporate theoretical and practical sessions including
regular facilitated small groups with preparatory learning and applied cases. This may
include opportunity for a Marae visit as well as social gatherings with postgraduate year 1s
(PGY1s) and Pre-Vocational Educational Supervisors to provide participants with the
opportunity to develop their peer support network.

• Further detail on the topics covered within the 6 week orientation programme is included on
the following slides

Goals:
The goals of the 6 week clinical orientation include:
• Preparation for 13 week clinical programme
• Develop a knowledge base to support successful integration for working within the New
Zealand health system
Professionalism
Doctor and society
• Te Tiriti o Waitangi
• Cultural safety
• Pacific Health obligations
• Māori models of health
• Te Reo Māori and Tikanga (key concepts and key terms)
• Kiwi English glossary
• Medico-Legal issues including – Mental Health act, end of life care, Accident
Compensation Corporation (ACC), Health and Disability Commissioner (HDC),
Health Quality and Safety Commission (HQSC), medical indemnity, enduring
power of attorney (EPOA) and protection of personal and property rights (PPPR),
training pathways and career structures in New Zealand
• Role of the Medical Council of New Zealand (MCNZ) in professional standards
• Complaints procedures internal and external
• Audit and quality control
• Incident reporting

Professional behaviours
• Structure of the medical team and role/function of the multi-disciplinary team
• Self care and stress management; role of occupational health
• Professional development and behaviours

Teaching, learning and supervision

• Expectations around clinical teaching, basic teaching skills, Interaction with
students
• Fundamentals of case presentation
Communication
Patient interaction
• How to deliver difficult news and manage challenging situations
• Family and Whanau meetings/communications
• Patients with English as a second language, including those who use Te Reo
Māori and sign language
• Cultural safety and Hui process
• How to welcome people
• Discussion of New Zealand social norms
• Phone skills

Team work
• Appropriate use of interpreters/translators
• Team dynamics

Managing information
• Confidentiality and security of information including electronic
• How to compose a ward round note
• How to compose a discharge summary
• How to prescribe, complete a drug chart and discharge prescription both in
writing and electronically
• Document a clinical encounter in the patient record
Clinical Management
Safe patient care
• Demonstrate infection control, use of personal protective equipment (PPE)
and sterile theatre procedures
• Radiation safety

Patient assessment
• Written and verbal referrals within and outside hospital setting
• Review physical examination and patient history taking in New Zealand
context

Emergencies
• Advanced Cardiovascular Life Support (ACLS)
• Acutely deteriorating patient
• Resuscitation status, advanced care planning, shared goals of care

Patient management
• Death certification
• Transfers and handovers including introduction, situation, background,
assessment, recommendation (ISBAR) model
• Admission procedures
• Discharge planning
• Informed consent including for blood products
• Placement and capacity assessment
• Pharmacy workshops
Clinical Problems
• Escalation in hours and out of hours – how to ask for help
• Recognition of limits of capabilities
• Differential diagnosis, clinical reasoning and case presentations in New Zealand
setting
• Request and interpret routine investigations in a New Zealand context

Procedures and Interventions

• Venous access
• Urinary catheterisation
• Arterial blood gases
• Referring for complex procedures and radiology referral – who, how, when and
why

Practical Hospital Orientation

• Hospital orientation, fire, disaster, health and safety
• Regional Information Systems (IS) clinical systems training
• Week 6 of the clinical orientation will include on-site orientation to the district
where the NZREX is allocated for the 13 week clinical placement
13 Week Clinical Role
Overview:
• The 13 week supernumerary clinical period is designed to provide programme participants with practical first hand
experience working on the wards as part of a multi-disciplinary team in the New Zealand Health Setting. The 13 week
period is designed to progressively introduce participants to the roles and responsibilities of a PGY1 in a hospital
environment, reaching the equivalent standard of a New Zealand trained PGY1 at the end of the 13-weeks.

• During this period the NZREX participants will predominantly be with the clinical team with some ongoing formal learning
and peer group sessions. All clinical activity will be supervised by a clinical professional.

• The 13 week supernumerary clinical role is broken down into two 6 week blocks with 1 week of leave. One of the blocks will
be spent in either General Medicine or Geriatrics and the other block will be spent in General Surgery.
- 17/04/2023 – 28/05/2023 = first 6 week block
- 29/05/2023 – 04/06/2023 = planned week of leave
- 05/06/2023 – 14/06/2023 = second 6 week block

• During the 13 weeks, NZREX participants will have a minimum of one half day per week of dedicated time to build on
education sessions delivered earlier in the programme. Education sessions may be delivered from either the Waitematā,
Counties Manukau or Te Toka Tumai - Auckland District. Education sessions may include pharmacy workshops, peer
feedback and presentation of interesting cases. This may also include an opportunity to observe in different clinical
settings. The half day education sessions will provide participants with an opportunity to re-group with peers and
continue to build a peer network.

• During the clinical period, participants will be expected to participate in evening out of hours for the purposes of learning.
Appropriate notice will be provided. There may also be opportunity to attend PGY1 teaching at various district sites.
Supervision
Supervision
Clinical Supervisor
• All NZREX participants will be assigned to a team during the clinical blocks and the Senior Medical Officer (SMO) of that team will
be the clinical supervisor for that period.

• The teams that NZREX will be assigned to will be carefully chosen to ensure appropriate clinical supervisors are assigned. This will
include consideration of the number of year 4 Medical Students, Trainee Interns (TIs), and PGY1s already allocated to a team to
ensure the team does not become too large.

Programme Supervisor
• NZREX bridging programme participants will also be allocated a programme supervisor. Programme supervisors will meet with
the participants weekly to discuss progress and to complete formative assessments.
• In addition, the programme supervisor will work with the participants to set goals and evaluate progress. This will include:
o Goal setting for the 13 week clinical role to be completed in week 1
o Interview completed mid way through the run to understand how the programme is going, and what they need out of the
next 6 weeks
o Interview completed at the end of the programme with evaluation against goals and feedback on future areas of
improvement

Mentorship:
• Each participant will be assigned an SMO as their mentor. This may include a current SMO who came via the NZREX pathway
and/or an enthusiastic educator.
• The Education Fellow from the district will also contact the NZREX every day for the first week to provide any support as required
and will contact NZREX either weekly or fortnightly from week 2 onwards.
Assessment
Assessment
During the 13 week clinical placement, NZREX will complete both formative and summative
assessments

Formative Assessments (weekly)

• Designed to identify strengths, weaknesses and future improvements
• Likely include a mini clinical evaluation exercise (mini-CEX) or long case each week for 12
weeks

Summative assessments (week 6 and week 13)

• Designed to identify participant progress/performance against agreed standards.
• The expectation is successful completion of all aspects will be required to pass the
programme. For some assessments there may be an opportunity for re-assessment.
• May include long case assessment and written/discussed scenarios