The HPCSA board exam: 2026 dates, fees, format & pass rates

At a glance: the 2026 exam

What this exam is (and what it isn’t)

The official name is the Medical Board Examination of the HPCSA’s Medical and Dental Professions Board, administered since 2023 by the University of KwaZulu-Natal (UKZN). You’ll also hear it called the “board exam”, the “foreign exam” or the “IMEE” in WhatsApp and Facebook groups — “IMEE” is not a term the HPCSA uses, so search official communications for “board examination” instead. It tests whether a foreign-qualified doctor is ready to practise in the South African public system: one online MCQ paper, then a practical OSCE if you pass the paper.

Who has to write it

Most foreign-qualified doctors applying to register in the public-service category write the exam. The HPCSA also operates a registration-without-examination route for some applicants, usually with conditions attached — the Board decides your track case by case, as covered in the foreign-qualified doctors guide. But note the rule that catches people out: anyone who has not been in active clinical practice for ten years or more must write the board exam, whatever track they would otherwise be on. Foreign-qualified specialists follow a separate assessment route — confirm the current specialist-registration requirements with the HPCSA before assuming this exam applies to you.

The format on the day

Theory: 100 MCQs, online, no negative marking

The written paper is 100 multiple-choice questions: 75 on clinical knowledge and 25 on ethics and medical law. There is no negative marking, and the pass mark is 50%. Don’t under-prepare the ethics quarter — HPCSA ethical rules and South African health legislation are a full 25% of the paper, and they’re the part foreign-trained candidates have usually never studied.

OSCE: station-based clinical exam

The practical is a multi-station OSCE at UKZN. In past sittings it has run at around 17 stations of roughly five and a half minutes each — examining patients, interpreting X-rays and side-room results, and answering examiner questions. The exact format can vary by sitting, so treat that as a benchmark for practice, not a promise — and expect strict invigilation rules on the day; your candidate instructions will say exactly what you may bring in.

Pass rates: the real numbers

Under the previous administrator (Sefako Makgatho University), pass rates were reported at 60–80%. The UKZN era has been much tougher: across the October 2023 and February 2024 sittings, roughly 70% of about 750 candidates failed the theory paper (a ~30% pass rate), while OSCE pass rates swung from 94% (December 2023) to 61% (May 2024) — figures reported by Health-e News, including in its coverage of the HPCSA and UKZN’s response. Candidate groups have disputed the marking and demanded script access; the HPCSA maintains the standard is appropriate and that 50% passes. Plan your preparation around the harder numbers, not the older ones.

Attempts: the rules to plan around

• One attempt = the theory paper plus, if you pass it, the OSCE. Form 176 adds a timing rule in its own words: “the next practical attempt should be within one year after the last attempt”.
• The HPCSA currently allows no more than three attempts within two years, and failing the OSCE means redoing the whole exam — theory included — at your next attempt.
• There is no remarking of either component. (An older version of the Form 176 guidelines described a discretionary fourth attempt — treat the current HPCSA examinations page as authoritative and confirm your remaining attempts with the Board directly.)

Failed a sitting, or worried you might? There is a right way to respond, with real deadlines — written reasons, script access and the formal challenge routes. We’ve covered it separately: Failed the HPCSA board exam? What to do next.

What the whole thing costs

• Exam: R7,283 per component — about R14,566 for a full theory-plus-OSCE attempt, self-funded.
• EPIC verification (USD): ECFMG lists an account/identity fee of $110, a $35 portfolio fee, $110 per credential verified, $60 per subsequent report, and courier fees — see the current EPIC fee schedule.
• HPCSA registration and pro-rata annual fees once you pass — check the HPCSA fee schedule.
• Add notarial certification, sworn translations if your documents aren’t in English, and travel and accommodation for the OSCE in Durban.

After you pass

Passing the exam isn’t the finish line — it unlocks registration. From there, South African citizens and permanent residents are placed into internship or community service through ICSP (depending on what your assessment credited), and foreign-national doctors follow the conditions attached to their registration category, which commonly include a period of public-service practice. The step-by-step registration sequence is in our HPCSA registration guide.