Revalida 2nd stage: how the exam tests clinical reasoning

A beep marks entry into the station. The participant puts on a white coat, reads the posted material and meets a simulated 62-year-old patient with abdominal pain for 12 hours. Within ten minutes they must take the history, form hypotheses, propose a plan and, if the station calls for it, write a referral. When the next beep sounds, they leave. What remains is the walk to the next room. There are ten stations over two days.

NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.

This scene sums up what the 2nd stage of Revalida demands: clinical reasoning shown in action, under a clock, with communication in Portuguese and with the Sistema Único de Saúde in the background. This text explains what the exam is, how the clinical skills test works according to Edital Inep nº 14/2026, how the stations assess reasoning, what the literature says about structured clinical exams and how to train. At the end there is a table, frequently asked questions and a checklist for the final stretch.

Key points

• Revalida is the National Exam for Revalidation of Medical Diplomas Issued by a Foreign Higher Education Institution, governed by Law nº 13.959/2019, amended by Provisional Measure nº 1.370/2026, which links the theoretical stage to Enamed, and operated by Inep; it is not a public competition nor a professional council exam (Edital Inep nº 14/2026; Inep, Revalida).
• The 2nd stage is the clinical skills test: ten stations over two days, five per day, up to ten minutes each, scored from 0 to 10, with a maximum of 100 points (Edital Inep nº 14/2026).
• The stations cover Internal Medicine, Surgery, Gynecology-Obstetrics, Pediatrics and Family and Community Medicine, and, in an interdisciplinary way, Public Health and Mental Health; the assessment is in Portuguese and may include written tasks (Edital Inep nº 14/2026).
• Scoring uses recordings and the Expected Standard of Procedures (PEP), with a scale of inadequate, adequate or partially adequate; in the 2025/2 edition, after rectification, approval requires at least 62.104 of the 100 points, with no rounding (Edital Inep nº 14/2026; Inep, 2025/2 result).

What Revalida is

Revalida is the unified instrument that Inep applies to support the revalidation of medical diplomas issued abroad. It is aimed at foreigners who graduated outside the country and at Brazilians who graduated in another country and want to practice medicine in Brazil. The goal, according to the edital, is to verify knowledge, skills and competencies at the level of the National Curriculum Guidelines for the Undergraduate Medicine Course, suited to the principles and needs of the SUS (Edital Inep nº 14/2026; Inep, Revalida).

The exam is not a public competition and is not a professional council exam that, on its own, guarantees the right to practice. Passing the stages, under the terms of the editais, would support the endorsement of the diploma by the partner revalidating university chosen by the participant (Edital Inep nº 14/2026).

Two eliminatory stages

The assessment process has two eliminatory stages at different times: written exams and the clinical skills test (Inep, Revalida). On the exams and answer keys page, the 1st stage appears as an objective test with 100 multiple-choice questions and five hours of duration; the 2nd stage as ten tasks in clinical skills stations (Inep, exams and answer keys).

Those also preparing for other licensing exams can compare formats in the texts on how USMLE Step 2 CK assesses clinical reasoning, how PLAB and UKMLA assess clinical reasoning, how MCCQE assesses clinical reasoning and how the AMC Clinical Exam assesses clinical reasoning. Revalida, in its 2nd stage, requires reasoning to be shown in short stations, recorded and scored afterwards.

How the 2nd stage works

Notice Inep No. 14, of March 12, 2026, organizes the 2nd stage of Revalida edition 2025/2: the clinical skills exam. It simulates care conditions to assess the practical skills and competencies of physicians trained abroad (Notice Inep No. 14/2026).

The participant goes through ten stations over the two exam days: five on the first day and five on the second. Each station is worth 0 to 10 points; the maximum for the whole set is 100. At each station there are at most ten minutes for the tasks, from the entry sound signal to the finishing signal. The room change is called a rotation. On each day, about 50 minutes are enough for that day's five stations (Notice Inep No. 14/2026).

What the exam assesses

According to the notice, the exam may assess verbal and nonverbal communication with patients, family members and the team; clinical history taking; general or specific physical examination; use of clinical reasoning and formulation of hypotheses; proposing and carrying out actions; health guidance and education. It may also assess written competencies closer to daily practice: reports, prescriptions, medical certificates, notifications, referrals and handover notes at shift change (Notice Inep No. 14/2026).

The exam is administered in Portuguese. The content reference is the Common Reference Matrix for the Assessment of Medical Training, published by Inep Ordinance No. 478, of July 18, 2025, aligned with the Curricular Guidelines, SUS rules and good practices. For the edition covered by Notice No. 14/2026, the cutoff date for regulatory and bibliographic updates is March 7, 2026: documents released after that date are not used in building the exam or in appeals about its content (Notice Inep No. 14/2026).

Who is at the station

There are two fronts. In on-site supervision, a Station Chief ensures the conditions for execution. Performance assessment is handled by the Assessing Physician, who reviews the recordings from both days based on the final PEP, in an electronic system. All sites also have an Academic Supervisor, a physician responsible for the academic aspects of the exam. The recording is used for assessment and for reviewing appeals (Notice Inep No. 14/2026).

After approval

Those approved in the 2nd stage, who also have a valid 1st stage under the terms of the notice, become eligible to proceed with the revalidation process at the partner revalidating university, by endorsement, provided they meet the institution's documentary requirements. The partner university is indicated in the Revalida System, within the schedule deadline (Notice Inep No. 14/2026).

• Read the notice for the edition you are applying to; each edition has its own rules and schedule.
• Treat the ten stations as a set: the final score is the sum of the ten.
• Practice in Portuguese and in the SUS context, not only in the protocol of the country where you trained.
• Include written tasks in your practice: referral, medical certificate, notification and shift handover.

Areas and tasks of the stations

The notice sets out content, skills and competencies from Internal Medicine, Surgery, Gynecology-Obstetrics, Pediatrics and Family and Community Medicine and, in an interdisciplinary way, Collective Health and Mental Health (Notice Inep No. 14/2026). On the exams and answer keys page, examples of tasks include clinical history investigation, interpretation of tests, formulation of hypotheses, demonstration of procedures and counseling of patients or family members (Inep, exams and answer keys).

Area	What the station may ask	Where reasoning shows up	How to practice
Internal Medicine	History, examination, hypotheses and management in adults	In the questions that separate hypotheses and in the warning signs	List three hypotheses for a common complaint and the questions that distinguish them
Surgery	Acute abdomen, trauma, basic procedure or perioperative communication	In prioritizing what is urgent and what can wait	Rehearse the abdominal examination and explaining risk out loud
Gynecology-Obstetrics	Gynecological complaint, pregnancy or postpartum	In focused data collection and in care for privacy and consent	Practice obstetric history taking and communicating sensitive findings
Pediatrics	Child or adolescent, often with a caregiver	In adapting language and reading pediatric risk	Practice history taking with two speakers and age-related warning signs
Family and Community Medicine	Primary care, longitudinality, prevention	In the care plan and the connection with the network	Build short plans with return visits, referrals and health education
Public Health and Mental Health (interdisciplinary)	Notification, surveillance, psychiatric crisis, stigma	In the clinical and collective coordination of management	Practice notification, welcoming and network referral

Written tasks

The official notice states clearly that the exam may ask for written reports, prescriptions, medical certificates, notifications, referrals and shift handover notes (Inep Notice No. 14/2026). This changes how you practice: speaking well is not enough. You need to write clearly, under time pressure, what another professional or the patient needs to read. The text on how to write a clinical case for teaching helps structure short, objective reports.

How clinical reasoning shows up in the stations

In a multiple-choice exam, reasoning stays hidden in the option you mark. In the station, it is on display: what you ask, in what order, what you examine, what you write and how you explain the conclusion. The official notice explicitly mentions applying clinical reasoning and formulating hypotheses among the skills assessed (Inep Notice No. 14/2026).

The minutes before acting

Before you start the tasks, the station material and the Station Chief's instructions define what to do. Use this moment for three questions: What is the exact task? Which hypotheses fit this patient, in this setting? Which one would be dangerous to miss? With these answers, the history stops being a memorized script and becomes a test of hypotheses.

Hypotheses that guide the questions

A consultation guided by hypotheses has a recognizable shape. Questions cluster around a suspicion, change course when an answer surprises you, and return to red flags before the end. In abdominal pain, for example, asking about fever, vomiting, diarrhea, bleeding, pregnancy and previous surgeries is not a random list: each question tests a hypothesis. When the evaluator sees this pattern in the recording, they see reasoning.

This habit also protects against premature closure. If you decide too early that the pain is gastroenteritis, you may stop asking about pregnancy or about signs of a surgical abdomen. Keeping two or three hypotheses open and checking red flags even when the main hypothesis seems clear is the same care as differential diagnosis in daily practice. Narrative medicine reminds us that the patient's story is the raw material of this reasoning.

Reasoning spoken and written

In several stations the participant must say what they think or write what another professional will read. A simple structure works in both formats: a summary sentence with age, complaint and findings; the most likely diagnosis with two or three data points that support it; the important differentials; and the next step. Practicing this speech and this writing until they come naturally is worth as much as reviewing content. The post on calibrating confidence in diagnosis helps you avoid asserting too much or too little.

Communication and the context of SUS

The exam is in Portuguese and targets professional practice suited to the needs of SUS. This includes patient guidance, health education, use of the network and notifications when applicable. Clear communication and respect matter as much as technique. The SPIKES protocol offers a structure for difficult conversations, and the text on empathy and clinical reasoning in the consultation shows how the two go together. Cultural humility in medical training helps those who trained in another country adapt language and expectations.

How the station is scored

For each station there is an Expected Standard of Procedures, the PEP: a list of parameters and expected responses. The PEP may cover history taking, physical examination, differential diagnoses, additional tests, diagnosis, treatment and written output. The preliminary version of the PEP is released after the exam is administered; there is an appeals phase on the appropriateness of the expected procedures; then the final version comes out, the basis for scoring (Inep Notice No. 14/2026).

Scale and recording

The Evaluating Physician watches the recordings and marks items on the scale as inadequate, adequate or, when relevant, partially adequate. The scale does not allow intermediate scores outside the predetermined values. Item scores may vary; if items are annulled or changed on appeal, the score is redistributed, and each station keeps at most 10 points. The final grade is the sum of the ten stations, in absolute values with up to three decimal places, without rounding (Inep Notice No. 14/2026).

Minimum performance in the 2025/2 edition

Item 15.3 of Notice No. 14/2026 states that approval depends on the minimum performance published in a specific notice. Inep Notice No. 31, of March 31, 2026, complemented this item; the rectification of September 4, 2026 set the minimum at 62.104 out of 100 points, without rounding, for the 2nd stage of Revalida 2025/2 (Inep, 2025/2 result; Inep, Revalida legislation). In other editions, the value may change: always read the notice for your application.

Appeals

There are two appeal phases: against the preliminary version of the PEP and against the preliminary result of the exam. In the second, only participants in a failing situation (and who are not absent or eliminated) may appeal, based on the answer sheet and the recordings made available on the Revalida System during the specified period. Downloading or sharing the recordings outside this use is prohibited (Inep Notice No. 14/2026).

What the studies say

There is little indexed research solely on Revalida, but the literature on the objective structured clinical examination, the OSCE, and on physicians trained abroad helps to understand what the 2nd stage measures.

The logic of the OSCE

The idea of the OSCE was described in 1975 by Harden and colleagues: several short stations, with tasks and criteria defined in advance, instead of a single long, poorly standardized case (Harden et al., 1975). Harden and Gleeson detailed the setup and application of this format (Harden and Gleeson, 1979). The two-part AMEE guide revisits the history and the organization: writing stations, training simulated patients and examiners, taking care of logistics (Khan et al., 2013, part I; Khan et al., 2013, part II).

Miller's pyramid

In 1990, George Miller proposed four steps: knows, knows how, shows how and does (Miller, 1990). The 1st stage of Revalida, objective, comes close to knows how. The 2nd stage rises to shows how: the participant must demonstrate, in a simulated situation, what they know how to do. That is why the two stages are eliminatory and sequential.

Agreement and predictors

Sam and colleagues studied the agreement between examiners from UK schools when assessing scripted simulated performances; agreement was high, which matters for any high-stakes OSCE (Sam et al., 2021). A systematic review gathered predictors of success and difficulty in physicians trained abroad, in qualification exams and in later practice (Schabort et al., 2024). The practical reading is to treat each edition seriously and review your own performance before a new registration.

Simulation and safety

Ziv and colleagues discussed simulation in medical education and the ethics of training directly in patient care without prior preparation in simulation; simulation offers room to make mistakes and correct them before clinical care (Ziv et al., 2003). This connects with the design of the 2nd stage: simulated patients, mannequins and controlled tasks, with recording for standardized correction.

How to train reasoning for Revalida

Preparation for clinical stations requires another person. Reading about history taking is not enough. You need to take histories, write referrals and receive feedback, with timed practice and in Portuguese.

Set up a training group

Three people work well. One plays the candidate, another the simulated patient with a script, and the third observes with a checklist of steps in the PEP style. After each station, the three talk and switch roles. Playing the patient and the evaluator teaches as much as playing the candidate.

Write short stations

Cover the areas in the exam notice: Internal Medicine, Surgery, Gynecology-Obstetrics, Pediatrics, Family and Community Medicine, plus Public Health and Mental Health. Each station needs a short instruction, a patient script (what counts on its own and what only counts if asked) and a list of expected steps. Include written-only stations: medical certificate, notification, shift handover. The text on how to write a clinical case for teaching is a good starting point.

Practice the summary and communication

Record yourself summarizing cases in under a minute. Listen and cut what is left over. Practice breaking bad news and consent with the SPIKES framework. Ask the observer to note what was clear and what sounded rushed. Metacognition in medicine helps classify the error after each station: lack of knowledge, poor reading of the task, early closure or a forgotten communication step.

Practice under pressure

Simulate a block of five stations in a row, with rotations, and then another block the next day. The tiredness of the second day is part of the exam. The text on acute stress and clinical reasoning explains what happens to thinking under pressure. The post on feedback in clinical cases shows how to get more from each round of feedback. To spread review over time, see retention of medical knowledge.

Checklist for the final stretch

• Reread the exam notice for your edition and the schedule on the Sistema Revalida.
• Confirm your white coat, clothing suitable for the hospital setting and a valid ID document.
• Do at least one mock exam of five stations in one day and another the next day.
• Include at least two written-task stations per block.
• Practice the final summary out loud and in writing.
• Review the warning signs of the areas in the exam notice, within the normative framework of the edition.
• Sleep and eat well; bring a snack in transparent packaging if the exam notice allows it.
• After each mock station, classify the error and correct only that.

How NEXO helps train the reasoning for Revalida

NEXO offers one clinical case per day, with fictional cases with a real clinical presentation, to be solved in up to six clues. Each clue adds a piece of data, as a patient telling the story little by little would, and you decide when you already have enough information to reach the diagnosis. It is a short differential diagnosis workout that fits between one station session and another, and that forces you to think before seeing the answer.

The format does not replace group training with a simulated patient or practice of written tasks, but it exercises the part of reasoning that the history and hypothesis stations demand: gathering data little by little, keeping hypotheses open and not closing too early. To understand how scoring and the pace of the game work, see the NEXO Economy page. If you coordinate a study group, a league or a preparatory course and want to use cases with your class, get to know NEXO Closer. Researchers in medical education can propose studies through NEXO Researcher, physicians who review cases take part through NEXO Curator and medical content creators can get to know NEXO Creators.

Want to train differential diagnosis every day, without losing your study rhythm? Play the case of the day on NEXO.

Frequently asked questions

Is Revalida a public competitive exam?

Edital Inep nº 14/2026 states that the exam is not a public competitive exam and is not a professional order exam that alone guarantees the right to practice medicine. It supports the revalidation of the diploma with the partner university (Edital Inep nº 14/2026).

How many stations does the 2nd stage have?

There are ten stations in total: five on the first day and five on the second, with up to ten minutes per station and a score from 0 to 10 on each one (Edital Inep nº 14/2026).

In what language is the clinical skills exam?

The exam is administered in Portuguese, with texts, prompts and multimodal language, according to Edital Inep nº 14/2026 (Edital Inep nº 14/2026).

What is the PEP?

The Padrão Esperado de Procedimentos (Expected Standard of Procedures) is the instrument for each station with the parameters assessed and the expected answers. The preliminary version comes out after the exam; after appeals, the final version guides the scoring of the recordings (Edital Inep nº 14/2026).

What was the minimum performance in the 2nd stage 2025/2?

After the rectification of Inep Notice No. 31/2026, published on September 4, 2026, passing the 2nd stage of Revalida 2025/2 required at least 62.104 of the 100 points, with no rounding (Inep, 2025/2 result). Other editions may set a different value.

Can the 2nd stage require written tasks?

Yes. The notice lists written competencies such as reports, prescriptions, medical certificates, notifications, referrals and shift handover reports (Inep Notice No. 14/2026).

References

1. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Notice No. 14, of March 12, 2026. 2nd Stage of Revalida 2025/2. https://www.in.gov.br/web/dou/-/edital-n-14-de-12-de-marco-de-2026-692617566
2. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Revalida (overview). https://www.gov.br/inep/pt-br/areas-de-atuacao/avaliacao-e-exames-educacionais/revalida
3. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Revalida exams and answer keys. https://www.gov.br/inep/pt-br/areas-de-atuacao/avaliacao-e-exames-educacionais/revalida/provas-e-gabaritos
4. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Revalida legislation. https://www.gov.br/inep/pt-br/centrais-de-conteudo/legislacao/revalida
5. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira. Final result of the 2nd stage of Revalida 2025/2 released. https://www.gov.br/inep/pt-br/centrais-de-conteudo/noticias/revalida/inep-divulga-resultado-final-da-2a-etapa-do-revalida-2025-2
6. Brazil. Law No. 13,959, of December 18, 2019. Establishes the National Examination for Revalidation of Medical Diplomas issued by a foreign higher education institution; amended by Provisional Measure No. 1,370/2026 (theoretical stage linked to Enamed). https://www.planalto.gov.br/ccivil_03/_ato2019-2022/2019/lei/l13959.htm
7. Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975. https://pubmed.ncbi.nlm.nih.gov/1115966/
8. Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ. 1979. https://pubmed.ncbi.nlm.nih.gov/763183/
9. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990. https://pubmed.ncbi.nlm.nih.gov/2400509/
10. Khan KZ, Ramachandran S, Gaunt K, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part I. Med Teach. 2013. https://pubmed.ncbi.nlm.nih.gov/23968323/
11. Khan KZ, Gaunt K, Ramachandran S, Pushkar P. The Objective Structured Clinical Examination (OSCE): AMEE Guide No. 81. Part II. Med Teach. 2013. https://pubmed.ncbi.nlm.nih.gov/23968324/
12. Sam AH, Reid MD, Thakerar V, et al. National inter-rater agreement of standardised simulated-patient-based assessments. Med Teach. 2021. https://pubmed.ncbi.nlm.nih.gov/33198538/
13. Schabort I, Esfahani MA, Couban R, et al. Predictors for success and failure in international medical graduates: a systematic review of observational studies. BMC Med Educ. 2024. https://pubmed.ncbi.nlm.nih.gov/39160554/
14. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003. https://pubmed.ncbi.nlm.nih.gov/12915366/