How to Pass the German Medical Licensing Exam (Kenntnisprüfung)

Germany relies heavily on internationally trained doctors. According to the German Medical Association, about 446,000 doctors were working in Germany at the end of 2025, and 16 percent of them did not hold German citizenship. If your medical degree is from outside the EU, EEA or Switzerland, your route to a full licence (the Approbation) usually runs through two exams: the Fachsprachprüfung (medical German) and the Kenntnisprüfung (medical knowledge).

For full detail in German, see our pillar pages on the Kenntnisprüfung and the Fachsprachprüfung.

The legal basis in one paragraph

Doctors with a non-EU degree receive the Approbation if their training is equivalent to German training. If the authority finds substantial differences – or if checking your documents would require unreasonable effort – you must prove equivalent knowledge in an exam based on the content of the German state exam. That exam is the Kenntnisprüfung. Once all required documents are in, the authority must decide within four months; in the accelerated skilled-worker procedure, within two months.

Step 1: Medical German (Fachsprachprüfung)

German language skills are a requirement for the Approbation. In 2014 the conference of state health ministers set the required level for medical language at C1, replacing the earlier B2. The exam is usually run by the state medical chamber (Landesärztekammer).

Format as described by the Berlin medical chamber. Medical knowledge itself is not the focus – communication is. Our German cluster article Fachsprachprüfung vorbereiten has a 10-week plan and phrase bank.

Step 2: The Kenntnisprüfung

What a typical exam day looks like

1. You examine a real inpatient: history, physical exam, working diagnosis, differentials, plan.
2. Many states ask for a short written report; your invitation letter will say.
3. You present the patient to the panel.
4. The panel asks questions on internal medicine, surgery and the cross-cutting topics.

What examiners expect

• German standards, not your home country's. Know the German guidelines (AWMF) and German drug names.
• Structured case presentation. Patient, complaint, history, findings, diagnosis, differentials, plan.
• Emergency algorithms you can explain without hesitation.
• Law and ethics: informed consent, confidentiality, documentation, death certification.

A 16-week study plan

Daily routine that works:

• 60–90 minutes of question blocks, e.g. the MediFlow Kenntnisprüfung course
• one case presented out loud in German
• 20 minutes of lay-term/medical-term vocabulary
• one weekly mock exam with a study partner

Working while you prepare: the Berufserlaubnis

While your application is pending, the authority may grant a temporary licence (Berufserlaubnis). It is revocable, can be limited to specific tasks and employers, and is generally capped at two years of medical practice in total. Use that time to build clinical routine in German – but schedule your Kenntnisprüfung well before it runs out.

Differences between federal states

Licensing is handled by the 16 states, so authorities, waiting times, fees and the order of exams vary. Some states add an extra subject to the Kenntnisprüfung. The responsible authority is generally the one in the state where you work or plan to work. Fees change; each authority publishes its own information sheet.

Documents checklist

Required documents include, among others: a short CV, birth certificate (plus marriage certificate if married), proof of identity, a police certificate and a medical fitness certificate (each no older than one month), a declaration on pending criminal proceedings, and your degree certificate. Documents not in German need a certified translation. Authorities typically also ask for transcripts, your curriculum, proof of licensure in your home country and a certificate of good standing. Full details in German: Approbation für ausländische Ärzte.

Should you wait for the equivalence review or go straight to the exam?

An equivalence review based on your documents can lead to an Approbation without any exam – if no substantial differences are found. But it can take a long time, and many reviews still end in a Kenntnisprüfung. Choosing the exam directly gives you a clear target. Whether you can waive the document review depends on your state authority; ask before you decide.

How the two exams fit together

Most candidates take the Fachsprachprüfung first because German is a precondition for everything that follows – and because the Kenntnisprüfung itself is conducted entirely in German.

What about Austria and Switzerland?

Austria does not use a German-style Kenntnisprüfung: non-EU degrees generally go through Nostrifizierung at a medical university, followed by registration with the Austrian Medical Chamber. In Switzerland, the MEBEKO commission at the Federal Office of Public Health handles foreign diplomas; for non-EU/EFTA degrees, full recognition usually means passing the Swiss federal exam. Check the official authorities before you plan.

Common mistakes

• Learning only in English. The exam is in German; practise speaking from day one.
• Treating the first attempt as a trial run. You only get three.
• Ignoring law questions. Consent and documentation come up regularly.
• Incomplete applications. The four-month decision deadline starts only when everything is in.
• Letting the Berufserlaubnis expire before passing.

After you pass

With the Approbation you can work without restriction across Germany and start specialist training. Pay at municipal hospitals follows the TV-Ärzte/VKA collective agreement – see the official tables in our German article Ärztegehalt in Deutschland. The full licensing process is covered in Approbation in Deutschland für ausländische Ärzte.

Further reading (German)

• Kenntnisprüfung Medizin
• Fachsprachprüfung Medizin
• Fachsprachprüfung vorbereiten
• Approbation für ausländische Ärzte