Kenntnispruefung Made Simple: What Foreign Doctors Should Know

This guide is for foreign-trained physicians seeking to practice in Germany. Here’s how to master the Knowledge Examination (also referred to as the knowledge exam oder knowledge test) step by step.

The moment you register for the Knowledge Examination (Kenntnisprüfung) often feels like the first real step toward your Approbation. Maybe your studies are a while behind you, or perhaps you’ve just started to settle in Germany. What all candidates share is the hope to pass the next milestone – and the uncertainty of what exactly awaits. Proper preparation is essential to increase your chances of success in the exam.

The Kenntnisprüfung (KP) is a medical licensing examination required for international doctors whose medical qualifications are not considered equivalent to a German medical degree. It primarily assesses whether foreign-trained physicians possess the necessary knowledge and practical skills to practice medicine safely and effectively in Germany.

The exam is typically conducted as a combined oral-practical examination (mündlich-praktische Prüfung), which includes either a real patient case or a simulated clinical scenario, followed by a structured discussion with the examiners. The exact format and structure of the exam can vary by federal state and examination authority.

In some locations, the test is held as a group examination, where multiple candidates are assessed together, but this is not a nationwide standard—individual examinations are also possible. The exam usually lasts 60 to 90 minutes per candidate; however, the total duration may appear longer in group settings.

Most Kenntnisprüfung (KP) exams include:

• A clinical examination of a real or simulated patient, including taking a full medical history and performing a physical examination
• Presentation and discussion of the patient case (case presentation) with the examiners
• An oral-practical examination (case-based interview) focusing on diagnosis, differential diagnosis, prognosis, and therapeutic strategy
• Assessment of your ability to communicate clearly, empathetically, and professionally in German, including medical terminology and patient interaction
• Evaluation of your clinical reasoning and decision-making skills, including emergency care and general medical knowledge
• In some cases, discussion of cross-disciplinary topics such as pharmacology, radiology, legal aspects, and hygiene

🩺 Exam content:
The focus of the Kenntnisprüfung is on core areas such as internal medicine and surgery, but it often integrates cross-disciplinary subjects like emergency care, clinical pharmacology, and infectious diseases. The clinical assessment tests your ability to evaluate, diagnose, and treat medical cases under realistic conditions. Additional topics may be examined if substantial differences were found during the equivalency review of your medical degree.

🗣️ Language requirements:
The exam is held entirely in German. Strong medical German and general German language skills are essential, not just for passing the medical language exam (FSP) beforehand, but also for demonstrating your ability to treat patients safely and effectively in the healthcare system in Germany.

Whether you need to take the Kenntnisprüfung depends primarily on where you completed your medical degree and whether it is formally recognized as equivalent to a German medical degree. This exam is part of the official recognition procedure for foreign professional qualifications, which assesses whether your medical training meets the standards required for full licensure (Approbation) in Germany.

For applicants from non-EU countries, the requirement is usually straightforward: Yes, you will typically need to take the Kenntnisprüfung. In most cases, degrees from non-EU countries are not automatically recognized as equivalent, and German authorities often require a compensation measure, such as the Kenntnisprüfung, to close identified gaps in training.

This exam is therefore the standard route to Approbation for non-EU doctors, enabling unrestricted medical practice in Germany once passed.

The situation is more nuanced for candidates from the European Union (EU), the European Economic Area (EEA)—which includes countries like Norway, Iceland, and Liechtenstein—or Switzerland. While there is a principle of automatic recognition for medical qualifications that comply with EU Directive 2005/36/EC, this automatic recognition only applies if the qualification meets all requirements of the directive. If there are deviations from the directive, gaps in specific competencies, or uncertainties on the part of the German authorities, an individual assessment is carried out. This can result in a required Kenntnisprüfung or an alternative compensation measure, such as an adaptation course.

Therefore, automatic recognition is not unconditional—it depends on whether the training corresponds fully to the standards outlined in EU law and German administrative practice.

And what if you're already a specialist doctor? Even in that case: If your basic medical degree is not formally recognized, you must still pass the Kenntnisprüfung (or prove equivalence) to obtain Approbation. Specialist training can only be recognized after successful recognition of your basic qualification.

The recognition procedure ensures that all physicians working in Germany—regardless of where they trained—meet the same professional standards required of German-trained doctors.

👉 Your Overview of the Approbation Process – Clear, Complete, and Easy to Follow.

Before you can even think about sitting for the Knowledge Examination, every foreign doctor must first pass through the equivalence assessment. This crucial step in the recognition process determines whether your medical qualifications are on par with the German professional qualification required to practice medicine in Germany.

The competent authority in your federal state will carefully review your medical degree, transcripts, and other relevant documents to assess whether your training and experience provide the necessary medical expertise and skills expected in the German healthcare system. This evaluation is designed to ensure that all doctors—regardless of where they trained—can deliver safe, effective care to patients in Germany.

👉 In some cases, further documents may be requested—such as internship records or curriculum details—especially if there are ambiguities in your submitted qualifications.

If the equivalence assessment finds that your medical qualifications fully match the German standards, you may receive full recognition and a recognition notice confirming that you are allowed to practise medicine without further exams. However, if there are substantial differences in your training or experience, the recognition notice will indicate that you are required to demonstrate your medical expertise through the Knowledge Examination. In some cases, partial recognition is possible, but you will still need to prove that you meet the necessary medical skills to obtain the Approbation in Germany.

Understanding the importance of the equivalence assessment—and preparing your documents thoroughly—can help you move smoothly through this first hurdle on your path to practicing medicine in Germany.

For many foreign-trained doctors, the Kenntnisprüfung serves as a formal compensation measure when their medical degree is not fully recognized as equivalent to a German qualification. If substantial differences are found during the equivalence assessment, German authorities may require you to take this exam to prove that your knowledge and skills meet local standards. This process ensures that all doctors, regardless of where they were trained, can deliver high-quality medical care in Germany. Understanding the role of the Kenntnisprüfung as a compensation measure helps clarify why the exam is not just a bureaucratic step – but a key gateway to professional practice.

Before you're allowed to take the Knowledge Examination in most German states, you must first pass the medical language exam – the Fachsprachprüfung. This exam tests your ability to communicate confidently and professionally in a clinical setting. It's one of the biggest hurdles in the recognition process – and just as important as your clinical knowledge.

👉 Read our full article: The Ultimate Guide to the Medical Language Exam (Fachsprachprüfung) in Germany

You’ll find insider tips, detailed exam formats, and preparation strategies that have helped many doctors from abroad succeed.

🎯 Want to practise with real-life simulations and expert guidance?
Check out our tailored online course and get step-by-step support for mastering the FSP. Start preparing today – and pass with confidence.

Before you can practise medicine in Germany as a foreign-trained physician, you'll need to navigate a clearly defined recognition process. One of the most important stages is the Kenntnisprüfung, or medical knowledge exam, which ensures that your professional competencies meet the standards required to work safely and effectively in the German healthcare system.

Below, we’ll walk you through each essential step—from the initial application to the final exam—so you can understand what to expect and plan ahead with confidence.

The first step is to submit an application for recognition of your foreign medical qualifications to the responsible licensing authority—this may be the state or district government or the medical chamber. You’ll need to provide documentation of your medical education, professional experience, and language skills (typically at least B2 level in general German).

Once submitted, you’ll need to wait for the result of the equivalence assessment. The competent authority will evaluate whether your foreign medical education is equivalent to a German medical degree. If significant differences are identified, you will be required to take the Kenntnisprüfung as a compensation measure to prove your medical knowledge.

Once deficits have been identified in your equivalence assessment, you must formally register for the Kenntnisprüfung with the competent authority—usually a state examination office or medical chamber. This step is closely tied to your Approbation application, which forms the legal basis for taking the exam. Without having submitted this application, registration for the Kenntnisprüfung is not possible.

⚠️ Important: Many candidates underestimate the timelines involved. Examination offices are often overwhelmed, and there may be long waiting lists. We recommend starting the process at least six months before your desired exam date to secure a spot and align your preparation accordingly.

Once your documents have been reviewed, you’ll receive an official invitation—sometimes only a few days or weeks before the exam—with the date and location. It’s common not to know who your examiners will be until the day of the exam. This is standard practice and nothing to worry about.

Please note: As part of the registration process, additional documents may be requested depending on the region. Always double-check requirements with the relevant authority.

Preparation focuses on mastering the relevant exam content—particularly in internal medicine and surgery, as well as cross-disciplinary areas such as emergency care, pharmacology, imaging techniques, radiation protection, and legal aspects of medical practice. A strong command of medical terminology in German is also essential, as the exam requires precise and professional communication in clinical settings.

Make sure your study plan covers high-yield medical topics that are commonly tested during the exam and reflect the German curriculum. To prepare effectively, it's crucial to structure your learning around the core competencies evaluated in both the clinical and oral-practical parts of the exam.

Many candidates prepare using specialized courses, online learning platforms, and medical textbooks aligned with the German curriculum.

In some federal states, examiners may also refer to specific legal frameworks such as the Radiation Protection Ordinance, particularly when evaluating your knowledge of diagnostic imaging and radiological safety standards.

👉 Looking for expert support? Our tailored preparation courses and 1:1 exam coaching are designed to help you master every topic that counts in the Kenntnisprüfung – so you can walk in confident and walk out licensed.

The Kenntnisprüfung typically takes place at a university hospital or an officially recognized teaching hospital in Germany. It consists of two main parts:

• Clinical Exam / Patient Presentation
  You will examine a real or simulated patient, take a full medical history, perform a physical examination, make a diagnosis, and write a medical report. This report usually includes the patient's history, diagnosis, differential diagnosis, prognosis, treatment plan, and a discharge summary (Epikrise). Candidates typically have around 30–45 minutes for the clinical component, followed by up to 30 minutes for the written documentation.
  
• Oral-Practical Exam / Case-Based Interview
  This is followed by an oral-practical session, often held in small groups, in which the examiners ask in-depth questions based on clinical cases. The focus lies on internal medicine and surgery, but may also cover areas such as emergency medicine, pharmacology, and infectious diseases. This part usually lasts 60–90 minutes per candidate.

📅 Exam Schedule and Duration Variability
While both parts are often conducted on the same day, this is not a nationwide rule. Whether the exam is split over one or multiple days depends on the federal state and the examination authority. In some cases, the clinical examination (e.g., patient presentation) may occur on one day, and the oral discussion on another. This flexible structure is part of the decentralized organization of medical licensing exams in Germany.

🗣️ Language
The entire examination is conducted exclusively in German, and requires strong command of both general and medical language skills.

Immediately after the exam, the examination board decides whether you’ve passed. The result is officially confirmed in writing—though no grade is issued.

If you pass, you may proceed to receive your Approbation (full medical license). If you do not pass, you may repeat the exam twice, for a total of three attempts.

Important Notes:

• The exact process—including the order of language and knowledge exams, deadlines, and registration procedures—may vary slightly between German federal states.
• Strong communication skills and the ability to clearly and empathetically explain medical issues to patients are key evaluation criteria during the exam.

In Summary:

1. Application & Equivalence Assessment
2. Registration for the Kenntnisprüfung
3. Exam Preparation
4. Exam Day (Patient Case & Oral Interview)
5. Results & Possible Retakes

The Kenntnisprüfung is not limited to general medicine and surgery, nor are additional subjects only assessed in exceptional cases. In fact, the exam can cover all subject areas relevant to the German medical licensing examination (Zweiter Abschnitt der Ärztlichen Prüfung). This includes not only internal medicine and surgery, but also a broad range of cross-disciplinary subjects, such as:

• Emergency medicine
  
• Clinical pharmacology / pharmacotherapy
  
• Imaging procedures (bildgebende Verfahren)
  
• Radiation protection (Strahlenschutz)
  
• Legal aspects of medical practice (Rechtsfragen der ärztlichen Berufsausübung)
  
• Pathology
  
• Hygiene and infection control
  
• Medical microbiology and virology
  
• Public health and epidemiology

Depending on the results of the equivalence assessment (Gleichwertigkeitsbescheid), the exam may also include additional clinical subjects such as:

• Pediatrics
  
• Gynecology and obstetrics
  
• Neurology
  
• Psychiatry

Furthermore, depending on the individual recognition decision (Gleichwertigkeitsbescheid), the exam may include specialties such as pediatrics, gynecology, neurology, and others. These subjects are examined regularly, not just in rare or exceptional cases. The exam content is based on the identified deficits in comparison to the German medical curriculum.

This comprehensive structure ensures that all candidates meet the same professional standards required of domestically trained physicians in Germany.

It’s a difficult topic, but an important one: not everyone passes the Kenntnisprüfung on their first attempt—and that’s okay.

You generally have three attempts to pass the Kenntnisprüfung—this means one initial try and two possible retakes. These attempts are centrally registered across all German federal states, regardless of where the exam is taken. So even if you change the examination location (e.g., from Bavaria to Berlin), each attempt counts toward the nationwide total.

⚠️ If you fail all three attempts, you are typically no longer eligible for Approbation in Germany. However, it’s important to note:

• This is not a strict, unchangeable ban in every case.
  
• Rare exceptions may occur—for example, after a successful legal appeal or following a new recognition procedure with updated documentation.
  
• There is no legal entitlement to a fourth attempt, and such outcomes are subject to individual assessment by the competent authority.

If you do not pass, the examination commission usually provides a recommendation for further preparation, including a suggested time frame for retaking the exam. Many candidates use this period to focus on their weak areas, often with support from specialized preparatory courses.

While there are no official nationwide statistics on pass rates, anecdotal data from some federal states suggest that many candidates succeed on their second attempt. For example, informal reports from Berlin mention a pass rate of around 82%, but such figures vary significantly by region and year.

✅ With structured preparation, strong clinical knowledge, and proficient medical German, your chances of passing increase substantially.

While the Kenntnisprüfung is primarily designed to test your medical expertise and clinical skills, examiners are also paying close attention to your overall personal aptitude. This includes your ability to stay calm under pressure, communicate clearly and respectfully with colleagues and patients, and approach complex situations with sound clinical judgment. In many cases, candidates with strong technical knowledge struggle simply because they lack confidence or fail to structure their thoughts under exam conditions. That’s why it’s essential to train not just your knowledge—but also your mindset. Practise speaking out loud, simulate exam situations with peers, and reflect on your communication style. Remember: The way you present yourself can make just as much of a difference as the facts you know.

In addition to preparing for the content, many candidates ask: How much does the Kenntnisprüfung actually cost?

The exam fee is not standardized nationwide. It is set individually by the responsible authority in each federal state and (as of 2025) typically ranges from around €400 to €1,100. This range is accurate, but it’s important to emphasize that regional variations and additional administrative charges (e.g., for document verification) may apply.

However, this examination fee is only part of the total cost. You should also budget for other related expenses:

• Fees for preparatory courses specific to the Kenntnisprüfung
  
• Learning materials and textbooks
  
• Travel costs if the exam location is not near your residence
  
• Possible accommodation expenses
  
• Fees for official translations, notarized copies, and document handling in the recognition process

These indirect or “hidden” costs can add up quickly and should be included in your overall financial planning.

💡 Tip: Many federal states offer funding programs and financial aid for foreign healthcare professionals. These are available through foundations, regional integration initiatives, or educational support schemes. Be sure to check with your local authority or recognition office. A comprehensive overview of support options is often available on regional government or chamber of physicians' websites.

The Kenntnisprüfung is undoubtedly a significant challenge – but it’s manageable. You are not alone on this path. Thousands of international doctors have successfully completed this step – many with the same questions, uncertainties, and hopes as you.

To succeed, focus on developing your practical clinical skills through hands-on training and direct patient interaction. Mastering theoretical knowledge, clinical reasoning, and the ability to create effective treatment plans for patient cases is essential. Make sure to study high-yield medical content, including key areas such as emergency medicine and clinical pharmacology. Practice using medical terminology in German and work on improving your language skills, especially medical German, to ensure strong German language proficiency and effective communication in the German language during the exam.

What really matters is structured preparation for the Kenntnisprüfung, confidence in your professional skills, and the willingness to embrace the German healthcare system and its language.

• What language level is required for the Knowledge Test?
  You typically need at least B2 in general German and C1 in medical German. The Fachsprachprüfung (FSP) is a mandatory prerequisite in most federal states and must often be passed before the Kenntnisprüfung. However, some states allow both exams to be scheduled in parallel – check with your local authority for the specific requirements.
  
• What practical clinical skills are tested in the oral-practical part of the Knowledge Test?
  The content of the Kenntnisprüfung is based on the subjects of the German medical licensing examination (Staatliche Abschlussprüfung). The exam primarily covers surgery and internal medicine, but also includes additional areas that are regularly assessed. These include emergency medicine, clinical pharmacology and pharmacotherapy, imaging procedures, radiation protection, and legal aspects of medical practice. The exam is designed to ensure that international medical graduates demonstrate equivalent knowledge and clinical competence to that of graduates from German medical faculties. The exact scope of subjects may vary depending on the outcome of the equivalency assessment (Gleichwertigkeitsprüfung) and the specific deficits identified in your training.
  
• Do I need to pass the FSP before the Kenntnisprüfung?
  In most states: Yes. But in some, both exams can be scheduled in parallel. Always confirm locally.
  
• How many attempts do I have?
  Three in total – regardless of the federal state. Each attempt counts nationwide, even if taken in a different federal state. The competent authorities exchange information across Germany to ensure that attempts are tracked consistently throughout the country. ⚠️ Important: If you fail the Kenntnisprüfung three times, you are generally no longer eligible to obtain Approbation in Germany. Exceptions to this rule are extremely rare and only granted under exceptional circumstances. Plan and prepare carefully to make the most of your opportunities.
  

Our courses and materials are designed to prepare you in the best possible way for the knowledge exam (Kenntnisprüfung). However, we cannot guarantee that you will pass the exam, as this also depends on your individual preparation, language proficiency, and the specific exam situation.

All information provided without guarantee.