The knowledge test for doctors
An oral and practical examination with a patient presentation. It takes place on a single day and lasts 60 to 90 minutes per candidate.
The knowledge test (in German, Kenntnisprüfung) shows that your knowledge and skills correspond to the German state examination.
Under Section 9d(2) of the Federal Medical Practitioners Act (BÄO), the knowledge test is the standard route for qualifications from outside the EU. If you want your documents assessed instead, you must say so within four weeks of applying; the choice binds you for the whole procedure. The authority has to explain this option and its consequences to you. The test is also required if your documents cannot be obtained for reasons beyond your control (§ 9d(3) BÄO). We discuss the choice with you before you apply. More on the choice: Test or document assessment?
How the test is structured
- You are assigned one or more patients, take their history (Anamnese) and examine them under the supervision of a board member. You then present the patients to the board. Simulated patients, meaning trained actors, may also be used (§ 37(2) and (5) ÄApprO).
- You write a report covering history, diagnosis, prognosis, treatment plan and a case summary (Epikrise). A board member countersigns it. It becomes part of the examination and counts towards the result (§ 37(5) ÄApprO).
- The examination lasts at least 60 and at most 90 minutes per candidate; no more than four candidates are examined together (§ 37(2) ÄApprO).
- A state examination board of three members, university teachers or medical specialists, examines you in German (§ 37(4) ÄApprO).
- The authority invites you at least five calendar days before the date (§ 37(3) ÄApprO). The states should offer the examination at least twice a year (§ 37(7) ÄApprO).
What is examined
- Internal medicine
- Surgery
You are also examined in emergency medicine, clinical pharmacology and pharmacotherapy, imaging, radiation protection and the legal aspects of medical practice. The authority may add a further subject or cross-sectional area (a field that links several subjects) in which it found substantial differences from your training (§ 37(1) ÄApprO). Questions start from the patient you presented.
How many attempts you have
You may retake the knowledge test twice (§ 37(7) ÄApprO). Several states count failed attempts made in other states, so moving does not give you a fresh start.
Some states set a waiting time between attempts. Bremen schedules the retake at the earliest three and at the latest twelve months after the test; Hamburg sets it about six months later. Hesse and Mecklenburg-Western Pomerania count at most three attempts across Germany (data as of September 2026).
Once all attempts are used up, this route to the Approbation is closed. Preparation courses for the knowledge test can be funded with up to €3,000 from the recognition grant. Apply before you file your licensing application, and you must live in Germany. See funding of up to €4,800.
Test fees in the 16 states
Who runs the test, what it costs and how long you wait for a date is decided by each state. For 14 of 16 states a fee or fee range is documented (1 as a range, 1 as a standard fee with a range, 2 as an upper limit or a minimum). Where a state sets a fixed or standard fee, it ranges from €400 (Schleswig-Holstein) to €1,350 (Hesse).
| State | Fee |
|---|---|
| Baden-Württemberg | €1,100 |
| Bavaria | up to €1,200 |
| Berlin | €540(range €250–€2,000) |
| Brandenburg | €799 |
| Bremen | €730 |
| Hamburg | €900 |
| Hesse | €1,350 |
| Lower Saxony | €980 |
| Mecklenburg-Western Pomerania | €640 |
| North Rhine-Westphalia | €1,050 |
| Rhineland-Palatinate | — |
| Saarland | €400–€800 |
| Saxony | €850 |
| Saxony-Anhalt | — |
| Schleswig-Holstein | €400 |
| Thuringia | up to €450 |
A dash means that no figure is given. A range such as €400–€800 is the frame within which the authority sets the fee. Where a figure is followed by “range” or “standard; otherwise”, the authority names that figure as its standard fee and the range is the framework of the fee schedule for cases with more effort. “Up to” and “from” mark a ceiling or a minimum, and further expenses can apply. The state pages (in German) give the wording of the fee, the examining body and the dates. Data as of 8 September 2026; state details checked on 15 September 2026.
How long you wait for a date
Where a state publishes a waiting time, it ranges from none at present in North Rhine-Westphalia to about 12 months in Schleswig-Holstein and about 16 months in Rhineland-Palatinate. Bavaria gives 1 to 6 months from registration to the formal invitation, Baden-Württemberg 4 to 6 months from registration (data as of September 2026).
What the test costs together with the other steps is shown in the fees for all 16 states and in the cost calculator. The German pages describe the knowledge test in detail, the procedure step by step and the temporary permit (German).