Medical exam · €400–€600 · 3-attempt limit
The Kenntnisprüfung, sourced.
Clinical-knowledge exam non-EU doctors sit when their foreign training is judged not equivalent to German standards. Format per § 37 ÄApprO: oral-practical with a real patient, 60–90 minutes per candidate, modelled on the third section of the German state exam (M3). Federal cap: 3 attempts total — moving Bundesland does not reset it.
Verified · § 37 ÄApprO · Bayerisches Ärzteblatt 10/2025 · FragDenStaat FOIA
Coming 1 November 2026
KP becomes the default route.
The Bundestag passed the enabling law on 26 March 2026. From November, most Drittstaat applicants will skip the documents-based Gleichwertigkeitsprüfung and go directly to KP — a 4-week opt-out window preserves the document route on request. Read the full reform breakdown →
What it tests
Clinical reasoning at M3 level — not your German.
The KP examiners assess whether you can take a history, present a case, defend a differential, propose a workup, and discuss treatment — at the level expected of a German graduate at the end of medical school. Bayerisches Ärzteblatt 10/2025 confirms the exam is "modelled on the third section of the medical exam (M3)."
The FSP is a prerequisite. You cannot generally be scheduled for KP until you have passed the chamber FSP. Two different competences, two different bodies — Landesärztekammer for FSP, Landesprüfungsamt at a university faculty for KP.
Pass/fail only. No grade. Maximum three attempts federally — changing Bundesland does NOT reset the counter.
Exam format · § 37 ÄApprO
Three phases. One pass or one fail.
- 01Preparation phase
Patientenfall
Patient case + write-up
Take a history from a real patient at the examining university clinic, perform a physical examination, write the structured report (Anamnese, Befund, Diagnose, Prognose, Therapieplan, Epikrise).
- 0260–90 min
Mündliche Prüfung
Oral examination panel
Up to four candidates per session (three in Lower Saxony). Panel examines your case first, then cross-disciplinary: emergency, drugs, imaging, radiation safety, legal frame.
- 03Pass / fail only
Bescheid
Result issued
No grade is recorded. Three attempts maximum federally. A failed attempt in one Land counts toward the federal total — the exam register is checked before scheduling repeats.
Who sits the KP
EU doctors don't. Drittstaat doctors might.
EU, EEA and Swiss-trained doctors do not sit the KP. Automatic recognition under Article 24 of Directive 2005/36/EC applies when training meets EU minimum standards.
Drittstaat (non-EU) doctors are potentially subject to it. No official country list. Per § 3 Abs. 3 BÄO the decision is case-by-case, based on wesentliche Unterschiede in training. Frequent applicant populations dominate the KP cohort because they apply most: Syria, Egypt, Iran, India, Pakistan, Turkey, Ukraine.
State-specific exception
Rheinland-Pfalz routes Syria-trained applicants directly to KP.
Since 9 May 2016, the LSJV in Rheinland-Pfalz has not performed document-based equivalence assessments for Syria-trained applicants — verifiability of Syrian credentials during the war prompted the change. Those candidates skip Gleichwertigkeitsprüfung entirely.
Subjects examined
Two dominate. Five are tested briefly.
- PrimaryInnere Medizin
- PrimaryChirurgie
- SecondaryNotfallmedizin
- SecondaryKlinische Pharmakologie / Pharmakotherapie
- SecondaryBildgebende Verfahren
- SecondaryStrahlenschutz
- SecondaryRechtsfragen der ärztlichen Berufsausübung
Source: § 37 ÄApprO; Bayerisches Ärzteblatt 10/2025; Regierung Oberbayern KP-FAQ. Innere Medizin and Chirurgie dominate the case and oral examination time.
Pass rates
No national figure. FOIA tells the story.
BIBB confirmed in writing: "Die amtliche Statistik referiert keine Daten zu den Erfolgsquoten oder der Anzahl von benötigten Prüfungsversuchen für die Kenntnisprüfung." What follows are FragDenStaat FOIA responses, counted differently across states.
| State | Period | Reported | Notes |
|---|---|---|---|
| Bayern | recent | ~80–85% first attempt; ~90% by 2nd | ~5% fail definitively across all three attempts. Bayern publishes most regularly. (FragDenStaat FOIA) |
| Berlin | 2021–2022 | ~82% pass rate | ~18% fail any single attempt; only ~2% fail definitively after all three. (FragDenStaat FOIA to LAGeSo) |
| Sachsen | 2019–2021 | Final fail rate 1.67% / 15.75% / 13.66% | Three consecutive years, no clear trend — final = exhausted all attempts. (FragDenStaat FOIA to SMS) |
| Rheinland-Pfalz | 2017–2018 | ~50% fail rate (per-attempt) | Older data from Ärztezeitung. Not directly comparable to states reporting final fail rates. (Ärztezeitung) |
| Sachsen-Anhalt | — | Not tracked | FragDenStaat FOIA confirmed: the chamber keeps no statistics. (FragDenStaat FOIA) |
AMBOSS and Lingoda estimate that without structured preparation, pass rates "in most cases sit below 50%," rising to ~76% with their combined course. Treat that as a vendor claim, not independent data.
Slot waits (2018 MDR data)
From 6 weeks to 18 months.
From the 2018 MDR Thüringen cross-state survey — still the most complete public picture of state-by-state KP waiting times. Eight years old; orientational. The Medizinischer Fakultätentag warns waits will worsen once KP becomes the default in November 2026.
Exam fees
€400 to €600 per attempt. Repeats charged in full.
Bayern charges approximately €520 per attempt, published by Regierung Oberbayern. Other Bundesländer fall in the €400–€600 range. The Bildungsgutschein covers preparation courses, not exam fees. Per-attempt fees are separate from the Approbation fee (€130–€600 across the 17 Länder) — see the per-state comparison.
Preparation
Six-step pathway from FSP to KP.
- 1
Pass the FSP before KP can be scheduled
PrerequisiteThe Fachsprachprüfung must be in hand before the Landesprüfungsamt opens a KP slot. Chambers run FSPs from €350 to €700. Two states (Saarland, Schleswig-Holstein) accept telc B2/C1 Medizin.
- 2
Submit your Approbation file and wait for the Bescheid
Pre-reformThe authority reviews your documents and issues a Defizitbescheid identifying wesentliche Unterschiede. This routes you to KP. Bayern FOIA reports 16.5 months under current regime; M-V cites 4 weeks officially. From 1 Nov 2026 this step shortens dramatically.
- 3
Register at your state Landesprüfungsamt
Pay €400–600Each Bundesland organises KP through its Landesprüfungsamt, usually at a university medical faculty. Bayern uses Regierung Oberbayern; Berlin uses LAGeSo. Slot waits range from ~6 weeks (Bayern) to ~18 months (Thüringen) on 2018 data.
- 4
Build a 100-day study plan around Innere + Chirurgie
~3 monthsAMBOSS recommends 50 days at 8 h/day or 100 days at 4 h/day. Dominant subjects: Innere Medizin, Chirurgie. Shorter sections on Notfallmedizin, Pharmakologie, Bildgebung, Strahlenschutz, Rechtsfragen. Bayerisches Ärzteblatt 10/2025 confirms M3-level.
- 5
Fund preparation with a Bildungsgutschein where eligible
VoucherDoctors registered with the Bundesagentur or a Jobcenter can apply. The Lingoda + AMBOSS combo (20 weeks full-time / 37 weeks part-time) is AZAV-certified and one of the few language + clinical bundles eligible.
- 6
Sit the exam — plan for the 3-attempt federal limit
Exam dayOral-practical with a real patient: anamnesis, examination, write-up, then 60–90 min examiner panel. Maximum four candidates per session. Result bestanden or nicht bestanden — no grade. Three attempts federally — moving Bundesland does NOT reset.
Avoiding KP under the current regime
Two OVG decisions shape the test.
Until 31 October 2026, the Gleichwertigkeitsprüfung is the statutory first step — KP is only triggered if the authority finds wesentliche Unterschiede. Two Oberverwaltungsgericht decisions have shaped how examiners apply that test:
OVG Sachsen · 29 August 2023 · 2 A 370/22
The Gleichwertigkeitsprüfung takes priority over the Kenntnisprüfung. Examiners may not arbitrarily expand the scope of the assessment to manufacture deficits. Strengthened applicants' ability to demand a formal Bescheid before being routed to KP.
OVG NRW · 5 February 2020 · 13 A 1115/17
A Korean orthopaedic specialist with 20 years of clinical experience challenged a Defizitbescheid built around a 26-hour psychosomatic-medicine training gap. The OVG ruled that an overly formalistic approach to small training deltas — without weighing documented post-qualification experience — is angreifbar.
Practical implication: Authorities sometimes try to persuade applicants to voluntarily agree to KP without issuing a Defizitbescheid. The route to avoiding KP under the current regime is to require the Bescheid in writing, then file a Widerspruch and (if necessary) a Klage at the Verwaltungsgericht. From 1 November 2026 this changes — the document-based assessment becomes opt-in with a 4-week filing window. See the reform breakdown.
Preparation platforms
What KP candidates actually use.
AMBOSS Kenntnisprüfung
AffiliateThe de-facto German medical-knowledge platform, partnered with Marburger Bund (MB members get discounted access with a pre-built KP study plan). 50 days at 8 h/day or 100 days at 4 h/day covers all subjects.
Try AMBOSS KPMB member discount
Lingoda × AMBOSS combo
AffiliateAZAV-certified combined course — eligible for full Bildungsgutschein funding. C1 medical-German + AMBOSS KP study plan. Full-time 20 weeks; part-time 37 weeks. One of the few language + clinical bundles voucher-eligible.
Start Lingoda × AMBOSSBildungsgutschein eligible
Funding
Bildungsgutschein covers preparation, not the exam fee.
Doctors registered with the Bundesagentur für Arbeit or a Jobcenter can apply for a Bildungsgutschein covering up to 100% of an AZAV-certified preparation course. Lingoda's medical-German programmes and the Lingoda + AMBOSS combo qualify. The voucher covers the course; the exam fee (€400–€600) remains your cost.
IQ Netzwerk also runs state-funded preparation courses for foreign professionals — referral from the Approbation authority sometimes suffices. Lower fees but fewer slots and longer waitlists than commercial providers.
FAQ
Frequently asked.
How much does the Kenntnisprüfung cost?+
Around €520 in Bayern, with other states in the €400–€600 range per attempt. Most states charge the full fee again for repeats. The Bildungsgutschein from the Bundesagentur für Arbeit can cover preparation costs but not the exam fee itself.
What is the Kenntnisprüfung pass rate?+
No national pass rate exists — BIBB has formally confirmed this. Bayern reports ~80–85% first-attempt and ~90% by the second, with only ~5% failing definitively. Berlin averaged ~82% across 2021–2022 with ~2% failing after all three attempts. Sachsen reported final fail rates of 1.67%, 15.75%, and 13.66% across 2019–2021. Rheinland-Pfalz reported ~50% fail in 2017–2018. These figures are not directly comparable — states count differently (per-attempt vs final, with vs without repeat takers).
How long does it take to get a KP slot?+
From a 2018 MDR cross-state survey (still the most complete public data, but eight years old): Bayern ~6 weeks, Baden-Württemberg 6+ months, Sachsen ~12 months, Thüringen ~18 months. Bayerische Regierung confirms 1–6 months after the examination office is notified. The Medizinischer Fakultätentag has warned waits will worsen once KP becomes the default in November 2026.
How many attempts do I get?+
Three total, federally. Changing Bundesland does NOT reset the counter — Approbation authorities check the federal exam register before scheduling repeats. After three failed attempts you lose the right to Approbation as a physician in Germany.
What subjects does the exam cover?+
Primary subjects are Innere Medizin and Chirurgie — these dominate the patient case and follow-up questioning. Secondary subjects: Notfallmedizin, klinische Pharmakologie/Pharmakotherapie, bildgebende Verfahren, Strahlenschutz, Rechtsfragen der ärztlichen Berufsausübung. Bayerisches Ärzteblatt 10/2025 confirms the exam is modelled on M3.
Can I avoid the Kenntnisprüfung entirely?+
Under the current regime (until 1 November 2026), yes — case law supports it. The Gleichwertigkeitsprüfung route lets you argue your foreign training plus documented post-qualification experience is equivalent to German standards. Two key decisions: OVG Sachsen 2023 (2 A 370/22) holds that Gleichwertigkeitsprüfung takes priority over KP; OVG NRW 2020 (13 A 1115/17) ruled against a formalistic 26-hour psychosomatic-medicine deficit for a Korean orthopaedic specialist with 20 years' experience. After 1 November 2026, the document route becomes opt-in with a 4-week application window.
Is the FSP enough, or do I need KP too?+
FSP and KP test different things. FSP is medical-German language competence, run by the Landesärztekammer. KP is clinical knowledge at M3 level, run by the Landesprüfungsamt at a university faculty. FSP comes first and is always required; KP is only triggered when the authority finds wesentliche Unterschiede. From 1 November 2026, KP becomes the default for Drittstaat applicants regardless of training assessment — but FSP remains a prerequisite.
What happens if I fail my third attempt?+
You lose the right to obtain Approbation as a physician in Germany. You may still be able to work in adjacent healthcare roles that do not require Approbation, but the medical-licence pathway closes federally — not just in the state where you failed.
Personalised plan
Get a state-specific KP plan.
Tell us your country of training, German level, and target Bundesland. We'll recommend the prep platform that matches your timeline and connect you with recruiters in our network when you're ready.