Kenntnisprüfung new rules 2026: what the Bundesrat changed

What happened on 16 October 2026?

Under a law passed in summer 2026, the Kenntnisprüfung becomes the normal route to the Approbation (the full German medical licence) for doctors trained outside the EU, the EEA and Switzerland, from 1 November 2026 (background in Kenntnisprüfung 2026: what changes for foreign doctors). How the exam itself runs is set by a separate ordinance (Verordnung) from the Federal Ministry of Health. It rewrites, among other things, § 37 of the Approbationsordnung für Ärzte (ÄApprO), the licensing regulation for doctors.

This kind of ordinance needs the consent of the Bundesrat, the chamber of Germany's 16 federal states. At its 1069th session the Bundesrat gave consent, but only with conditions ("mit Maßgaben"). Four of them change the exam day for doctors directly.

What changes in the Kenntnisprüfung for doctors?

The table puts three versions side by side: the rule in force today, the ministry's draft and the version the Bundesrat demands. We have not seen this comparison anywhere else.

The Bundesrat's reason is the ordinance's own goal: faster recognition. By its estimate, longer exams with the same number of examiners would mean one third fewer Kenntnisprüfungen, and so longer waits for a date. A second exam day would also tie up examiners and rooms.

What stays as in the draft?

The Bundesrat did not touch these points, so they apply in any case once the ordinance is in force:

• Subjects: internal medicine and surgery, plus in every exam emergency medicine, clinical pharmacology and pharmacotherapy, imaging, radiation protection, the legal framework of medical practice and doctor-patient communication, including talking to relatives and other health professionals.
• Format: you take the history from and examine a patient or simulated patient without seeing the file first. Then you write a report with history, diagnosis, prognosis, treatment plan and epicrisis (a short summary of the case).
• Materials: for the report you only get parts of the file, such as imaging, ECG or lab results. Guidelines, textbooks and the internet are not allowed, according to the ministry's explanatory notes.
• Exam: you first present your case. Questions start with this case and your report, then move to all subjects.
• Marking: the board decides on overall performance, including the report. For the report, structure and clarity count too.
• Dates: at least twice a year; exam within six months; invitation at least five calendar days before.

Do the new rules apply to your application?

Under the ordinance's transition rule (new § 42(2) ÄApprO), the old version still applies to everyone who applied for the Approbation or a temporary licence (Berufserlaubnis) by 31 October 2026. The new exam is for applications from 1 November 2026. The Bundesrat did not change this rule.

What does this mean for your preparation?

If the Bundesrat version applies, the day gets shorter but denser. 20 minutes for history and examination and 30 minutes for a full report in German is tight. If you cannot write the report in a fixed order, you lose time here, and the report counts in the result.

1. Practise with the stricter times. If you manage 20 and 30 minutes, you are also ready if more time is allowed in the end.
2. Write the report in the same order every time: history, findings, diagnosis with differentials, prognosis, treatment plan, epicrisis. The structure in our article FSP exam: the Arztbrief (doctor's letter) works well for this.
3. Train the case presentation. The exam opens with your own case. A short, clearly structured presentation gives you a steady start.
4. Treat communication as exam content, not as a side issue: it is explicitly part of every Kenntnisprüfung.
5. Ask in writing which rules your application falls under, especially if you apply shortly before or after 1 November 2026.

If you are waiting for a decision on your documents, read Defizitbescheid: what it means and what comes next. You can practise history taking, the doctor-to-doctor talk and the Arztbrief under real time in our medical German practice area.

What about pharmacists?

The Kenntnisprüfung for pharmacists was also meant to get longer: 60 to 90 minutes in the draft instead of 30 to 60 today. The Bundesrat demands that it stays at 30 to 60 minutes (decision, items 10 and 11).