FSP or Kenntnisprüfung? Differences and order

In short

The Fachsprachprüfung (FSP, medical language exam) tests whether you have a command of medical German at C1 level — your medical knowledge is not assessed there. The Kenntnisprüfung (knowledge exam), by contrast, tests your medical knowledge and skills at the level of the German final state examination. Physicians whose degree was not taught in German generally need the FSP regardless of whether the degree comes from the EU or a third country; the Kenntnisprüfung only concerns degrees from third countries. From 1 November 2026, the Kenntnisprüfung is the statutory default route for new applications with a third-country degree — the law does not change the requirements for the FSP.

Two exams, two different questions

For the Approbation (full medical licence), the Bundesärzteordnung (BÄO, Federal Medical Practitioners' Act) requires, among other things, two things: training that corresponds to German medical training — or proof of the knowledge this requires — and "die für die Ausübung der Berufstätigkeit erforderlichen Kenntnisse der deutschen Sprache" (the knowledge of German required to practise the profession; § 3(1) sentence 1 no. 5 BÄO). The FSP answers the language question, the Kenntnisprüfung the medical one. Neither replaces the other: if you hold a third-country degree and pass only one of them, you will not be granted the Approbation.

	Fachsprachprüfung (FSP)	Kenntnisprüfung
What is tested	Medical German at C1 level in the patient conversation, in documentation and in the conversation with a colleague; medical knowledge is not assessed	Medical knowledge and skills in internal medicine and surgery, plus emergency medicine, clinical pharmacology, imaging, radiation protection and legal aspects
Legal basis	§ 3(1) sentence 1 no. 5 BÄO; the format follows the 2014 guidelines of the health ministers' conference and differs from state to state	§ 37 Approbationsordnung für Ärzte (ÄApprO, Medical Licensure Regulations), uniform nationwide
Who examines	Usually the state medical chamber (Landesärztekammer) on behalf of the licensing authority	A state examination board (chair and two members) appointed by the authority
Format	About 60 minutes, usually 3 × 20: doctor–patient conversation, documentation, doctor–doctor conversation	Oral-practical with a patient presentation: history-taking and examination, a written report, then the oral exam; under the previous version of § 37 ÄApprO 60–90 minutes per candidate, no more than four candidates
Who needs it	Degree not taught in German — from the EU and from third countries alike	Third-country degrees only
Retakes	Unlimited, always as a whole	Twice; after that the Approbation is refused

How the FSP runs in each chamber is explained under FSP procedure, how it is graded under Grading. Two points are often confused. The chambers stress that the FSP does not test medical knowledge — according to the Lower Saxony medical chamber, whether your diagnosis is correct does not matter, but expressing yourself clearly and coherently does. Conversely, the Kenntnisprüfung is not a pure knowledge test either: it is held in German, and the candidate has to show the necessary skills "auch in der ärztlichen Gesprächsführung" (including in medical communication with patients; § 37(1) ÄApprO).

Who needs which exam?

Degree from the EU, the EEA or Switzerland

Medical degrees covered by automatic recognition under the EU Professional Qualifications Directive are recognised without a Kenntnisprüfung. If there are exceptionally substantial differences, the law provides for an Eignungsprüfung (aptitude test) — not a Kenntnisprüfung. The Kenntnisprüfung is only for people who completed their medical studies outside the EU, the EEA and Switzerland.

You still need the FSP if your degree was not taught in German. Hessen, for instance, requires a B2 certificate and a C1 medical language certificate for EU degrees too. Under EU law, the professional qualification is checked first for these degrees and the language only afterwards. Some states also accept private medical language exams for EU degrees; which ones is explained in FSP, telc or FaMed: which certificate counts where?

Degree from a third country

For the Approbation you must prove, in addition to language, that your level of training is equivalent to the German one. Until now this has been done first through a document-based Gleichwertigkeitsprüfung (equivalence assessment): the authority compares your study documents — often with an expert report from the Gutachtenstelle für Gesundheitsberufe (central expert office for health professions) — with the German degree. If it finds substantial differences, or if your documents cannot reasonably be assessed, the Kenntnisprüfung follows. For applications from 1 November 2026, the law reverses this logic (see below).

If your third-country degree has already been recognised by another EU or EEA state, from 1 November 2026 the law explicitly treats your application like an EU application: your qualification is assessed first, and substantial differences lead to an aptitude test (§ 9b(1), § 9c(7) BÄO).

Who does not have to take the FSP

The authorities usually waive the FSP if you obtained your degree at a German-language university, completed at least ten years of schooling at a German-language school, or completed at least three years of vocational training in German. Whether this applies to you is decided case by case by the licensing authority (Approbationsbehörde).

The usual order

There is no nationally binding order of FSP and Kenntnisprüfung; each state organises the procedure itself. The typical route with a third-country degree looks like this:

Application for the Approbation to the state's licensing authority, often together with an application for a Berufserlaubnis (temporary licence to practise). A general-language B2 certificate is usually required at this point or, at the latest, for admission to the FSP.
Registration for the FSP — only after you have applied. The authority usually registers you, in Bavaria "ausschließlich über die Regierung" (exclusively via the regional government); in Berlin and Hessen you register with the medical chamber yourself, using the acknowledgement of receipt for your application.
Fachsprachprüfung at the state medical chamber. In many states it is the first exam in the procedure: in Schleswig-Holstein the C1 certificate must already be available for admission to the Kenntnisprüfung; in Lower Saxony the Approbation procedure continues once the FSP has been passed.
Equivalence assessment or Kenntnisprüfung. If a Kenntnisprüfung is required, the states must ensure that you can take it within six months of the decision (§ 37(3) ÄApprO).
Approbation, once all requirements are met.

Temporary licence in the meantime

While the procedure is running, the authority can grant holders of a third-country degree a Berufserlaubnis under § 10 BÄO: usually for a total of two years at most, often restricted to certain activities, places of employment or one state. You need German language skills for this too. The states handle this differently: in Schleswig-Holstein, B2 is enough for the application at first, but the C1 medical language certificate must be submitted within six months of starting work; in North Rhine-Westphalia applicants are told after passing the FSP which documents they need to submit for the Berufserlaubnis; in Hessen it requires a medical employer in the state. For EU degrees, a Berufserlaubnis is generally not granted — the route there leads directly to the Approbation.

What changes from 1 November 2026

The Gesetz zur Beschleunigung der Anerkennungsverfahren ausländischer Berufsqualifikationen in Heilberufen (Act to Accelerate Recognition Procedures for Foreign Professional Qualifications in the Health Professions) of 22 July 2026 (BGBl. 2026 I No. 225) enters into force on 1 November 2026. The Bundestag passed it on 26 March 2026 and the Bundesrat gave its consent on 8 May 2026. For physicians with a third-country degree, the following then applies:

The Kenntnisprüfung becomes the default route. You prove the required knowledge through a "Berufszulassungsprüfung, die sich auf den Inhalt der staatlichen Abschlussprüfung bezieht (Kenntnisprüfung)" (a licensing exam based on the content of the state final examination; § 9d(2) BÄO). The document-based assessment of your study content then no longer applies; according to the Federal Ministry of Health, curricula no longer need to be translated or certified. You must still prove that you have completed your degree.
The equivalence assessment is only available on request. You can opt for the document-based assessment, but only up to four weeks after submitting your application; the choice is binding for the entire procedure, and the authority must inform you of its consequences. If it then finds substantial differences, the Kenntnisprüfung follows as before (§ 9d(3) BÄO).
The same exam for everyone. The Kenntnisprüfung is explicitly a licensing exam with the same standards for everyone — it does not focus on an individual's specific gaps.
The language check may come earlier. Until now, equivalence was supposed to be checked before the other requirements — including language skills. In future, this order only applies to EU, EEA and Swiss degrees (§ 9b(1) BÄO). For third-country degrees, the states may check language skills before the professional qualification.
The state you live in is responsible. If you live in Germany, you submit the recognition application to the authority of the state of your habitual residence; if you live abroad, to the state in which you want to work (§ 12(2a) BÄO). For the Berufserlaubnis, the state in which you want to work remains responsible. The authorities may also ask other states whether a procedure of yours is already pending there (§ 3(4) BÄO).
Transitional rule: applications for recognition of a third-country degree submitted by the end of 31 October 2026 continue under the previous rules (§ 15 BÄO).

What stays the same for the FSP

The requirement itself is unchanged: you need "die für die Ausübung der Berufstätigkeit erforderlichen Kenntnisse der deutschen Sprache". The law does not regulate the format, content or fee of the FSP — it remains an exam run by the state medical chambers at C1 level with the familiar parts. What may change is the timing: whether your state moves the FSP ahead of the other steps is up to each state. Ask your licensing authority which order applies to your application.

The details of the new Kenntnisprüfung are set by the licensure regulations

How the new Kenntnisprüfung works is not set out in the Act but in an amendment to the Approbationsordnung für Ärzte. The Federal Ministry of Health has sent the regulation to the Bundesrat (printed paper 504/26 of 3 September 2026); it is also due to enter into force on 1 November 2026 and requires the Bundesrat's consent. Among other things, the draft provides for:

a patient-based preparation (history-taking and examination no more than 30 minutes, written report no more than 60 minutes) and the actual exam spread over two days,
90 to 120 minutes of examination time per candidate,
medical communication as a fixed exam topic alongside internal medicine and surgery, explicitly including communication with relatives and with other health professions,
the previous version of the licensure regulations for everyone who submitted their application by 31 October 2026.

The Bundesrat's committees have recommended changes, among others to duration and procedure. Only the version promulgated in the Federal Law Gazette (Bundesgesetzblatt) is therefore authoritative.

What this means for your preparation

The FSP and the Kenntnisprüfung call for different preparation. For the FSP you train language under time pressure: a complete history-taking conversation in lay language, a clean written summary from your notes and a structured patient presentation to the "Oberarzt" (senior physician) — see Doctor–doctor conversation. For the Kenntnisprüfung you revise clinical knowledge at state-exam level and practise examination, report writing and case presentation in German. Because the FSP is the first hurdle in many states, it pays to start preparing early; every retake costs the full fee again (Costs).

You can practise the three FSP parts on fsppruefung.de with an AI patient and an AI examiner in the 3 × 20-minute format; this does not replace preparing the medical content for the Kenntnisprüfung.

This text describes the general route and is not legal advice. Which rules apply to your application — especially around 1 November 2026 — is decided by your licensing authority; confirm your individual case with them.

Sources

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