Fachsprachprüfung Nordrhein: format, 36-point rule, fees

In short

The Ärztekammer Nordrhein (ÄKNO, the medical chamber for the Rhineland part of North Rhine-Westphalia) examines in Düsseldorf on the OSCE model: three stations of 20 minutes each, in which an actor plays the patient, you fill in a pre-printed Anamnesebogen (history form) and present the case to two physicians on a "ward round". Three examiners award up to 20 points each; you pass with at least 36 of 60 points. The exam costs €430 per attempt. You are registered by the Bezirksregierung Münster, the authority responsible across North Rhine-Westphalia for licensing physicians with a foreign degree.

At a glance

Item	Nordrhein (ÄKNO)
Examining body	Ärztekammer Nordrhein, Tersteegenstraße 9, Düsseldorf
Registration via	Bezirksregierung Münster — no personal registration
Fee per attempt	€430 by bank transfer, due again for every retake
Duration and parts	60 minutes, three stations of 20 minutes
Patient role	an actor
Part 2 (documentation)	the chamber's pre-printed Anamnesebogen; a sample is online
Terminology task	no separate task published; in station 3 the examiners may hand you further documents about the patient
Permitted aids	a blank notepad and pen from the chamber, nothing else; bags and coats stay outside
Result	communicated "zeitnah" (promptly) and reported to the authority
Pass rule	60% of the maximum score, i.e. at least 36 of 60 points
Retakes	possible several times, €430 each; the chamber recommends a few months in between

The exam in Nordrhein

The ÄKNO took over the Fachsprachprüfung on 1 January 2014 and designed it as an OSCE — a circuit of three standardised stations. At the start you receive a blank notepad and a pen; your notes are not graded. If you arrive late, you have failed. Our article on the FSP format explains the structure shared by all chambers; in Nordrhein the differences lie mainly in the patient role, the form and the third station.

Station 1: conversation with an actor patient

Unlike in most chambers, the patient is played not by an examiner but by an actor. This is meant to give every candidate an equally difficult case. After taking the history you explain your suspected diagnosis, propose diagnostics and therapy and respond to questions — so that the patient clearly understands you, since patients are rarely familiar with technical terms. According to ÄKNO examiner Dr. Jaswant Singh, this station is usually harder than the other two.

Station 2: the Anamnesebogen

You transfer the history onto a form of the kind used "so oder ähnlich" (in this or a similar way) in hospitals of the chamber's region. The ÄKNO sample Anamnesebogen has three pages:

Patient (first name, surname, date of birth), date and a large field "Aufnahmegrund/Diagnose (stichwortartig)" (reason for admission/diagnosis, in keywords)
Allergien/Unverträglichkeiten (allergies/intolerances), Genussmittel/Drogen (stimulants/drugs), Sozialanamnese (social history), Familienanamnese (family history), then the block "Verdachtsdiagnose/Differentialdiagnose/weitere Diagnostik/Therapievorschläge" (suspected diagnosis/differentials/further diagnostics/therapy proposals) with the note "Bitte benutzen Sie Fachwörter, wo möglich" (please use technical terms where possible)
Differential diagnosis, further diagnostics, therapy proposals

Worth noticing: the large field on page 1 explicitly asks for keywords, and the sample form has no separate fields for previous illnesses or medication. Decide beforehand where you will put that information.

Beispiel — fiktiver Fall. Aufnahmegrund: seit heute Nacht ca. 3 Uhr Schmerzen, Schwellung, Rötung und Überwärmung am rechten Großzehengrundgelenk, Schmerzstärke 9/10; am Vorabend Grillfest mit Fleisch, Innereien und Bier. Verdachtsdiagnose: V. a. akuten Gichtanfall (Podagra) rechts.

(Example — fictional case. Reason for admission, in keywords: since about 3 a.m. last night pain, swelling, redness and warmth at the right big-toe joint, pain 9/10; barbecue with meat, offal and beer the evening before. Suspected diagnosis: acute gout attack (podagra), right side.) How to phrase such entries cleanly is covered in documentation in the FSP.

Station 3: ward round with two doctors

The third station recreates a ward round: you meet two physicians, "for example a head of department and a senior physician", present the patient in a structured way and explain your assessment and your ideas for further treatment. Questions follow. A particular feature: the examiners may hand you further documents about the patient for you to assess. More on this part in our article on the doctor–doctor conversation.

Registration and exam date

You file your application for the Approbation (medical licence) with the Bezirksregierung Münster (central recognition office, ZAG-aH). It is responsible statewide for physicians with degrees from both the EU and third countries, and registers you for the Fachsprachprüfung once you have applied. Registration requires a B2 certificate from a recognised language provider. The authority sends your data to the ÄKNO, which usually contacts you by e-mail. You are only assigned a date once the €430 has arrived — the earlier you pay, the earlier you are invited. The chamber publishes no waiting time. Other chambers' fees: FSP fees.

Grading and result

The three examiners use structured assessment sheets, each worth up to 20 points. To pass you need 60% of the maximum, i.e. at least 36 points. The ÄKNO names no minimum per station — unlike Berlin, for example, where each part must reach 60% on its own.

Only language is graded. A wrong diagnosis or a misjudged therapy is not in itself a reason to fail — but what you say must be internally consistent. The chamber gives its own example: anyone who says a humerus fracture needs a cast on the foot will be asked what "Humerus" and "Fuß" (foot) mean. What is required is flexible language use that can paraphrase when needed.

The result is communicated "zeitnah" and reported to the authority. In 2023 the ÄKNO held a record 2,040 exams; 35.8% failed (2022: 33%). In its first exam year, 2014, the pass rate had been 74.6%.

Retakes

The exam can be retaken several times, at €430 each. The ÄKNO recommends allowing a few months between two dates to keep working on your German. Examiner Dr. Singh advises analysing exactly what went wrong — writing, speaking or listening — and working on that specifically. More: failed the FSP.

Tips for the exam in Nordrhein

Ask instead of guessing. Actor patients use everyday words. Dr. Singh gives the example "Leberfleck" (mole): ask for unknown words to be paraphrased and for difficult names to be spelled, without embarrassment.

Ärztin: Entschuldigung, ich möchte Ihren Namen richtig aufschreiben. Könnten Sie ihn bitte buchstabieren?

Patient: P wie Paula, I, E, T, S, C, H …

(The doctor apologises, says she wants to write the name down correctly and asks the patient to spell it; he starts spelling with the German phonetic alphabet, "P as in Paula".)

No memorised stock phrases. According to Dr. Singh, examiners quickly notice when someone uses sentences they do not understand, and ask about them.
Practise with the sample form. Download the sample Anamnesebogen and write practice cases straight into it: keywords on page 1, technical terms in the diagnosis block.
Be ready for documents in station 3. Practise reading an unfamiliar document about the patient and placing it in two or three sentences of medical German.
Be punctual and travel light. Arriving late counts as a fail. Bags and coats are not allowed in the exam rooms; the lockers at reception need a €1 coin as a deposit.
Watch the chamber's videos. The ÄKNO shows the procedure in videos in German and English.

Sources

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