Licensing exams in Germany: M2, Kenntnisprüfung and the language test

Medical and health education in Germany

Medical study in Germany lasts six years (12 semesters) and is regulated nationally by the Approbationsordnung. It combines a pre-clinical stage, a clinical stage and a final practical year (Praktisches Jahr) of 48 weeks, with state examinations (M1, M2 and the oral-practical M3). There are around 40 medical faculties, almost all public, which are state-funded and recognised by the Länder. Teaching is in German, and an English-taught track is rare. Pharmacy takes four years of study plus a practical year, dentistry five years, and nursing is now a generalist three-year vocational training or a degree.

There is no separate internship: after passing the state examinations, doctors apply for the Approbation (licence to practise) from the state authority, then enter specialist training (Weiterbildung) of about five to six years governed by the state medical chambers. This ties graduation directly to licensing, and the Approbation is valid throughout Germany. Doctors trained outside the EU usually take the Kenntnisprüfung (knowledge test) if their degree is not judged equivalent.

What makes Germany different: sixteen states, one national paper

Germany has the largest written medical exam market in Europe, and it is built on a split. The questions for doctors and pharmacists are national and come from one body, the Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP). Everything else, including who may practise, is decided by the Länder. A Landesprüfungsamt in Bavaria and one in Hamburg sit under the same federal rules, but they are separate offices with their own forms, fees and queues.

For a candidate this means two things. If you train in Germany, the exam is predictable: the IMPP publishes blueprints and sample questions, and every student in the country sits the same paper on the same days. If you trained abroad, the exam you face is not a paper at all. It is an oral-practical test with examiners, set locally, and the preparation is very different.

Who needs a licensing exam in Germany

German graduates do not apply for a licence separately. Passing the final state examination is the licence step, and the Approbation follows on application. The table of who sits what looks like this.

• Doctors: locally trained students sit M1 and M2, then M3. Non-EU graduates take either a document-based equivalence check or go straight to the Kenntnisprüfung, and all foreign doctors whose first language is not German pass the Fachsprachprüfung.
• Pharmacists: local students sit the IMPP-set first section and later sections. Non-EU graduates take a Kenntnisprüfung and a Fachsprachprüfung.
• Dentists: local students sit the university-based Zahnärztliche Prüfung. Non-EU dentists take an oral-practical Kenntnisprüfung with practical tasks, plus a language test.
• Nurses, midwives, physiotherapists: local trainees sit a state exam that combines written, oral and practical parts. Non-EU professionals can choose a Kenntnisprüfung or an Anpassungslehrgang (adaptation course) where training differs substantially.

EU and EEA diplomas are recognised under the EU directive on professional qualifications, so the exam question mostly concerns non-EU graduates. They still need to show language competence.

Doctors: M1, M2, M3 and the foreign route

The Ärztliche Prüfung has three parts. M1 comes after the preclinical years and is 320 single-best-answer questions over two days of about four hours each. M2 is the large written exam: 320 questions with five options, spread over three days of about five hours. It sits after the clinical years and before the practical year (PJ). M3 is oral-practical, conducted after the PJ, and is examined in person.

The IMPP publishes the M2 blueprint and sample items on its website. Since 2025 it no longer releases current exam questions for practice, which makes structured question banks more important for German students than they used to be.

Foreign-trained doctors

The path has three separate hurdles, and they are often mixed up.

1. Equivalence of training. The Landesprüfungsamt compares your degree with the German one. Where training is not found equivalent, you are directed to the Kenntnisprüfung. Federal reforms in 2025 to 2026 aim to let candidates go straight to that exam without waiting for the full document comparison.
2. Language. You need general German at B2 and then the Fachsprachprüfung at C1 level, run by the regional medical chamber (Landesärztekammer).
3. Kenntnisprüfung. An oral-practical exam of roughly 60 to 90 minutes, including a patient examination. Internal medicine and surgery are tested, plus one further subject.

The Fachsprachprüfung is not an MCQ. Candidates take a simulated patient interview, write a doctor's letter (Arztbrief) and present a case to a colleague, each about 20 minutes. The format is broadly standard across states, but check your own chamber, for example the Hessen information sheet.

Pharmacists: a written first section, then practice and oral parts

German pharmacy students sit the Erster Abschnitt der Pharmazeutischen Prüfung, the first state examination. It is a written paper of 360 questions with five options, split 100, 100, 80 and 80 over four days. The pass mark is 50 per cent of the questions, or a result within 18 points of the national mean, whichever the rules allow in that sitting. The IMPP publishes sample items and results reports on its pharmacy pages.

Later sections are examined differently, and you should read the current Approbationsordnung rather than rely on a summary. For non-EU graduates, the route is a Kenntnisprüfung covering pharmaceutical practice, law and pharmacology, plus a Fachsprachprüfung organised through the regional Apothekerkammer. General German at B2 is required as well.

Dentists: university-based exams

Dentistry follows the Approbationsordnung für Zahnärzte (ZApprO 2019). The state exam is held at universities and combines written and practical elements. There is no single national MCQ comparable to M2. Foreign dentists take an oral-practical Kenntnisprüfung that includes practical tasks, and a Fachsprachprüfung through the Landeszahnärztekammer. German B2 is required.

Nurses, midwives and physiotherapists

Nursing is now a generalist training under the Pflegeberufegesetz, ending with a state exam of written papers (three times 120 minutes), an oral part and a practical part. Midwifery became a degree programme in 2020, with a state exam inside the dual Bachelor. Physiotherapy graduates sit a state exam made up of written, oral and practical elements.

Non-EU nurses are a large recruitment flow into Germany, with many coming from India, the Philippines and Tunisia. They choose between the Kenntnisprüfung (oral and practical) and the Anpassungslehrgang, and must show German at B2. None of these exams is a national multiple-choice paper, so MCQ practice helps most with the theoretical background rather than with the exam format itself.

Exams at a glance

Language: B2 for everyone, C1 for the clinical professions

German is the language of every exam and every examiner. There is no English-language route for licensing. Foreign nurses, midwives and physiotherapists need B2 general German. Doctors, dentists and pharmacists need B2 and then a professional language test at about C1. Several Länder accept the certificates of recognised providers for the general level, but the Fachsprachprüfung is held by the chamber and cannot be replaced by a certificate.

A practical sequence for a foreign-trained doctor

1. Choose a Land. The authority responsible is the one where you intend to work. Check its forms and current waiting time.
2. Collect and translate documents. Sworn translations of degree, transcripts and certificates are needed.
3. Reach B2 German and book the Fachsprachprüfung.
4. Apply for the Berufserlaubnis if you want to work under supervision while the main file is processed.
5. Prepare and sit the Kenntnisprüfung if your training is not found equivalent.
6. Receive the Approbation.

How to use this page

If you are a German medical student, begin with the M2 blueprint and work through the subject weights. If you are a foreign-trained doctor, spend most of your time on case-based oral practice and on medical German. Everything on this page is a summary of public sources. The recognition portal Anerkennung in Deutschland and your Land's authority give the binding rules, and TriagePass is not affiliated with the IMPP or any regulator.

Last reviewed October 2026