Applications that are filed from 1 November 2026, the Kenntnisprüfung is the default route to Approbation for doctors trained outside the EU, EEA, and Switzerland. That includes an Indian MBBS. You can ask for a document-based Gleichwertigkeitsprüfung (equivalence check) instead, but you get only four weeks after you apply. Applications filed by 31 October 2026 stay under the old rules. The exam takes one day. Each candidate gets about 60 to 90 minutes in front of a panel. Passing it does not replace the German language, health, and reliability checks that every applicant still faces. The change aims to speed up recognition and cut paperwork. Confirm your route with your state authority before you act.
What changed on 1 November 2026
The Act of 22 July 2026 flipped the order of the process. Until 31 October, the authority compared your training with German medical school on paper, and the exam came only if it found big gaps. Now the exam comes first.
| Topic | Until 31 Oct 2026 | From 1 Nov 2026 |
|---|---|---|
| Default route | Paper check first, exam only after substantial differences | Direct Kenntnisprüfung |
| Gleichwertigkeitsprüfung | Standard first step | Opt-in, within 4 weeks of applying |
| Curriculum and hours papers | Needed for the comparison | Not needed on the direct route |
| Legal nature of the exam | Fills gaps found on paper | Licensing exam, same bar for everyone |
| Exam name | Kenntnisprüfung | Still Kenntnisprüfung |
Does this apply to an Indian MBBS?
Yes. India sits outside the EU, EEA, and Switzerland, so your MBBS counts as a third-country qualification. Germany looks at the country where you earned your degree. Your passport does not matter. An Indian citizen with an MBBS from an EU country follows the EU route instead.
Under the old process, you had to gather curricula and subject-hour records from your Indian university. Anyone who has chased a registrar for stamped transcripts knows how long that can take. On the direct route, you skip those papers unless you choose equivalence.
Dentists and pharmacists with third-country degrees follow the same default, according to the health ministry. This guide covers doctors only.
Direct exam or equivalence check: how to decide
You make one choice in the first month after you file. Do nothing and you head to the exam. Ask for the equivalence check and the authority compares your file with German training.
| Factor | Direct exam (default) | Equivalence check (opt-in) |
|---|---|---|
| Deadline | Nothing to elect | Elect within 4 weeks of applying |
| Paperwork | Core credentials only | Adds curriculum and hours evidence |
| Outcome | Pass the exam | Full recognition, or the exam if big gaps show |
| Changing your mind | Not applicable | Treat the choice as final |
Points to weigh
The exam can still catch you
If the authority finds significant differences, you sit the exam anyway. The same applies when you cannot produce documents for reasons outside your control.
Gaps are likely for Indian graduates
A DAAD page places the Indian MBBS at roughly the middle of German clinical studies. For many applicants, the direct exam avoids a long paper chase. Treat this as a judgment call, not a rule.
Equivalence can fit well-documented files
If you hold complete, stamped curricula and hour records, and your training looks close to German medical school, the paper route may work.
Ask in writing
Request that the authority explain both options before the four weeks end, and keep the reply. Sources describe the choice as binding for the whole procedure, so move with care.
Applied before 1 November 2026? Which rules apply
§ 15 BÄO sets the cut-off. If you filed to have a third-country qualification recognized by the end of 31 October 2026, the old § 3 BÄO rules still apply to you. Under them, the authority checks equivalence first. The exam follows only if it finds considerable differences, which the authority lists in a Defizitbescheid (deficiency notice).
| Situation | Rules that apply |
|---|---|
| Recognition application filed by 31 Oct 2026 | Old rules, equivalence check first |
| Application filed from 1 Nov 2026 | New rules, direct exam by default |
| Berufserlaubnis holder with no Approbation application yet | Unclear in the text I checked. Get written confirmation |
Say you sent your file on 28 October. The old recognition rules still cover it, whatever month your exam falls in.
Berufserlaubnis cases deserve extra care. Many doctors start work on a Berufserlaubnis and file for Approbation later. The law speaks of applications for recognition, so the safe move is to ask.
Keep proof of the date your authority received your file. A receipt or confirmation email works. Do not withdraw and refile unless the authority tells you to in writing. If you can, write in German: “Bitte bestätigen Sie, dass auf meinen Antrag vom [Datum] die bisherige Rechtslage gilt.”
What the exam involves
The Kenntnisprüfung is an oral-practical exam built around a Patientenvorstellung (patient presentation). You present a case to a panel and answer questions about it.
| Element | Detail |
|---|---|
| Format | Oral-practical, with a patient presentation |
| Duration | About 60 to 90 minutes per candidate, on one day |
| Panel | Three examiners, with up to four candidates per session |
| Subjects | Internal medicine and surgery, plus emergency medicine, clinical pharmacology, imaging, radiation protection, and legal questions |
| Communication | Assessed, including how you talk with patients |
| Language | German |
| Attempts | Three in total, which means two retakes |
| Frequency | Offered at least twice a year |
Examiners grade your whole performance, not each subject alone. Practice your case out loud in German until the flow feels natural. States must offer the exam at least twice a year, so a failed attempt can mean a wait for the next session.
Germany amended the Approbationsordnung für Ärzte (ÄApprO) alongside the Act, and the § 37 text I could reach shows earlier wording. Trust your summons for exact timings.
What has not changed
The exam proves your medical knowledge. Approbation needs more than that.
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Reliability. You still show a clean police record. Your authority lists which countries it wants certificates from.
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Health. You still hand in a medical fitness certificate.
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German language. Most applicants need general German around B2, then the Fachsprachprüfung, a medical-language exam at about C1 level. Your state sets the exact level and the order. The exam itself runs in German, so language work comes first for most people.
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Berufserlaubnis. This permission lets you work under limits. It is a separate permit under § 10 BÄO, and it is not an Approbation.
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EU, EEA, and Swiss degrees. They follow § 9c BÄO, a different route.
Next steps for Indian applicants
- 1
Confirm your filing date and route. Check whether your application reached the authority by 31 October 2026. Without that date, you cannot tell which rules apply.
- 2
Find your authority. Use the official Anerkennung in Deutschland portal to identify the competent Approbationsbehörde for your state.
- 3
Decide on equivalence within four weeks. Record the time at which the clock turned on, include the date also.
- 4
Gather data for each condition. Collect evidence of your qualification and qualification to practice in India. That is your State Medical Council or NMC registration. Add a police clearance certificate, a health certificate, and language proof. Some certificates lose validity after a few months, so ask about age limits before you order. Your authority's checklist is the final word.
- 5
Prepare in German. Practice case presentations and patient conversations aloud. A study partner who plays the patient helps a lot.
- 4
Ask about timing in writing. Waits vary by state, so request the expected exam window and keep the answer. Never plan a job start around a date you have not received.
