The knowledge examination is a state professional examination for internationally trained healthcare professionals. Until now, it was mandatory when the competent authority had not recognized the foreign qualification as equivalent to the German one. With the reform of recognition law taking effect on November 1, 2026, the knowledge examination becomes the standard pathway for professionals with qualifications from third countries – regardless of the outcome of the equivalency assessment. This article explains how the path to the exam appointment works, what documents must be submitted, what the exam costs, and what applies if it is not passed.

Target group

The knowledge exam applies to all international healthcare professionals with qualifications from third countries, that is, outside the EU, the EEA, and Switzerland. For professionals with EU or EEA qualifications, the knowledge exam remains limited to cases where the authority has identified significant differences from the German training. Registration takes place by submitting an application form to the competent state authority.

Prerequisite: passing the professional language exam

In most federal states, passing the professional language exam is a prerequisite for registering for the knowledge exam. For nursing professionals, a language certificate at B2 level or a nursing-specific professional language exam is generally sufficient. The exact requirements vary by federal state. Detailed information on the professional language exam can be found here.

Responsible bodies by profession

The knowledge exam is administered, depending on the profession and federal state, by the competent recognition authority or an examination body appointed by it. This may include state examination offices, universities, university hospitals, or professional chambers.
In many federal states, contact with the chamber is handled through the recognition authority. In some states, direct contact with the chamber is also possible. This should be clarified on a case-by-case basis with the relevant authority. For nursing professionals, no chambers are involved. The state authorities or state examination offices are directly responsible and organize and administer the entire exam process.
Since responsibility for the exam process lies with the individual federal states, registration procedures, appointment scheduling, and fee amounts can vary. Binding information is available directly from the competent recognition authority or the relevant chamber.

From the recognition certificate to the exam appointment

Those who have received their recognition certificate indicating that a knowledge examination is required do not need to submit a new application. The authority initiates registration as part of the ongoing recognition process. Once the professional language exam has been passed and all required documents are complete, the authority submits the registration to the competent chamber; for nursing professionals this step does not apply, as registration is handled directly through the authority. The competent chamber is informed by the authority of the passed professional language exam result. The professional does not need to forward the result themselves.
The chamber then makes contact by email. Once the exam fee has been received, an appointment is assigned and confirmed in writing. A specific exam date cannot be guaranteed. A preferred time period indicated by the applicant is taken into account as far as available capacity allows.
From the point of referral by the authority to the actual exam appointment, one to six months typically pass in practice. The exact waiting time depends heavily on the federal state and the current workload of the chamber. This time can be used productively for subject-specific preparation. Those who are able to indicate a preferred time period should realistically assess when they will genuinely be ready for the exam, since a confirmed appointment in many federal states cannot simply be rescheduled but can only be canceled.

Canceling an appointment

Whether and under what conditions a confirmed appointment can be canceled varies by federal state. As a rule, free cancellation is possible up to a certain point before the exam. For last-minute cancellations without an accepted reason, the fee may be forfeited and must be paid again for a new appointment.

Required documents

After initial contact from the chamber, the following documents are generally required: the exam fee by bank transfer, a current CV, and a signed data protection declaration, which is usually sent with the chamber's first email. Where provided for by the competent authority, applicants are also asked to indicate a preferred time period for the exam. The exact requirements may vary slightly by federal state and chamber.

Exam fees

Exam fees vary by profession and federal state. Costs of approximately 300 to 2,000 euros should generally be expected (as of 2026). The fee must usually be paid by bank transfer before an appointment is assigned. Cash payment is not possible. For nursing professionals, fees are set directly by the competent state authority and may differ from the amounts above. Binding information is available from the relevant recognition authority. Those already living in Germany may be able to apply for financial support under certain conditions through the Federal Employment Agency or the Jobcenter, for example via an education voucher for a preparation course for the knowledge examination. Whether the exam fee itself is also covered depends on the individual case and should be clarified in advance with the relevant authority.

Exam result

Depending on the federal state and examination body, the result of the knowledge examination is either communicated verbally immediately after the exam or announced once the assessment process has been completed. The examination documents are then forwarded to the competent recognition authority, from which the professional receives the official written notification of the result along with information on the next steps. Depending on the federal state, this can take anywhere from a few days to several weeks. No grade is given. The exam is assessed as passed or not passed. Those who pass the knowledge examination and meet all further legal requirements will subsequently receive the Approbation.

Retaking the exam after a failed attempt

The knowledge exam can be retaken a total of twice, meaning a maximum of three attempts are available nationwide. Switching federal states does not change this. If the exam is not passed, the examination board generally recommends the earliest point at which a retake would be advisable and provides guidance on further preparation.
Those who do not pass have the right to request the exam report. It documents the course of the exam and the weaknesses identified, and can be requested in writing from the competent authority or chamber. The report is a valuable basis for tailoring preparation for the next attempt.
Each new attempt requires a new registration and payment of the exam fee. Those who do not pass all three attempts cannot in principle receive the Approbation. Exceptions are subject to a case-by-case decision by the competent authority.