Medical Exams in Germany, Austria and Switzerland: Structure and an Evidence-Based Study Guide

If you're studying medicine in Germany, Austria or Switzerland, or you've moved here from abroad, the path to a licence can look like a maze of German terms: Physikum, Famulatur, PJ, KPJ, Eidgenössische Prüfung. This guide explains what each country actually requires, drawing on the legal texts and university documents. It then sets out the study methods with the strongest evidence for long-term retention.

Germany: what the licensing regulations require

The framework is the Approbationsordnung für Ärzte (ÄApprO) of 2002, the federal licensing regulations for doctors. Medical school lasts six years and 5,500 hours, including a 48-week practical year. On top of that come first-aid training, three months of nursing service (Krankenpflegedienst), four months of clinical clerkships (Famulatur) and a state examination in three parts. The standard period of study is six years and three months.

The three parts of the state exam

The written questions come from the IMPP (Institut für medizinische und pharmazeutische Prüfungsfragen), the national exam institute. M3 covers patient-centred questions in internal medicine, surgery and whichever field you chose for your elective rotation. It explicitly tests history-taking, clinical examination and communication.

Famulatur: four one-month clerkships

Under section 7 of the ÄApprO, the four months of Famulatur are done during non-teaching periods between passing M1 and sitting M2. They're split into four one-month blocks:

1. an outpatient facility under medical direction, or a suitable practice,
2. a hospital or inpatient rehabilitation unit,
3. a general practice / primary care setting,
4. a free choice among these or another suitable setting, including public health services.

Clerkships done abroad in an outpatient facility or hospital can be recognised.

The practical year (PJ): three rotations of 16 weeks

The Praktisches Jahr starts after M2, in the second half of May or November, and has three 16-week rotations (Tertiale):

• internal medicine,
• surgery,
• general practice or another clinical specialty (elective).

The PJ can be done part-time at 50% or 75% of weekly hours, with the total duration extended to match. Each university sets out the content in a logbook.

Reform: status as of October 2026

A new set of licensing regulations based on the Masterplan Medizinstudium 2020 has been in preparation for years. Among other things, it would make the national competency-based learning objectives catalogue (NKLM) binding and give general practice a bigger role. In May 2026 the Deutsches Ärzteblatt reported that a draft is ready but stalled because federal and state governments haven't agreed on funding. Health Minister Nina Warken said the government still intends to reform medical education in this legislative period.

Separately, the Federal Ministry of Health published a draft ordinance in 2026 changing PJ rules. It would allow up to ten additional certified sick days and remove the cap that limits PJ allowances to the maximum BAföG student grant. At the time of writing that draft wasn't yet in force.

In practice: the 2002 ÄApprO, as amended, still applies. Check with your state examination office (Landesprüfungsamt) before making plans that depend on the rules.

Austria: the Clinical-Practical Year (KPJ)

In Austria medicine is a single-cycle Diplomstudium. The equivalent of the German PJ is the Klinisch-Praktisches Jahr (KPJ). At the Medical University of Vienna it takes place in year six and lasts 48 weeks, split into three 16-week rotations:

• Rotation A: internal medicine,
• Rotation B: surgical and perioperative specialties,
• Rotation C: electives (one subject for 16 weeks or two for 8 weeks each; general practice for 8 or 16 weeks).

Vienna's KPJ documents stress that observing alone isn't enough. Students learn by caring for patients under supervision on wards, in outpatient clinics or in teaching practices. Each university sets its own curriculum, so Graz, Innsbruck and Linz may differ in the details.

Switzerland: the Federal Examination in Human Medicine

Swiss medical school ends with the Eidgenössische Prüfung Humanmedizin, which has two parts:

• a written, interdisciplinary multiple-choice exam, split into two sub-exams,
• a nationally standardised practical Clinical Skills (CS) exam run as an OSCE.

It's overseen by the Federal Office of Public Health (FOPH/BAG) through the Medical Professions Commission (MEBEKO), Education Section. Swiss faculties work to the national learning-objectives framework PROFILES.

Studying with evidence: what actually works

The exams differ, but memory works the same way everywhere. Dunlosky and colleagues reviewed ten popular learning techniques. Only practice testing and distributed practice earned a "high utility" rating. Highlighting, summarising and rereading, the methods students use most, were rated "low utility".

1. Retrieve, don't reread (the testing effect)

In a classic experiment, Roediger and Karpicke had students either reread prose passages or take recall tests on them. At five minutes, rereading looked better. At two days and one week, the tested group remembered substantially more, even though the rereaders felt more confident.

It holds in medicine too. In a randomised trial of paediatric and emergency medicine residents, repeated short-answer tests with feedback produced 39% correct answers after more than six months, against 26% after repeated study of review sheets.

How to apply it:

• Start doing past-paper and question-bank questions early and regularly, not just in the last weeks before M2.
• Use free recall ("list the CRB-65 criteria") as well as multiple choice. Effortful recall builds stronger memory than recognition.
• Read the explanation after every wrong answer. Feedback is what makes testing work.

2. Space it out

A meta-analysis of 839 comparisons from 317 experiments found that spaced study beats massed study. The longer you need to retain something, the longer the gaps between reviews should be. With M2's huge syllabus, build review cycles in from day one. Flashcard software with a spaced-repetition algorithm does this for you.

3. Interleave and explain

Dunlosky's group rated interleaving different problem types, self-explanation and elaborative interrogation (asking yourself "why?") as "moderate utility". For case-based exams this makes sense. Questions don't arrive labelled "cardiology", and telling differential diagnoses apart is exactly what's being tested.

4. Use guidelines as references, not reading lists

On the PJ and in M3, what counts is whether your management matches current standards. Don't read guidelines cover to cover. Use them in a targeted way:

• the AWMF register for German S3 and S2k guidelines and the national care guidelines (NVL),
• ESC, ERS, ESCMID and other European societies for cardiology, respiratory medicine and infectious diseases,
• summary tables of recommendations as study material for exam cases.

A good M3 drill is to present a patient from your rotation and justify every decision with the relevant guideline recommendation. Scores such as CHA₂DS₂-VA, the Wells score for pulmonary embolism and the Glasgow Coma Scale come up often, so practise them on real cases. See all our clinical calculators.

5. Make clerkships and the PJ count

• Keep a case log: one case a day with the presenting complaint, differentials and the guideline that applies. It makes M3 revision far easier.
• Practise presenting: the structured patient presentation is part of M3, and the more you do it on ward rounds, the calmer you'll be in the exam.
• Know the learning objectives: in Germany the NKLM describes what's expected at graduation. In Austria the KPJ follows the national competency-level catalogue for clinical skills, and in Switzerland faculties follow PROFILES.

A realistic plan for M2

Bottom line

Germany's requirements are set out clearly in the ÄApprO, even with reform still pending. Austria and Switzerland have their own structures. For studying itself, the evidence points the same way in all three countries: test yourself early and often, spread your reviews, mix question types and explain each answer to yourself. Guidelines are the reference shelf, not bedtime reading.

When a clinical question comes up while you're doing questions or on the PJ, Medelix can give you an answer with citations to guidelines and literature. Open the original source yourself before relying on it.

Sources

1. Approbationsordnung für Ärzte (ÄApprO), sections 1, 3, 7, 22, 23, 28, 30 (in German). gesetze-im-internet.de
2. Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP). impp.de
3. Deutsches Ärzteblatt. Medizinstudierende hoffen auf Reform des Studiums (13 May 2026, in German). aerzteblatt.de
4. Deutsches Ärzteblatt. Medizinstudium: Verbesserungen im Praktischen Jahr (issue 12/2026, in German). aerzteblatt.de
5. Medical University of Vienna. Mitteilungsblatt 2015/16, no. 34: Klinisch-Praktisches Jahr (in German). PDF
6. Medical University of Vienna. KPJ training plan, Rotation B, surgical specialties (2025, in German). PDF
7. Federal Office of Public Health (BAG). Eidgenössische Prüfung in Humanmedizin (in German). bag.admin.ch
8. SMIFK-CIMS. PROFILES 2023. smifk-cims.ch
9. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving Students' Learning With Effective Learning Techniques. Psychol Sci Public Interest. 2013;14:4–58. doi:10.1177/1529100612453266
10. Roediger HL, Karpicke JD. Test-enhanced learning: taking memory tests improves long-term retention. Psychol Sci. 2006;17:249–255. doi:10.1111/j.1467-9280.2006.01693.x
11. Larsen DP, Butler AC, Roediger HL. Test-enhanced learning in medical education. Med Educ. 2008;42:959–966. doi:10.1111/j.1365-2923.2008.03124.x
12. Larsen DP, Butler AC, Roediger HL. Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial. Med Educ. 2009;43:1174–1181. doi:10.1111/j.1365-2923.2009.03518.x
13. Cepeda NJ, Pashler H, Vul E, Wixted JT, Rohrer D. Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychol Bull. 2006;132:354–380. doi:10.1037/0033-2909.132.3.354
14. AWMF guideline register (in German). register.awmf.org