Swiss federal medical exam: what is tested

Two exams. Seven faculties. One national blueprint. The Eidgenössische Prüfung Humanmedizin (Swiss federal examination in Human Medicine) combines a written test of clinical knowledge (Clinical Knowledge, CK) and a structured practical test (Clinical Skills, CS) in the OSCE format. In 2026 the design documented by BAG and MEBEKO keeps 240 multiple-choice questions in two parts of 120 items and a circuit of eleven stations with simulated people.

NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.

This text explains what the federal exam requires, how CK and CS test clinical reasoning in different ways, the role of the PROFILES catalogue and how to train without treating Switzerland as "just another European MCQ". Anyone who has read the series on M2 Staatsexamen, French ECOS, AMC Clinical or Revalida second stage will recognize the pieces; the Swiss rule is its own: pass both unit exams, with no compensating CK with CS.

Key points

• The federal exam is coordinated nationally and applied uniformly at the seven faculties (Basel, Bern, Freiburg, Genf, Lausanne, Lugano, Zürich), with the same content and at the same time (Informationen 2026; Vorgaben MEBEKO 2026).
• CK: two parts of 120 MCQs (3 h 15 min each), 240 in total; types A, Kprim and Long Menu; item sequences; tablets on site (Informationen).
• CS: OSCE with 11 stations and at least one break; in at least ten stations there is a simulated person (SP); an example station lasts 13 minutes (Vorgaben; Informationen).
• The blueprint relies on the PROFILES objectives catalogue. The federal exam is passed only if both CK and CS are passed; there is no compensation between them. The failed unit can be retaken (limits in the official document).
• Languages: CK in German, French or Italian; CS generally in the language of the site (with rules for Fribourg and Lugano). Confirm the cycle at BAG.

What the Swiss federal exam is

The Eidgenössische Prüfung Humanmedizin verifies whether the candidate has the knowledge, skills, behaviours and social competence needed to practise the corresponding medical profession and meets the prerequisites for continuing education (Informationen 2026). It is not a foreign residency competition: it is the Swiss federal licensing exam under MedBG and the Prüfungsverordnung.

Two unit exams

1. CK (Clinical Knowledge): an interdisciplinary written multiple-choice exam.
2. CS (Clinical Skills): a structured practical exam in the OSCE model.

The federal exam is passed only when both are passed. Scores are not compensated between CK and CS. If failed, the unit not passed is retaken, within the attempt limits of the official document (Informationen).

Where it fits in Miller's pyramid

CK sits at the "knows how" level: application in written cases. CS rises to "shows how": observed performance with a simulated person, history taking, examination and management (Miller, 1990). It is the same family as the German M2 on the written axis and the ECOS / AMC Clinical on the practical axis, with the Swiss rule of joint passing.

Who does what

The faculties write items and stations; a national review board reviews content, level and relevance; the Prüfungskommission Humanmedizin sets the pass limits; the IML and MEBEKO (Ressort Ausbildung) take part in coordination and in the annual Vorgaben published at BAG. The candidate reads the PDF for the year, not last year's class summary.

CK: 240 items and question types

Format

Two parts of 120 questions, each lasting 3 hours and 15 minutes, on tablets provided on site. The total relevant for passing is performance across the parts together; details of scoring and Kprim (for example, three correct sub-items worth half a point) are in the Vorgaben (Vorgaben MEBEKO 2026).

Types that change the reasoning

The official material gives examples:

• Type A (Einfachwahl): one best answer among alternatives (most likely diagnosis, next step).
• Type Kprim: four true/false statements; the key is the pattern (+-+- etc.), not "a single letter".
• Long Menu: the answer is chosen from a long searchable list, not from four visible options.
• Sequences: two or more items about the same case (for example, most likely cause and appropriate treatment).

Each type punishes a different mistake. In Type A, the classic distractor. In Kprim, marking "all true" out of haste. In Long Menu, typing the wrong term or choosing the near synonym. In the sequence, getting the first right and the management wrong, or the other way around.

Scoring and threshold (candidate's view)

The commission sets the CK pass threshold with difficulty calibration. The candidate does not control the cutoff score; the candidate controls the sampling of their own study. Kprim with partial scoring (three correct subitems worth half a point, per the Vorgaben) changes the strategy: guessing the whole pattern without reading each line is costly. Long Menu changes another thing: the long list reduces guessing by visual recognition of the four letters.

Dates of the CK parts in the 2026 cycle appear in the Vorgaben (documented example: parts in August). Always confirm the PDF for your year; the calendar changes.

Relation to other written exams in the series

Anyone who has trained for the M2 Staatsexamen recognizes the long clinical MCQ. Switzerland adds Kprim and Long Menu explicitly in the official examples. Anyone coming from ENARM or MIR needs to add these formats to the mock exam, not just "more of the same Type A".

Example of the logic (not an official training item to memorize)

The BAG PDFs show vignettes of subacute thyroiditis, otitis with a surgical indication, post-fracture compartment syndrome and community-acquired pneumonia in Long Menu. The common move is: discordant data + best label or best action. Training by copying the example word for word helps little; training the move helps a lot.

CS: an OSCE with eleven stations

Structure

A circuit with 11 stations and at least one rest station. In at least ten stations with a task, a trained simulated person (SP) plays the role of patient. Phantoms, models, cards, photo, video or audio may be used when the finding cannot be simulated. Intimate examinations and corneal reflex/nausea are not performed on the SP: the candidate states the intention to the examiner when the task requires it (Informationen; Vorgaben).

Time and typical task

The official example of a station in a general practice office lasts 13 minutes: problem-oriented history, oriented clinical examination, further investigation and discussion of management with the patient. The assessment covers relevant history information, correct examination, management and communication (emotions, structure, verbal and non-verbal expression).

What the examiner does

As a rule, observes and scores. Findings that cannot be simulated may be presented by card, image or audio. In some stations, test results are released during the consultation. Hygiene and the SP's comfort are part of the expected behavior. The BAG also publishes a video for candidates and updated hygiene rules on the same exam page: check them before the day of the CS.

Station set and fairness

The same set of 11 stations runs at the sites on the same day; the set changes from one exam day to another. The idea is fairness across sites and difficulty control across days, with threshold procedures described in the Vorgaben. For the candidate, the implication is simple: memorizing "yesterday's station" from a colleague on another day does not help; the method does (oriented history, targeted examination, spoken plan, communication).

What the CS is not

It is not a test of a real invasive procedure. It is not free theater without a checklist. It is not an intimate examination on an SP. It is a sampling of consultations and clinical tasks under observation, with explicit hygiene and respect. Anyone who trains only "elegant speech" without a targeted examination fails in the same place as someone who trains only the maneuver without talking to the patient.

Link to other OSCEs in the NEXO series

Compare the time and the role of the SP with the French ECOS, the AMC Clinical and the second stage of Revalida. The "show how" move looks similar; the PROFILES blueprint, the number of stations and the rule of passing together with the CK are Swiss.

Passing the CS

Limit set by the commission, with a borderline procedure described in the Vorgaben. All stations carry the same weight in the overall design; criteria within a station may weigh differently. Communication with the SP uses a common scale in stations with an SP.

PROFILES and the blueprint

The PROFILES catalog of learning objectives (Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland) grounds the content of the federal exam within the framework of the Prüfungsverordnung MedBG. The overall blueprint relies on PROFILES, with main and secondary dimensions and sampling across the catalog categories (Vorgaben; PROFILES).

For clinical reasoning, this matters because the exam is not "tertiary hospital internal medicine only": it samples situations, competencies and contexts aligned with the profile of the Swiss generalist physician in training. Studying only by foreign residency specialty without looking at PROFILES misaligns the training.

PROFILES organizes objectives along axes that include professional roles and clinical situations, not just lists of diseases. In preparation, this becomes a study question: "which PROFILES situation does this case fit?" and "which competency am I showing in the station?". Without that anchor, training becomes an accumulation of forum tips. With it, CK and CS come to sample the same profile through different methods, which again explains the rule of passing both units.

Languages and locations

CK can be taken in German, French or Italian. CS generally follows the language of the location: Bern, Basel and Zürich in German; Geneva and Lausanne in French; Lugano in Italian or German; Fribourg in German or French, according to the cycle registration rules (Vorgaben). Training clinical vocabulary in the language of the exam is part of the reasoning: the stem only helps those who read it precisely.

How clinical reasoning appears

In CK

• Hypothesis selection: Type A and Long Menu ask for the most likely label or the most appropriate action.
• Statement judgment: Kprim requires evaluating each line; one sign error brings down the pattern.
• Chaining: sequences demand cause and management in the same case, the same muscle of "not abandoning the thread".
• Finding integration: an image or lab value in the stem forces reconciliation of discrepancies (e.g., good saturation with high inflammation).

In CS

• Focused history: it is not an endless checklist; it is information that changes the exam and the plan.
• Focused examination: handle with hygiene and respect for the SP; verbalize what you do not perform.
• Shared management: explain the suspicion and the next step in clear language.
• Scored communication: explicit scale; empathy and structure are not "extra".

Summary table

Item	CK 2026	CS 2026
Format	2×120 MCQ (3 h 15 each)	OSCE 11 stations (+ break)
Types / task	A, Kprim, Long Menu, sequences	History, examination, management with SP
Support	Tablets	SP ≥10 stations; phantoms/media
Pass	National commission limit	National limit; borderline
Relationship between exams	No compensation with CS	No compensation with CK
Content base	Blueprint / PROFILES	Blueprint / PROFILES

What the studies say

OSCE and MCQ sample different competencies. Harden and colleagues described the OSCE as a way of sampling clinical skills in a structured manner (Harden et al., 1975). Miller separated knowing, knowing how, showing how and doing (Miller, 1990). Van der Vleuten and Schuwirth argue for a combination of methods and broad sampling (van der Vleuten and Schuwirth, 2005). Key features explain why the decision at the case node discriminates better than the encyclopedic question (Page and Bordage, 1995; Bordage and Page, 2018).

The practical reading for Switzerland: CK without CS (or the reverse) leaves one of Miller's steps without evidence. That is why the joint pass rule is not empty bureaucracy: it is coherence with what the exam says it measures.

How to train for CK and CS

For CK

1. Practice Type A with a full stem and active elimination of distractors.
2. Practice Kprim line by line; resist "all true".
3. Practice Long Menu by typing terms and dealing with near synonyms.
4. Do sequences: close the case thread through to management.
5. Simulate long blocks (three hours) in the language of the exam.

For CS

1. Rehearsals with an SP or a colleague with a 13-minute timer.
2. Focused history: three hypotheses, targeted examination, spoken plan.
3. Hygiene and comfort routine for the SP from the first rehearsal.
4. Verbalize intimate exams / forbidden reflexes when the task calls for it.
5. Record the communication: structure, empathy, language without unnecessary jargon.

Preparation checklist

• [ ] I read the Informationen and Vorgaben for the year on the BAG
• [ ] I know I need to pass CK and CS without compensation
• [ ] I trained A, Kprim, Long Menu and sequences
• [ ] I did at least one mock of a CK part (3 h 15)
• [ ] I rehearsed stations of ~13 min with communication feedback
• [ ] I confirmed the language and location of the CS
• [ ] I reviewed the PROFILES in the blueprint categories
• [ ] I set up a separate notebook for CK errors vs CS errors

Four-week plan (example of a method, not an official schedule)

Week 1: map the PROFILES and CK item types; one Type A block + one Kprim block in the exam language. Week 2: Long Menu and sequences; first filmed 13-minute CS rehearsal. Week 3: mock of one CK part (3 h 15); three CS stations in sequence with a break. Week 4: second CK mock; CS focused on communication and hygiene; review only the classified errors.

Adjust it to your real calendar. The point is to separate units: someone who only does MCQs in the last week arrives at the CS without consultation automatism.

Error notebook on two pages

CK page: item type (A / Kprim / Long Menu / sequence), decisive data missed, distractor chosen. CS page: station (history / exam / plan / communication), time overrun, hygiene item forgotten. Mixing the two pages into a single list by "organ theme" hides whether the problem is format or content.

CS day: mental script

Before entering the station: read the task to the end, define the two or three most likely hypotheses, decide what needs to be asked and what needs to be examined. In the first minutes: introduction, SP comfort, hygiene. In the middle: targeted history and exam, without an endless checklist. In the final minutes: summary out loud, next step, what the patient should watch for, when to return. If time runs short, verbalize what you would do next; silence scores nothing.

This script is not an official BAG protocol: it is a rehearsal method. The official document describes what is assessed; the candidate decides how to train the sample.

After the unit exam

If you fail only CK or only CS, the focus of the second attempt is the unit you lost, not "redoing everything out of anxiety". The report and review rules are in the Vorgaben; use the official feedback when available. Avoid switching language on the second attempt without reason: the cognitive cost of changing the language of the stem or the consultation is high.

Frequent errors

• Treating Kprim as a single-letter Type A.
• Studying only MCQs and arriving at the CS without a timed rehearsal.
• History checklist without a hypothesis (loses time and management points).
• Ignoring the communication scale.
• Using material from another country without checking the Long Menu and Kprim types.

How NEXO helps you train

In researcher mode, you explore hypotheses more calmly; in closer, you practice closing under pressure; the curator and the creators area help you review what you have already seen. Usage limits are in /economy. There is no claim that NEXO raises your score on the federal exam: the product offers deliberate practice of reasoning under a case.

Useful links: /researcher, /closer, /curator, /creators. For clues and the differentiator, see differential diagnosis with clues and case-based learning. On the European practical axis, also compare with the ECOS and the M2.

After each written training block, compare what the stem asked for (diagnosis, next step, risk) with what you answered first. If the error was in reading, mark the stem; if it was in priority, mark the order of the hypotheses; if it was in communication at the station, mark the moment when the plan came out vague. This short record keeps you from repeating the same type of failure the following week and keeps the CS rehearsal and the CK notebook in the same review method.

Frequently asked questions

Do I need to pass CK and CS on the same day?

They are unit exams with their own schedule in the cycle; passing the federal exam requires both. Confirm dates and locations in the year's BAG.

Can I compensate for a weak CK with a strong CS?

No. The official document states that there is no compensation between CK and CS.

How many stations does the CS have?

Eleven stations along the route, with at least one break; SP in at least ten stations with a task.

What is Kprim?

A format with four true/false decisions about the same statement; scoring looks at the pattern of answers, with partial-credit rules in the Vorgaben.

In what language do I take the exam?

CK: German, French or Italian. CS: generally the language of the location, with documented exceptions (Fribourg, Lugano). Choose at registration. At registration, also confirm withdrawal deadlines and absence rules: missing without a valid justification has consequences described in the cycle's Vorgaben.

Is PROFILES a study bibliography?

It is the catalog of objectives that underpins the blueprint. Use it to map competencies; it does not replace cases and timed stations.

How does NEXO fit into preparation?

As practice in reasoning from clues, complementary to CK and CS rehearsals. With no promise of a score.

Final checklist

• [ ] PDFs of my year's BAG read
• [ ] The rule is clear: pass CK and CS
• [ ] Types A, Kprim, Long Menu and sequences practiced
• [ ] Long CK mock exam done
• [ ] CS stations rehearsed with a clock
• [ ] Language and location confirmed
• [ ] PROFILES consulted
• [ ] Errors separated by individual exam

Play the case of the day

Open the case of the day and practice putting the clues together before you commit. Then return to the Swiss MCQ or the station rehearsal with the same discipline: decisive data, explicit hypothesis, next step spoken aloud.

References

1. BAG / Prüfungskommission Humanmedizin. Informationen über die eidgenössische Prüfung Humanmedizin 2026. [bag.admin.ch](https://www.bag.admin.ch/de/eidgenoessische-pruefung-in-humanmedizin).
2. MEBEKO Ressort Ausbildung. Vorgaben betreffend Inhalt, Form, Zeitpunkt sowie Aus- und Bewertung der eidgenössischen Prüfung in Humanmedizin (valid for 2026). [bag.admin.ch](https://www.bag.admin.ch/de/eidgenoessische-pruefung-in-humanmedizin).
3. Swiss Confederation. Prüfungsverordnung MedBG (SR 811.113.3). Legal basis cited in the Vorgaben.
4. PROFILES. Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland. [profilesmed.ch](https://www.profilesmed.ch/).
5. BAG. Page for the federal examination in Human Medicine (materials and updates). [bag.admin.ch](https://www.bag.admin.ch/de/eidgenoessische-pruefung-in-humanmedizin).
6. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990. [PubMed](https://pubmed.ncbi.nlm.nih.gov/2400509/).
7. Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975. [PubMed](https://pubmed.ncbi.nlm.nih.gov/1119258/).
8. Page G, Bordage G. The Medical Council of Canada's key features project. Acad Med. 1995. [PubMed](https://pubmed.ncbi.nlm.nih.gov/7748379/).
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11. Norman GR, Eva KW. Diagnostic error and clinical reasoning. Med Educ. 2010. [PubMed](https://pubmed.ncbi.nlm.nih.gov/20051831/).
12. van der Vleuten CPM, Schuwirth LWT. Assessing professional competence. Med Educ. 2005. [PubMed](https://pubmed.ncbi.nlm.nih.gov/16147794/).
13. Epstein RM. Assessment in medical education. N Engl J Med. 2007. [PubMed](https://pubmed.ncbi.nlm.nih.gov/17215531/).
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