BIG-toets 2026: New Updates, Requirements, and Tips - Work in the Netherlands

BIG-toets language test 2026: what has changed and why it matters

If you are an internationally trained healthcare professional preparing for BIG registration in the Netherlands, 2026 marks an important turning point. The BIG Language Test has been substantially updated by the Dutch Ministry of Health, Welfare and Sport (VWS), with a stronger focus on real clinical communication, documentation quality and patient safety.

This page is an update to our earlier BIG language guidance. It focuses exclusively on what is new in 2026, how these changes affect you in practice, and what we see working best with healthcare professionals preparing for the exam today.

In this update you’ll learn:

• What changed in the BIG-toets language test in 2026
• Other important BIG-related updates in 2026
• What level of Dutch is now expected in practice
• Where candidates most often fail
• How professionals prepare successfully today

Key BIG-toets language test updates at a glance (2026)

These changes apply to all BIG-regulated professions: 

• Higher professional Dutch level required: B2+ to C1-
• Language assessed as a clinical competence, not general NT2
• Much stricter assessment of written medical documentation
• Realistic scenarios across hospital care, GGZ, elderly care and home care
• Three mandatory exam components with no language exemptions

For a full overview of eligibility and registration steps, see our earlier guide on BIG language test preparation.

Why the BIG language requirements were updated

According to official publications from the BIG-register, VWS and Vilans, the previous language assessment no longer reflected daily practice in Dutch healthcare.

Healthcare professionals today carry greater responsibility in:

• informed consent and shared decision-making
• medication safety and risk communication
• accurate documentation
• multidisciplinary collaboration under time pressure

The 2026 update ensures that candidates can function safely and independently in real Dutch clinical environments, not just pass a language test on paper. 

What the BIG language test 2026 really evaluates

The BIG Language Test does not assess general Dutch. It evaluates whether you can work safely as a healthcare professional in Dutch.

You are assessed on your ability to:

• explain risks and procedures clearly to patients
• accurate document care using correct medical terminology
• communicate professionally with colleagues and supervisors
• and besides that, apply the right protocols

The new professional Dutch level: B2+ to C1- explained

From 2026 onward, the required level is officially defined as B2+ to C1- professional Dutch. This means clear, structured explanations under clinical responsibility:

• correct use of sector-specific terminology
• unambiguous written documentation (SOAP, SBAR-style)
• clinical reasoning expressed in Dutch

Language proficiency is now treated as a core medical skill, comparable to clinical reasoning or protocol knowledge. 

Updated BIG language exam structure (2026)

Knowledge exam (online)

• Computer only; no tablet
• 60 multiple-choice questions
• 90 minutes
• Passing score: ≥ 40 correct answers (66%)
• Not branch-specific (hospital care, mental health (GGZ), elderly care, disability care, and community care)
• No dictionary or calculator allowed
• Result valid for 1 year
   

Practical exam (on location)

• At an official testing location
• 45 minutes
• Two clinical or nursing skills and one medication calculation
• Branch-specific, tailored to your healthcare specialty
• Apply the official Vilans protocols
• Result valid for 1 year
   

Oral exam (online)

• Online case discussion with two examiners
• 20-minute + 10 minutes assessment time
• Branch-specific, also tailored  
• Focus on reasoning, safety and communication (risk and procedure explanation, respond professionally to concerns 
  or complications, showing empathy, etc.)
• Allowed: Pocket cards
• Required: Prior passing of the knowledge & practical exams 

Professional-specific updates for 2026

• GZ-psychologists & psychotherapists: diploma verification simplified; no notarized documents needed if schools share data.
• Orthopedagoog-generalisten: same simplified diploma process.
• Registered dental hygienists (GMH): experiment ended; GMH is no longer an Article 3 profession and BIG-registration is discontinued. 

BIG-registration Updates for 2026–2027

Tariff changes from January 2027

The Dutch Ministry of Health will introduce new pricing:

• Registration: €121
• Re-registration: €121
• Temporary prescribing rights: €121
• Certificates: €30 (digital) or €50 (paper)
• Diploma evaluation: €100
• EPC card: €30

Faster processing (2025 Update)

80% of Dutch-diploma registrations are now fully automated. Foreign diploma applications still require up to 8 weeks, but complete files are typically processed faster.

What we see in practice with BIG 2026 candidates

At coLanguage, we work daily with international doctors, nurses, psychologists and allied health professionals preparing for BIG registration - both individually and in hospital teams in major Dutch cities.

The most common challenges we see in 2026 are:

• writing structured, objective medical reports
• explaining risks confidently in spoken Dutch
• switching register between patient talk and formal documentation
• speaking clearly under exam pressure during oral case discussions 

Why general NT2 courses are often no longer enough

Because the BIG exam now mirrors real clinical practice, many candidates struggle when they prepare only with general NT2 materials.

Effective preparation in 2026 means learning how to:

• document care according to Dutch healthcare standards
• communicate safely under legal responsibility
• apply protocols while explaining actions clearly 

How coLanguage prepares healthcare professionals for BIG 2026

At coLanguage, we train foreign healthcare professionals specifically for professional Dutch use in clinical contexts. Our approach combines:

• private live classes with specialised teachers
• a university-backed learning platform (developed with European universities)
• profession-specific learning paths aligned with BIG requirements
• training in writing, speaking, listening and reading

Learners work with real materials from their profession, such as patient cases, protocols and reports, transformed into exercises at their CEFR level.

Blended learning that fits busy healthcare schedules

Our blended model allows you to:

• study independently in the learning portal when your schedule allows
• receive instant corrections and progress tracking
• train spoken communication intensively with a mentor-teacher
• follow a clear monthly learning plan linked to BIG readiness 

In-company BIG language training for hospitals and care institutions

Hospitals and care organisations increasingly choose in-company BIG language training to:

• reduce exam failure rates
• improve patient communication and documentation quality
• support international staff integration

For HR and supervisors, we provide clear tools for:

• progress tracking per employee
• attendance reporting
• centralised invoicing

Case examples from practice

Improving clinical communication in a nursing team

Juul B., a senior nurse educated outside the EU, prepared for the BIG exam while working part-time. Through targeted documentation training and oral case simulations, she improved both exam performance and daily handovers with colleagues.

Supporting international doctors with structured Dutch reporting

A small team of international physicians followed blended training focused on written reports and risk explanation. Within months, supervisors reported clearer documentation and more confident patient communication, alongside successful BIG exam results.

Final expert conclusion

The BIG Language Test 2026 confirms that professional Dutch is no longer an administrative formality. It is a legal and clinical requirement for safe healthcare practice in the Netherlands.

With realistic preparation, clear structure and profession-focused training, international healthcare professionals can meet these requirements confidently — and integrate successfully into Dutch healthcare.

Start your BIG preparation with clarity and confidence

Whether you are just starting your BIG journey or preparing for the final language components, coLanguage supports you with structured guidance, expert teachers and proven learning methods.

Book a trial lesson and experience professional Dutch training aligned with BIG 2026 requirements.

FAQ (2026 Update)

Who qualifies for BIG re-registration (herregistratie)?
You qualify if you have enough recent work experience (urennorm), or you successfully pass the full updated exam programme

What if my diploma is older than five years and I was never registered?
In that case, you must immediately meet: the standard registration requirements, and the full re-registration requirements. This includes completing all required BIG exams and fulfilling the Dutch language requirements, regardless of your experience.

Is there a difference between MBO and HBO exams?
No. All candidates (MBO and HBO) take the same BIG exams. 
The BIG system evaluates competence, not the educational route.

How many retakes are allowed?
Unlimited. You may retake the knowledge exam, practical exam, and oral exam as many times as needed. 
Each attempt must be booked and paid for separately. Note: Exam results (knowledge + practical) are valid for 1 year.

Are exemptions possible?
No. There are no exemptions for the BIG Dutch language requirements.

Can I register for the Knowledge Exam and Practical Exam at the same time?
Yes. You can book both exams independently and plan them in any order.
However, both must be passed before you can access the Oral Exam.

Why must I pass the Knowledge and Practical Exams before the Oral Exam?
Because the BIG exam programme follows a structured, step-by-step assessment: 
1. Knowledge & skills (Knowledge Exam + Practical Exam) 
2. Analysis & reasoning (Oral Exam)
You must demonstrate foundational competence before progressing to the final analytical exam.