UFH Family Medicine Fellowship Application Form

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Introduction: Thank you for considering to become a Family Medicine Fellow with UFH's Family Medicine Training Program. This is an exciting opportunity for you to work in an innovative private healthcare system that has been in China since 1997, operating three hospitals and ten clinics across China. In addition, you will have an unprecedented opportunity to receive training developed by former family medicine faculty from the United States and supervised by a medical staff team from all over the world. Upon completion of your training, you may be offered an opportunity to become a permanent family medicine medical staff of UFH, a privilege now mainly occupied by physicians who have had to study abroad first.

The target fellows are expected to have:
1. Master level or higher medical degree;
2. Medical license in China;
3. Completed mandatory government three-year residency rotation programs or overseas clinical experiences;
4. Good command of English and Mandarin skills;
5. Chinese nationals preferred.

Interested applicants should submit the following:
1. This completed application form
2. Upload a typed resume(at the end of application)
    a) English only
    b) Identifying information (name, email, phone number)
    c) Education high school and above in chronological order
    d) Work Experience: List relevant experience in chronological order
    e) Other information as space permits.
3. Upload a picture of yourself
4. Copy of your medical school graduation certificate

If you do not receive email confirmation within 10 working days of your application submission or have other concerns, please email the Program at angela.xiong@ufh.com.cn  or evelyn.fang@ufh.com.cn.  We do not send out notices or reminders for incomplete applications.
1) Site you wish to join (check all that apply) * [Please Choose 1-5 items]
  • open for 2018
  • open for 2018
  • open for 2018
2) Name *
Tips:Given Name , Family Name
3) Date of Birth *
Month *
Date *
4) What is your age today? *
5) Gender: *
6) Email: *
7) Cell phone number: *
8) Have you been or are you currently an employee of United Family Healthcare? OR Have you applied for other fellow positions within United Family Healthcare? *
9) If yes, please state dates and position(s):
10) List language(s)/dialects you speak and rate fluency level from 0- 4 (Level 2 English or above is a requirement, Mandarin is desirable): 0 = Cannot read or write; 1 = Can speak or read/write some; 2 = Can give lectures in that language AND read/write; 3 = Can communicate easily in many topics and act as a live verbal translator; 4 = A native speaker. *
1234
English
Mandarin
Catonese
Shanghainese
Tianjin hua
shandong hua
11) Citizenship (list all applicable): *
If "other" is selected, please provide response here:
12) Your home town name: *
13) If China nationals, Location of your Hukou (户口): *
14) Which province do you currently live: *
15) Which medical school did you attend? *
16) High School Attended (name, city, province) *
17) Bachelor degree: Area of focus *
18) Received from (name, city, province) *
19) Year of completion *
20) Master degree: Area of focus *
21) Received from (name, city, province) *
22) Year of completion *
23) PhD degree: Area of focus
24) Received from (name, city, province)
25) Year of completion
26) Fellowship: Area of focus
27) Received from (name, city, province)
28) Have you received your Resident Standard Training? If yes, please write the Year of Completion in the space beside. *
29) Have you received your Attending Physician Title Certificate? If yes, please upload a copy of your certificate at the end of the application.
30) Internal Medicine experience during training. Count rotations only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 months
General Intensive Care Unit(ICU)
General Inpatient
General Clinic
Cardiology ICU
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
None1 month or less1-3 monthsMore than 3 months
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency care
Other:
Other Clinical Training
31)Pediatric Experience during TRAINING. Count rotations only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 months
Neonatal intensive care
Pediatric intensive care
General Inpatient
General Clinic
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
None1 month or less1-3 monthsMore than 3 months
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency
Vaccinations
Newborn exam
Well child checks
Other:
Other Clinical Training
32) Obstetrics/Gynecology during Training. Count rotations only if there was direct patient care. *
None1 month or less1-3 months4More than 3 months
Pre-natal care
High risk OB care
Labor and delivery
General Gynecology Inpatient
General Gyn clinic
Gyn emergency
Other
Other Clinical Training
33) Surgical subspecialities during training. Count rotations only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 months
Surgery ICU
General Surgery Inpt
General Surgery clinic
Gen Surgery ER
Orthopedic Inpt
Orthopedic clinic
Orthopedic ER
Ear Nose Throat Inpt
ENT clinic
ENT ER
Other
Other Clinical Training
34) Other experiences during training. May list direct patient care or observation/shadowing experiences. *
None1 month or less1-3 monthsMore than 3 months
Dermatology
Eye
Emergency
Psychiatry Inpatient
Psychiatry clinic
Psychiatry emergency
Radiology
Lab
Pharmacy
Traditional Chinese Medicine
Physical Therapy
Speech Therapy
Community clinic
Nutrition
Other
Other Clinical Training
35) Skill assessments: choose the best answer in each row *
Never ExposedSeen it by by othersDone this myself on more than 5 patientsHave taught this
Newborn exam
Well child check
Pediatric closed fracture reduction
Pediatric splinting
Otoscope ear exam
Ophthalmoscope eye exam
Pelvic Exam
Pap smears
Colyposcopy
Never ExposedSeen it by by othersDone this myself on more than 5 patientsHave taught this
ECG interpretation
Chest x-ray interpretation
Liquid nitrogen use on skin lesion
Skin biopsies
Abscess incision and drain of lesions
Placing PPD skin test
PPD skin test reading
Prenatal exam
Managing laboring patient
Vaginal delivery
Intubation
Central venous line
Arterial line
Paracentesis
Thoracentesis
Foley catheter placement
Other Clinical Training
36) Internal Medicine experience after graduation. Count experience only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 monthsSupervised others
General Intensive Care Unit(ICU)
General Inpatient
General Clinic
Cardiology ICU
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
None1 month or less1-3 monthsMore than 3 monthsSupervised others
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency care
Other:
Other Clinical Training
37) Pediatric Experience experience after graduation. Count only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 monthsSupervised others
Neonatal intensive care
Pediatric intensive care
General Inpatient
General Clinic
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
None1 month or less1-3 monthsMore than 3 monthsSupervised others
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency
Newborn exam
Well child checks
Vaccinations
Other:
Other Clinical Training
38) Obstetrics/Gynecology experience after graduation. Count only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 monthsSupervised others?
Pre-natal care
High risk OB care
Labor and delivery
General Gynecology Inpatient
General Gyn clinic
Gyn emergency
Other
Other Clinical Training
39) Surgerical Subspecialities experience after graduation. Count only if there was direct patient care. *
None1 month or less1-3 monthsMore than 3 monthsSupervised others?
Surgery ICU
General Surgery Inpt
General Surgery clinic
Gen Surgery ER
Orthopedic Inpt
Orthopedic clinic
Orthopedic ER
Ear Nose Throat Inpt
ENT clinic
ENT ER
Other:
Other Clinical Training
40) Other Postgraduate Experiences. May list direct patient care or observation/shadowing experiences. *
None1 month or less1-3 monthsMore than 3 monthsSupervised others?
Dermatology
Eye
Emergency
Psychiatry Inpatient
Psychiatry clinic
Psychiatry emergency
Radiology
Lab
Pharmacy
Traditional Chinese Medicine
Physical Therapy
Speech Therapy
Community clinic
Nutrition
Other Clinical Training
41) Please upload your English resume (2 pages maximum, Word or txt format): *
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
42) Please upload a photo of yourself (must be less than 1 MB in size, or less than 640x480): *
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
Tips:ID photo
43) Please upload a copy of your medical school graduation certificate (PDF or image; must be less than 1 MB in size): *
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
44) Please upload a copy of your master and Phd degree certificate if applicable (PDF or image; must be less than 1 MB in size):
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
Tips:ID photo
45) Please upload a copy of your Chinese Practice License (PDF or image; must be less than 1 MB in size):
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
46) Please upload a copy of your Qualification License (PDF or image; must be less than 1 MB in size):
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
47) Please upload a copy of your Resident Standard Training Certificate (PDF or image; must be less than 1 MB in size):
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
48)Please upload a copy of your Scholarship Certificate (PDF or image; must be less than 1 MB in size):*
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
49) Please upload a copy of your Socre Report (成绩单)(PDF or image; must be less than 1 MB in size)
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
50) Please upload a copy of your Attending Physician Title Certificate (PDF or image; must be less than 1 MB in size):
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
51) Please upload a copy of your Identification Card both sides (PDF or image; must be less than 1 MB in size) *
Please upload the file with exts .gif|.png|.jpg|.jpeg|.doc|.docx|.pdf|.xls|.xlsx
 (300 to500 words)
52) Please answer below question in English.
1) Please tell us what led you to decide to become a doctor.(300-500 words)


2) Please tell us what being a family medicine doctor means to you. (300-500 words)


3) Please tell us why you are interested in becoming a family physician at a United Family Healthcare facility.(300-500 words)
 *