1、Qualification & Certification Exams for American Family Physicians美国家庭医生资格考试,How Many Years of Training to be a FP in the USA?在美国培训家庭医生需要多少年？,Primary and Secondary School 12 years小学和中学12年University 4 years大学4年 Medical School 4 years 医学院4年Post Graduate Residency 3 years毕业后住院医师3年 Total总共 23 years,What
2、 are the requirements to be a FP in the USA?成为美国家庭医生的要求是什么？,Succesfully finishing medical school成功地完成医学院校的学习。All graduates have equal training background by the time they finish medical school 完成医学院校的学习后，所有的毕业生都有相同的培训背景。Passing the three steps of USMLE 通过三步美国行医执照考试。,Graduates and Practice毕业生和实践,All
3、graduates are not equal 所有毕业生的水平不是一样的The practice of medicine is not a right 医学实践不是一个权利Society must be protected from bad doctors. 必须保护社会不会受到水平差的医生的伤害Examinations for licensure and specialist certification help guarantee good doctors 执照和专家证书考试有助于保证水平高的医生,USMLE (United States Medical Licensing Examin
4、ation) 美国行医执照考试,sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) 由美联邦医学委员会(FSMB) 和全国医学考试委员会(NBME)发起。3 steps must be passed 必须通过3步考试。Required for all US and foreigner medical graduates before applying to practice medicine 是对所有的美国和外国医学毕业生在申请
5、行医前的要求。,USMLE (United States Medical Licensing Examination) 美国行医执照考试,Students or doctors who graduated from non US medical schools also need to pass the 3 steps independent of how high are their education, title or degree 非美国医学院校毕业的学生或医生，不管他们的教育、头衔或程度有多高，也需要通过3步考试。They also need to finish accredited
6、 residency in US 他们也需要在美国完成被认可的住院医师培训。,USMLE (United States Medical Licensing Examination) 美国行医执照考试 Step 1 步骤1,assesses application of concepts of the sciences basic to the practice of medicine 对做为医学实践基础的科学概念的应用进行评估。special emphasis on principles and mechanisms underlying health, disease, and modes
7、of therapy 重点在于健康、疾病和治疗模式的原则和机制。provide a foundation for the safe and competent practice of medicine 为安全的和有能力的医学实践提供基础。,USMLE (United States Medical Licensing Examination) 美国行医执照考试 Step 2 步骤2,assesses application of medical knowledge, skills, and understanding of clinical science essential for the p
8、rovision of patient care under supervision 对在医学知识、技术和临床医学的理解方面的应用进行评估，这是在监督下为病人提供照顾所必需的。emphasis on health promotion and disease prevention 重点在健康促进和疾病预防方面。,USMLE (United States Medical Licensing Examination) 美国行医执照考试 Step 2 步骤2,2 parts: 两部分：- Clinical Knowledge (CK) 临床知识- Clinical Skills (CS), imple
9、mented in 2004 临床技能，2004年实施,Step 2: Clinical Knowledge 步骤2：临床知识,multiple choice examination 多选题考试focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training 集中在临床医学原则方面，这对在监督下的毕业后培训中的医学实践很重要。emphasis on health promotio
10、n and disease prevention 重点在健康促进和疾病预防方面。2 dimensions: physician task and disease category 两方面：医师任务和疾病种类。,Step 2: Clinical Skills 步骤2：临床技能,standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate
11、their findings to patients and colleagues 以标准化的病人来测试医学生和医学毕业生的能力，这能力包括从病人那里收集信息、进行体格检查及与病人和同事交流的能力。8 hours, 12 patients 8小时，12个病人。15 minutes with each patient 每个病人15分钟。10 minutes to chart 10分钟制成图表。,USMLE (United States Medical Licensing Examination) 美国行医执照考试 Step 3 步骤3,must pass step 1 and 2 CK (+ o
12、r CS) before eligibility to take Step 3 必须通过步骤1和步骤2中的临床知识考试（加临床技术考试或不加临床技术考试），才有资格参加步骤3考试。,USMLE (United States Medical Licensing Examination) 美国行医执照考试 Step 3 步骤3,assesses application of medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of
13、 medicine 对医学知识的应用及生物医学和临床医学的理解进行评估，这对不在监督下的医学实践是必要的。emphasis on patient management in ambulatory settings 重点在门诊环境中对病人的处理。final assessment of physicians assuming independent responsibility for delivering general medical care 对医师是否能独立胜任医疗照顾进行最终评估。,After Passing USMLE在通过美国行医执照考试 后,Apply for residency
14、申请住院医师项目。Complete 3 years of approved residency program 完成3年许可的住院医师项目。1st year of internship 第1年实习医师期。2nd and 3rd year preferable in the same program 第2年和第3年在同一项目中做的更好。,Residency In-training Exam住院医师培训中的考试,240 multiple choice questions 240道多选题。Given annually in November 每年11月考试。All residents take th
15、e same exam 所有住院医师参加同一考试。No passing score 没有通过分数。Used to compare progress ( with self, within same program, nation wide) 用于比较进度（自我比较，在同一项目中，全国范围内）,Certification in ABFM*美国家庭医学专业委员会认证,Successfully completed 36 months of residency program accredited by Accreditation Council for Graduate Medical Educat
16、ion (ACGME) 成功完成由毕业医学教育认定委员会认定的36个月的住院医师项目。Must hold a currently valid, full, and unrestricted license to practice medicine in the United States or Canada 必须持有目前有效的、完全的和没有限制的执照才能在美国或加拿大行医。If not taking soon after residency, need to complete 50 hours of CME (Continuing Medical Education) per year 如果在
17、住院医师项目后没有很快拿到执照，需要每年完成50小时的继续医学教育（ CME ）。,*American Board of Family Medicine,Certification/ Recertification ABFM美国家庭医学专业委员会认证/再认证,1 full day of exam 一整天考试Computer-based examination 计算机化考试Same exam for certification or recertification 认证或再认证的同一考试 Offered twice a year 一年两次No limit for attempts, but ne
18、ed to have valid license all the time 参加没有限制，但需一直有有效执照。,Certification/ Recertification ABFM美国家庭医学委员会认证/再认证,Test of cognitive knowledge and problem-solving ability relevant to Family Medicine 对家庭医学相关知识及解决问题的相关能力进行考试。Questions include, but are not limited to, diagnosis, management, and prevention of i
19、llness 问题包括（但不限于）疾病的诊断、处理和预防。,Certification/ Recertification ABFM美国家庭医学专业委员会认证/再认证,370 multiple-choice questions 370道多选题Divided in 5 sessions 分成5部分2 sessions are from modules 其中2部分来自模块About 1 minute to 1 minute &15 sec each question 每一个问题大约1分钟至1分钟15秒钟,Certification/ Recertification ABFM美国家庭医学专业委员会认证
20、/再认证,Choose 2 from the following 8 modules: 从下面8个模块中选择2个： - Ambulatory medicine 门诊医学 - Child and adolescent care 儿童和青少年照顾 - Geriatrics 老年病学 - Womens health 妇女健康 - Maternity care 孕妇照顾 - Emergent/Urgent care 急救照顾 - Hospital medicine 医院医学 - Sports medicine 运动医学,Examination content 考试内容,1.Cardiovascular
21、心血管的12%2.Endocrine内分泌的 8%3.Gastrointestinal胃肠的 7%4.Hematologic/Immune血液学的/免疫的3%5.Integumentary皮肤的6%6.Musculoskeletal肌肉骨骼的12%7.Nephrologic肾病学的 3%,Examination content 考试内容,8.Neurologic神经病学的3%9.Nonspecific非特异的9%10.Psychogenic心理性的7%11.Reproductive-Female生殖的-女性4%12.Reproductive-Male生殖的-男性1%13.Respiratory
22、呼吸的13%14.Special Sensory特殊感觉的 2%,Examination content考试内容,15.Population-based Care5%(epidemiology, EBM, prevention, etc) 人群为基础的照顾 5%（流行病学，循证医学，预防，等）16.Patient-based Systems5%(communication, doctor-patient interaction, ethics, etc) 病人为基础的系统 5% （交流，医患互动，伦理学，等）,Example of Board Questions委员会提问举例,A 35-yea
23、r-old white male with known long QT syndrome has a brief episode of syncope requiring cardiopulmonary resuscitation. Which one of the following is most likely responsible for this episode? 一位35岁男性，白种人，已知患有长QT综合征，出现短暂晕厥发作，需要心肺复苏。下列哪一种最可能引起这种晕厥？A. Sinus tachycardia 窦性心动过速 B. Atrial flutter with third
24、degree block 伴有三度阻滞的心房扑动C. Asystole 心搏暂停 D. Torsades de pointes 尖端扭转性室性心动过速,www.aafp.org/cgi-bin/boardquestions,Maintenance of Certification Program for Family Physicians (MC-FP )家庭医生认证项目维持,Series of required tests to encourage continuous learning and self-assessment 要求参加一系列考试来鼓励继续学习和自我评估。Done in pe
25、riod between certification and re-certifications 在认证和再认证期间进行。,Maintenance of Certification Program for Family Physicians (MC-FP )家庭医生认证项目维持,Areas of assessment评估范围-professionalism专业水平-self assessment/lifelong learning自我评估/终生学习-cognitive expertise所掌握的专业技能-performance in practice实践水平,Certificates of A
26、dded Qualifications ( CAQ)增加的资格证书,Additional residency training额外的住院医师培训-Adolescent Medicine青春期医学-Geriatric Medicine老年医学-Sports Medicine运动医学-Sleep Medicine睡眠医学-Hospice and Palliative Medicine临终关怀和姑息医学,What are the requirements to be a FP in the USA?成为美国家庭医生的要求是什么？,Succesfully finishing medical schoo
27、l 成功地完成医学院校的学习Passing the three steps USMLE 通过三步美国行医执照考试Completing approved residency program 完成认可的住院医师培训项目Passing one day Family Medicine Board Exam 通过一天的家庭医学委员会考试Completing 150 hours of continuing medical education every 3 years (The American Academy of Family Practice was the first to require thi
28、s) 每三年完成150小时的继续医学教育（美国家庭医师学会首先要求继续医学教育）Recertification required every 7-10 years 每7-10年再认证一次,New: Maintenance of Certification新的方面：认证维持,Annual learning activity extends the period to 10 years between examinations在两次考试之间，每年学习活动延长至10年 First activity: Self Assessment Modules第一次活动：自我评估模块Second Activity
29、: Performance in Practice Modules.第二次活动：实践演示模块,Self Assessment Modules (SAM)自我评估模块(SAM),Computer, done at home 计算机，在家里完成Must do two every three years 每三年必须做两个Obtain 15 hours of CME credit 获得15小时的继续医学教育学分Choice of several modules, most relevant to your practice 从几个模块中选择与你的实践最相关的,Self Assessment Modul
30、e choices自我评估模块选择,Diabetes 糖尿病Asthma 哮喘Hypertension 高血压Depression 抑郁症Thyroid Disease 甲状腺疾病Childhood Illnesses 儿童疾病Coronary Artery Disease 冠状动脉疾病Preventive Care预防照顾,Care of the vulnerable elderly 体弱老人的照顾Cerebral Valscular Disease 脑血管疾病Heart Failure 心力衰竭Health Behavior 健康行为Maternity Care孕产妇照顾Pain Mana
31、gement 疼痛处理Well Child Care 儿童保健,Self Assessment Module: 1st part Knowledge Assessment自我评估模块第一部分 知识评估,Exam- 60 Questions 考试-60个问题May study to answer 可以学习来回答Keep taking until you pass with 80% correct. 一直做直到80% 回答正确,Self Assessment Module 2nd part自我评估模块第二部分,Clinical simulations 临床模拟Review cases and an
32、swer questions about evaluation and management of the patient. 回顾病例，回答有关评估和处理病人的问题,Performance in Practice 实际操作,Must do one each three years 每3年必须完成一例实际操作。Oriented to assess a part of your practice, identify ways your care could be improved 通过实践中每个部分的评估，认识提高医疗照顾水平的途径。The choices are individual and s
33、elf identified 所选择的要个性化并且自己认可。Assessment is done to see if improvements are made. 要做评估看能力是否得到提高。,Performance in Practice实际操作,15 hours of continuing medical education credit 15个学时继续医学教育学分Individually done on your computer 独立在电脑上完成。,Performance in Practice Modules Choices实际操作模块选择,Diabetes 糖尿病Asthma 哮喘
34、Comprehensive Performance in Practice 综合性实践操作 Coronary Artery Disease 冠心病Depression 抑郁症Heart Failure 心力衰竭Hypertension 高血压,Performance in Practice 1st step实践操作第一步,Perform a chart audit on 10 patients with the chosen disease 就选定疾病的10个病人做出评估表Answer questions chosen to indicate high quality care for tha
35、t condition 回答与此种疾病情况下能提供的优质照顾相关的问题。Record these answers记录这些答案Identify areas for improvement 明确需要改进的地方,Performance in Practice 2nd step实践操作第二步,Determine areas in which you will institute change in your patient managerment to improve care. 确定在处理病人方面为改善病人照顾你决定要改变的地方。Work with your office staff to see
36、that these changes are carried out. 和同事一起努力实践这些改变。,Performance in Practice 3rd step实践操作第三步,Fill out an audit of questions for these 10 patients when they return for follow up care to determine if you have made the changes you determined. 填一张这10位病人随访时的问题评审表，判断自己是否执行了自己要改变的地方。,Reference参考资料,American Academy of Family Physicians 美国家庭医师学会www.aafp.orgAmerican Family Physician美国家庭医师Family Practice Management家庭医学管理American Board of Family Medicine www.theabfm.org 美国家庭医学委员会The Journal of Family Practice家庭医学杂志USMLE 美国行医执照考试www.usmle.orgWikipedia, the free encyclopedia 维基百科，自由的百科全书www.wikipedia.org,
