We've detected that Javascript is not enabled. It is required for an optimal survey taking experience.
Please check your browser's settings and make sure Javascript is turned on. Learn how to enable Javascript.

Skip survey header

UFH Emergency Medicine Fellowship 2015-2016 academic year application

UFH Emergency Medicine Training Program Application

Welcome to the UFH EM Training Program 2015-2016 academic year application. To learn more in detail about our program, please our brochure attached at the bottom of this application, but as a reminder: although every fellow’s contract is with one of our five service areas (Beijing,Guangzhou,Shanghai,Tianjin or Qingdao), the actual training will often be AWAY from that service area—usually the first year is done at either Beijing United or Shanghai United, the second year at the other of those two facilities, and the third year is broken up over multiple service areas. On graduation after the three years of training, however, the fellow is to return to their ORIGINALLY CONTRACTED service area to begin work as an independent doctor within the UFH network.

1. Please check ALL the sites you would be willing to join (check ALL that apply)

2. Of the choices you have checked above, please rank them in order of most preferred FIRST. For instance, if you would accept placement at Qingdao and Shanghai, but prefer Qingdao, you would write 1. Qingdao, 2. Shanghai. PLEASE NOTE THAT THIS SELECTION REFERS TO THE FINAL EMPLOYMENT DESTINATION. MUCH OF THE TRAINING WILL BE DONE OUTSIDE THE CONTRACTED SERVICE AREA, AS DESCRIBED ABOVE.

3. How did you hear about the UFH Training Programs? (Please place an X by all that apply)

Friend or colleague
UFH Representative came to my hospital or school
UFH English classes
Job fair
51jobs
dingxiangyuan
威信-WeChat
searching on web and found information by myself

4. Is this the first time you are applying for a position at UFH? *This question is required.

5. If you answered "no" above, please note what position(s) you applied for in the past?

6. Your Name:

7. Date of birth (yyyy/mm/dd):

8. Gender:

9. Email:

10. Cell phone number:

11. Your home town name:

12. Have you been or are you currently an employee of United Family Healthcare?

13. If yes, please state dates and position(s):

14. List language(s)/dialects you speak and rate fluency level from 0- 4 (Level 2 English or above is a requirement, Mandarin is desirable).

Space Cell	Cannot read or write	Can speak or read/write some	Can give lectures in that language AND read/write	Can communicate easily and act as a verbal translator	A native speaker
English
Mandarin
Catonese
Shanghainese
Tianjin hua

15. Other language (please specify and grade fluency using the scale above):

16. fluency level:

17. What is your age today?

18. Citizenship (list all applicable):

Mainland China
Taiwan
Hong Kong
other

19. If “other,” please specify:

20. Home province:

21. Location of your Hukou (户口):

22. In which province do you currently live:

23. Which medical school did you attend?

24. High School Attended (School name, city, province)

25. Bachelor degree: Area of focus

26. Received from (University name, city, province)

27. Master degree: Area of focus

28. Received from (University name, city, province)

29. PhD degree: Area of focus

30. Received from (University name, city, province)

31. Internal Medicine experience during training. Count rotations only if there was direct patient care. Please note experience level for each area.

Space Cell	None	1 month or less	1-3 months	More than 3 months
General Intensive Care Unit-ICU
General Medicine Inpatient
General Medicine Clinic
Cardiology ICU
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency care

32. Other (please specify):

33. Pediatric Experience during TRAINING. Count rotations only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More than 3 months
Neonatal intensive care
Pediatric intensive care
General Inpatient
General Clinic
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency
Vaccinations
Newborn exam
Well child checks

34. Other:

35. Obstetrics/Gynecology during Training. Count rotations only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More than 3 months
Pre-natal care
High risk OB care
Labor and delivery
General Gynecology Inpatient
General Gyn clinic
Gyn emergency

36. Other

37. Surgical Subspecialities during Training. Count rotations only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More 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

38. Other

39. Other experiences during training. May list direct patient care or observation/shadowing experiences.

Space Cell	None	1 month or less	1-3 months	More 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

40. Other

41. Skill assessments: choose the best answer in each row

Space Cell	Never Exposed	Seen it done/practiced by others regularly	Done this myself on more than 5 patients
Newborn exam
Well child check
Pediatric closed fracture reduction
Pediatric splinting
Otoscope ear exam
Ophthalmoscope eye exam
Pelvic Exam
Pap smears
Colyposcopy
ECG interpretation
Chest x-ray interpretation
Liquid nitrogen use on skin
lesion
Skin biopsies
Wound suturing
Abscess incision and drain of
lesions
Placing PPD skin test
PPD skin test reading
Prenatal exam
Managing laboring patient
Vaginal delivery
Intubation
Ventilation management
Central venous line
Arterial line
Paracentesis
Thoracentesis
Foley catheter placement

42. Internal Medicine experience AFTER graduation from residency. Count experience only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More than 3 months
General Intensive Care Unit
General Inpatient
General Clinic
Cardiology ICU
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency care

43. Pediatric Experience experience after graduation from residency. Count only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More than 3 months
Neonatal intensive care
Pediatric intensive care
General Inpatient
General Clinic
Cardiology Inpatient
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonary Clinic
Nephrology Inpatient
Nephrology Clinic
Dermatology Inpatient
Dermatology Clinic
Neurology Inpatient
Neurology Clinic
Rheumatology
Allergy/Immunology
Gastroenterology
Emergency
Newborn exam
Well child checks
Vaccinations

44. Obstetrics/Gynecology experience after graduation. Count only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More than 3 months
Pre-natal care
High risk OB care
Labor and delivery
General Gynecology Inpatient
General Gyn clinic
Gyn emergency

45. Surgerical Subspecialities experience after graduation. Count only if there was direct patient care.

Space Cell	None	1 month or less	1-3 months	More 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

46. Other Postgraduate Experiences. May list direct patient care or observation/shadowing experiences.

Space Cell	None	1 month or less	1-3 months	More 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

50. Please tell us what led you to decide to become a doctor.(250-500 words)

51. Please tell us what being an emergency medicine doctor means to you (250-500 words)

52. Please tell us why you are interested in becoming an emergency physician at a United Family Healthcare facility. (approximately 250-500 words)

Survey Software powered by SurveyGizmo