United Family Healthcare Family Medicine Fellowship Application

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 seven hospitals and twelve 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. We do not send out notices or reminders for incomplete applications.
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1) Site you wish to join (check all that apply)[Please select 1-5 item]
Beijing United
Shanghai United
Tianjin United
Guangzhou United
Qingdao United
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2) Name
Given Name , Family Name
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3) Date of Birth
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Month
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Date
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4) What is your age today?
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5) Gender:
Male
Female
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6) Email:
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7) Cell phone number:
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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?
No
Yes
9) If yes, please state dates and position(s):
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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.
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English
English
Mandarin
Mandarin
Catonese
Catonese
Shanghainese
Shanghainese
Tianjin hua
Tianjin hua
shandong hua
shandong hua
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11) Citizenship (list all applicable):
China
United States
Other
If "other" is selected, please provide response here:
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12) Your home town name:
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13) If China nationals, Location of your Hukou (户口):
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14) Which province do you currently live:
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15) Which medical school did you attend?
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16) High School Attended (name, city, province)
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17) Bachelor degree: Area of focus
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18) Received from (name, city, province)
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19) Year of completion
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20) Master degree: Area of focus
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21) Received from (name, city, province)
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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)
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28) Have you received your Resident Standard Training? If yes, please write the Year of Completion in the space beside.
Yes
No
29) Have you received your Attending Physician Title Certificate? If yes, please upload a copy of your certificate at the end of the application.
Yes
No
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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 Intensive Care Unit(ICU)
General Inpatient
General Inpatient
General Clinic
General Clinic
Cardiology ICU
Cardiology ICU
Cardiology Inpatient
Cardiology Inpatient
Cardiology Clinic
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonlogy Inpatient
Pulmonary Clinic
Pulmonary Clinic
Nephrology Inpatient
Nephrology Inpatient
Nephrology Clinic
Nephrology Clinic
None1 month or less1-3 monthsMore than 3 months
Dermatology Inpatient
Dermatology Inpatient
Dermatology Clinic
Dermatology Clinic
Neurology Inpatient
Neurology Inpatient
Neurology Clinic
Neurology Clinic
Rheumatology
Rheumatology
Allergy/Immunology
Allergy/Immunology
Gastroenterology
Gastroenterology
Emergency care
Emergency care
Other:
Other:
Other Clinical Training
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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
Neonatal intensive care
Pediatric intensive care
Pediatric intensive care
General Inpatient
General Inpatient
General Clinic
General Clinic
Cardiology Inpatient
Cardiology Inpatient
Cardiology Clinic
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonlogy Inpatient
Pulmonary Clinic
Pulmonary Clinic
Nephrology Inpatient
Nephrology Inpatient
Nephrology Clinic
Nephrology Clinic
None1 month or less1-3 monthsMore than 3 months
Dermatology Inpatient
Dermatology Inpatient
Dermatology Clinic
Dermatology Clinic
Neurology Inpatient
Neurology Inpatient
Neurology Clinic
Neurology Clinic
Rheumatology
Rheumatology
Allergy/Immunology
Allergy/Immunology
Gastroenterology
Gastroenterology
Emergency
Emergency
Vaccinations
Vaccinations
Newborn exam
Newborn exam
Well child checks
Well child checks
Other:
Other:
Other Clinical Training
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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
Pre-natal care
High risk OB care
High risk OB care
Labor and delivery
Labor and delivery
General Gynecology Inpatient
General Gynecology Inpatient
General Gyn clinic
General Gyn clinic
Gyn emergency
Gyn emergency
Other
Other
Other Clinical Training
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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
Surgery ICU
General Surgery Inpt
General Surgery Inpt
General Surgery clinic
General Surgery clinic
Gen Surgery ER
Gen Surgery ER
Orthopedic Inpt
Orthopedic Inpt
Orthopedic clinic
Orthopedic clinic
Orthopedic ER
Orthopedic ER
Ear Nose Throat Inpt
Ear Nose Throat Inpt
ENT clinic
ENT clinic
ENT ER
ENT ER
Other
Other
Other Clinical Training
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34) Other experiences during training. May list direct patient care or observation/shadowing experiences.
None1 month or less1-3 monthsMore than 3 months
Dermatology
Dermatology
Eye
Eye
Emergency
Emergency
Psychiatry Inpatient
Psychiatry Inpatient
Psychiatry clinic
Psychiatry clinic
Psychiatry emergency
Psychiatry emergency
Radiology
Radiology
Lab
Lab
Pharmacy
Pharmacy
Traditional Chinese Medicine
Traditional Chinese Medicine
Physical Therapy
Physical Therapy
Speech Therapy
Speech Therapy
Community clinic
Community clinic
Nutrition
Nutrition
Other
Other
Other Clinical Training
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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
Newborn exam
Well child check
Well child check
Pediatric closed fracture reduction
Pediatric closed fracture reduction
Pediatric splinting
Pediatric splinting
Otoscope ear exam
Otoscope ear exam
Ophthalmoscope eye exam
Ophthalmoscope eye exam
Pelvic Exam
Pelvic Exam
Pap smears
Pap smears
Colyposcopy
Colyposcopy
ECG interpretation
ECG interpretation
Never ExposedSeen it by by othersDone this myself on more than 5 patientsHave taught this
Chest x-ray interpretation
Chest x-ray interpretation
Liquid nitrogen use on skin lesion
Liquid nitrogen use on skin lesion
Skin biopsies
Skin biopsies
Abscess incision and drain of lesions
Abscess incision and drain of lesions
Placing PPD skin test
Placing PPD skin test
PPD skin test reading
PPD skin test reading
Prenatal exam
Prenatal exam
Managing laboring patient
Managing laboring patient
Vaginal delivery
Vaginal delivery
Intubation
Intubation
Central venous line
Central venous line
Arterial line
Arterial line
Paracentesis
Paracentesis
Thoracentesis
Thoracentesis
Foley catheter placement
Foley catheter placement
Other Clinical Training
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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 Intensive Care Unit(ICU)
General Inpatient
General Inpatient
General Clinic
General Clinic
Cardiology ICU
Cardiology ICU
Cardiology Inpatient
Cardiology Inpatient
Cardiology Clinic
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonlogy Inpatient
Pulmonary Clinic
Pulmonary Clinic
Nephrology Inpatient
Nephrology Inpatient
Nephrology Clinic
Nephrology Clinic
None1 month or less1-3 monthsMore than 3 monthsSupervised others
Dermatology Inpatient
Dermatology Inpatient
Dermatology Clinic
Dermatology Clinic
Neurology Inpatient
Neurology Inpatient
Neurology Clinic
Neurology Clinic
Rheumatology
Rheumatology
Allergy/Immunology
Allergy/Immunology
Gastroenterology
Gastroenterology
Emergency care
Emergency care
Other:
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
Neonatal intensive care
Pediatric intensive care
Pediatric intensive care
General Inpatient
General Inpatient
General Clinic
General Clinic
Cardiology Inpatient
Cardiology Inpatient
Cardiology Clinic
Cardiology Clinic
Pulmonlogy Inpatient
Pulmonlogy Inpatient
Pulmonary Clinic
Pulmonary Clinic
Nephrology Inpatient
Nephrology Inpatient
Nephrology Clinic
Nephrology Clinic
None1 month or less1-3 monthsMore than 3 monthsSupervised others
Dermatology Inpatient
Dermatology Inpatient
Dermatology Clinic
Dermatology Clinic
Neurology Inpatient
Neurology Inpatient
Neurology Clinic
Neurology Clinic
Rheumatology
Rheumatology
Allergy/Immunology
Allergy/Immunology
Gastroenterology
Gastroenterology
Emergency
Emergency
Newborn exam
Newborn exam
Well child checks
Well child checks
Vaccinations
Vaccinations
Other:
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
Pre-natal care
High risk OB care
High risk OB care
Labor and delivery
Labor and delivery
General Gynecology Inpatient
General Gynecology Inpatient
General Gyn clinic
General Gyn clinic
Gyn emergency
Gyn emergency
Other
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
Surgery ICU
General Surgery Inpt
General Surgery Inpt
General Surgery clinic
General Surgery clinic
Gen Surgery ER
Gen Surgery ER
Orthopedic Inpt
Orthopedic Inpt
Orthopedic clinic
Orthopedic clinic
Orthopedic ER
Orthopedic ER
Ear Nose Throat Inpt
Ear Nose Throat Inpt
ENT clinic
ENT clinic
ENT ER
ENT ER
Other:
Other:
Other Clinical Training
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40) Other Postgraduate Experiences. May list direct patient care or observation/shadowing experiences.
None1 month or less1-3 monthsMore than 3 monthsSupervised others?
Dermatology
Dermatology
Eye
Eye
Emergency
Emergency
Psychiatry Inpatient
Psychiatry Inpatient
Psychiatry clinic
Psychiatry clinic
Psychiatry emergency
Psychiatry emergency
Radiology
Radiology
Lab
Lab
Pharmacy
Pharmacy
Traditional Chinese Medicine
Traditional Chinese Medicine
Physical Therapy
Physical Therapy
Speech Therapy
Speech Therapy
Community clinic
Community clinic
Nutrition
Nutrition
Other Clinical Training
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41) Please upload your English CV (2 pages maximum, Word or txt format):
选择文件( 不超过4M )
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42) Please upload a photo of yourself (must be less than 1 MB in size, or less than 640x480):
ID photo
选择文件( 不超过4M )
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43) Please upload a copy of your medical school graduation certificate (PDF or image; must be less than 1 MB in size):
选择文件( 不超过4M )
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):
ID photo
选择文件( 不超过4M )
45) Please upload a copy of your Chinese Practice License (PDF or image; must be less than 1 MB in size):
选择文件( 不超过4M )
46) Please upload a copy of your Qualification License (PDF or image; must be less than 1 MB in size):
选择文件( 不超过4M )
47) Please upload a copy of your Resident Standard Training Certificate (PDF or image; must be less than 1 MB in size):
选择文件( 不超过4M )
48)Please upload a copy of your Scholarship Certificate (PDF or image; must be less than 1 MB in size):*
选择文件( 不超过4M )
48)Please upload a copy of your Scholarship Certificate (PDF or image; must be less than 1 MB in size):*
选择文件( 不超过4M )
49) Please upload a copy of your Socre Report (成绩单）(PDF or image; must be less than 1 MB in size)
选择文件( 不超过4M )
50) Please upload a copy of your Attending Physician Title Certificate (PDF or image; must be less than 1 MB in size):
选择文件( 不超过4M )
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51) Please upload a copy of your identification card both sides.
选择文件( 不超过4M )
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52) Please answer below question in English (you need upload your answer papers).
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)
选择文件( 不超过4M )
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