1

Philippine Academy of Family Physicians, Inc.

Commission on Specialty Board of Examiners

PRIMER FOR EXAMINEES

2017 Diplomate Board Examinations

Prepared by

Commission on Specialty Board of Examinations in Family Medicine

The Certifying Examinations for the title of Diplomate in Family Medicine are administered yearly by the Commission on Specialty Board of Examiners of the Philippine Academy of Family Physicians.

2

ELIGIBILITY REQUIREMENTS Those qualified to take the diplomate exams upon the recommendation of the Committee on MEMBERSHIP are the following:

CME Track:

a Conferred as a certified family physician (CFP) b. Earned 180 CME/CPD units c. Quality Assurance Workshop Certificate* d. Endorsement from Chapter President (see appendix) Residency Training Track:

a Conferred as a certified family physician (CFP) b. Earned 60 CME/CPD units per year c. Quality Assurance Workshop Certificate* d. Endorsement from Chairman and Training Officer (see appendix)

*If QA workshop will be held after the application period, a photocopy of the official receipt for registration fee should be enclosed. Test results will only be released upon submission of the QA certificate.

Other Requirements

a. Paid the examination fees b. Settled all payable accounts to PAFP (e.g. Membership, Convention,

Assessment fees etc.) c. Signed the consent to agree and abide by the policies and procedures of the

Examination d. Refresher course certificate of completion for those whose 3-year validity has

lapsed.**

**If Refresher course will be held after the application period, a photocopy of the official receipt for registration fee should be enclosed. Test results will only be released upon submission of the Refresher course certificate.

ORIENTATION DATES & VENUES There will be NO orientation for the Written Examination. All the information can be

found in this primer. The primer will also be emailed to all eligible test takers and can be accessed in the PAFP website. Should an examinee have any questions, he/she can call the PAFP Office (Tel. No. 5162900) Contact Persons: Mr. RJ dela Cruz Mobile 0917-5486550, email rj.thepafp@gmail.com Dr. Tricia Bautista at jtbautistamd@yahoo.com.

Orientation for the Oral Examination (2 options, attendance to at least one is required):

1. Immediately after the Written Examination (same day, October 22, 2017) 2. Day prior to the Oral Examination (December 1, 2017, 4pm, UST)

EXAMINATION DATES Written Examination:

Date & Time: October 22, 2017, Sunday

Registration: 8:00 am - 8:45 am Instructions: 8:45 am

PART I: 9:00 am – 11:30 am PART II 12:30 pm – 3:00 pm

Venue: UST Medicine Building, exact room(s) to be posted at the building entrance

3

Oral Examination: Date & Time: December 2-3, 2017, Saturday & Sunday, 8:00- 5:00 pm Day 1: Seven (7) Focused OSCE Stations + 1 rest station Venue: 3/F UST Medicine Building, exact room(s) to be announced

Tentative testing rooms: Histology (3/F), Neuroanatomy (3/F) and Biochemistry (2/F). Room assignments will be posted at the bulletin board, beside Room 329, 3rd floor on the morning of the testing day.

Day 2: Seven (7) Integrated Case OSCE stations + 1 rest station Venue: Assigned rooms at the UST Medicine Building

In case of extreme weather conditions affecting the testing venues, the examination dates

will automatically be moved to the following week with the same schedule of days in the week and set time, unless otherwise specified.

Follow us and watch out for announcements at our Facebook page “PAFP Specialty Board Exams”

APPLICATION PROCEDURES & REQUIREMENTS The PAFP Secretariat and the Commission and the Committee on Membership will

perform the proper notification and coordination with those qualified to take the written exam not later than August 31, 2017.

All applications for written, oral exams or both should be coursed through the PAFP

Secretariat not later than the designated DEADLINES. Written examination: September 30, 2017, Saturday Oral examination: November 11, 2017, Saturday

Application Requirements:

1) Filled up application form 2) 3 pcs 2x2 most recent colored ID picture with white background labeled and signed

at the back. (2 photos pasted on the test permits) 3) Application fee of Php 4,000.00 for both examinations or Php 2,000.00 for either

oral or written exam only 4) Signed consent forms agreeing to the policies and procedures of the Examination 5) Submitted the filled up Test Permits for encoding of Examinee Number.

Permits will be claimed at the testing venue on the day of the examinations. 6) Endorsement letter from respective Training Officer and Chairman of the Training

Program; or the Chapter President for CME track. (See appendix) 7) Photocopy of Certificate of Attendance in PAFP Quality Assurance Workshop 8) Photocopy of the Certificate of Completion in Refresher course (only for those

required) Submission of the above-mentioned requirements can be done by:

Hand delivery to PAFP Office

Delivered by courier to PAFP Office with address 2244 Taft Avenue, Malate, Manila 1004 Philippines. Attention: Commission on Specialty Board of Examiners

For other concerns: Call PAFP Office (632) 5162900; 0908-8666124; 09328528743 Contact Persons: Mr. RJ dela Cruz Mobile 0917-5486550, email rj.thepafp@gmail.com

I. THE WRITTEN EXAMINATION

The written examination intends to assess the examinee’s ability to apply, analyze and synthesize acquired knowledge in clinical and family medicine in order to be considered as a competent family physician after years of training and practice.

4

A. CONTENT OF THE WRITTEN EXAMINATION The written examination consists of three hundred (300) multiple choice questions (MCQs) selecting the single best answer (SBA). It is divided into two (2) sets of 150. Each set is allotted 2.5 hours to complete (5 hours for the entire exam). The topics are mainly based on the latest Manual of competencies as well as the Summary of Cases and Procedures included in the resident’s learning portfolio. 1. Clinical Medicine: Child Care, Adult Care & Elderly Care (75% - 225 questions) 2. Non-Clinical Foundation Courses: (25% - 75 questions) B. GENERAL BLUEPRINT FOR THE WRITTEN EXAMINATION The number of questions and percent distribution per discipline or system (CLINICAL MEDICINE topics) are shown below. All items will be testing of application, analysis and synthesis of knowledge required for problem solving and identifying causes and evidences to

support generalizations.

The examination may include pictures or illustrations of disease manifestations (ex. skin lesions, fundoscopic findings, etc) and clinic and ancillary procedures (ex. medical imaging, ECG, etc.). Example: A 22 year old man has an acute, painful, red right eye with blurring of vision for one day. He had a similar episode one year ago and has had episodic back pain and stiffness relieved by exercise and diclofenac for four years. What is the most likely cause of his red eye?

A Chorioretinitis B Conjunctivitis C Episcleritis D Iritis

5

Blueprint for the written examination

CLINICAL Areas

Percentage Distribution

(75%)

Signs and Symptoms

Investigation / Diagnostics

Management Allotted No. of Questions

Across age groups 20% 40% 40%

Cardiology 10% 5 9 9 23

Endocrine/ Metabolic

10% 5 9 9 23

GIT/ Nutrition 10% 5 9 9 23

GUT/ Reproductive

10% 5 9 9 23

Infectious Diseases 10% 5 9 9 23

Neurology/ Musculoskeletal

10% 5 9 9 23

Respiratory 10% 5 9 9 23

EENT 5% 3 4 4 11

Dermatology 5% 3 4 4 11

Mental Health/ Developmental

5% 3 4 4 11

Occupational / School Health

5% 3 4 4 11

Oncology/ Palliative Care

5% 2 4 4 10

Hematology/ Immunology

5% 2 4 4 10

51 87 87

TOTAL 100% 225

NON-CLINICAL 25% No. of Questions

Areas

Family Psychodynamics, Principles, Wellness, Ethics

60% 45

Research/EBM 30% 20

Community (Leader, Advocate)

20% 10

TOTAL 100% 75

6

The MUST-KNOW topics can be found in the Summary of Cases and Procedures provided by the Residency Committee (see PAFP website, Residency Corner). Examples are the following common conditions but may not be limited to:

Respiratory Cardio Hematology/Immunology

Pneumonia, Bronchitis Hypertension Anemias

COPD Coronary Artery Disease Leukemias

Asthma Heart Failure Hypersensitivity

PTB Congenital Heart/ RHD Anaphylaxis

Endocrine/Metabolic GUT/Nephro Reproductive

Diabetes UTI, Pyelonephritis Abnormal uterine bleeding

Thyroid Diseases Urolithiasis Myoma uteri

Dyslipidemia Kidney Disease Pregnancy and complications

Obesity Glomerulonephritis Sexually Transmitted Infections

Nutritional Deficiencies BPH Women and Men’s Health

Oncology/Palliative Gastro Infectious

Cervical cancer Dyspepsia, GERD Malaria, Filaria, Schistosomiasis

Breast cancer Ulcers Dengue, other hemorrhagic fevers

Colorectal Cancer Acute Appendicitis Hepatitis

Liver Cancer Bowel Obstruction Measles, other Viral exanthems

Kidney, prostate cancer Acute Cholecystitis/Lithiasis Typhoid, Amebiasis

Wilms, Retinoblastoma Pancreatitis Infectious diarrhea

Osteosarcoma Malnutrition Meningitis, Mumps

Control of Constipation Influenza, influenza-like illnesses

terminal symptoms Chronic Diarrhea Emerging diseases

Neurology Occupational/School Health Mental Health/Developmental

Stroke Bullying ADHD, Autism

Headache Occupational violence Down’s syndrome

Insomnia Poisoning: Salicylates, alkalis Depression, mood disorders

Dementia Acids, INH, Pesticides (OP) Anxiety Disorders

Seizure Preventive recommendations Insomnia

Syncope Environmental hazards and Alcohol dependency

Febrile Convulsions Effects Addictions

Dermatology EENT Others: FM Principles related to

Impetigo BPPV the different roles of a FP:

Allergic dermatitis Conjunctivitis, Healer

Seborrheic dermatitis Differentials of Red Eye Communicator/ Counselor

Acne, Miliaria Error of refraction Researcher /Lifelong Learner

Pediculosis, Scabies Glaucoma, Cataract Leader/Manager

Carbuncle, Furuncle Blepharitis, Hordeolum Community Advocate/

Decubitus ulcers Impacted cerumen Social Mobilizer

Insect bites, Urticaria TMJ Dysfunction

Pityriasis rosea Pharyngitis, LPR Also included:

Burns Hearing Loss Preventive care

Fungal infections Otitis Media, externa Concepts of the Foundation

Skin manifestations of Allergic rhinitis courses

Systemic diseases Meniere’s Common Emergencies

The agreed major references to be used for the 2017 Specialty Board Examinations are: a. Leopando et al, Textbook of Family Medicine Volume 1 (Principles, Concepts, Practice and

Context) and Volume 2 (Enhancing the Performance of the Five Star Family Physician) b. Rakel’s Textbook in Family Medicine, 9th edition -- for FM principles c. Dr. Eva Irene Maglonzo, Geriatrics and Filipino Family Physician Today 2nd edition – d. Filipino Family Physician Journal (last 2 and 1st 2 issues of the previous and current year,

respectively) e. Latest known CPGs (international and local) – some links available at the PAFP website or

FB page. Here is a link to the compendium: http://www.thefilipinodoctor.com/cpm_pdf/

*Please always check FB page “PAFP Specialty Board Exams 2017” for updates

7

C. CONDUCT OF THE WRITTEN EXAMINATION

1. Qualified examinees should submit the complete requirements to the PAFP Office on or before the deadline set by the PAFP secretariat.

2. All examinees must be in proper attire: Smart casual. No shorts, no mini-skirts, no plunging necklines, no slippers will be allowed. Bring sweater or jacket.

3. At the venue, register in the assigned room one hour prior to the start of the examination.

The examinee must present a valid government ID (PRC card, Driver’s License, Passport) to claim their TEST PERMIT.

4. Pencil with eraser (Mongol No.2) will be provided at the testing venue. Sharpeners will also be available. No pencil case, erasers, pens, calculators and the like will be allowed.

5. Seats for the candidates are pre-numbered as indicated on the test permit. No change in seating arrangement is allowed unless authorized by the examiners.

6. All personal belongings including mobile phones, wrist watch, and unnecessary

accessories must be kept in their bags, which will all be placed in the front area of the room. Cellular phones should be turned off. A big clock will be displayed in the testing rooms.

7. Examinee answer sheets (EAS) will be machine validated. Write your assigned Examinee

Number on the EAS. You do not need to write your name. Please refer to the appendix of this primer for familiarization and practice purposes.

8. No identifying marks shall be placed on the EAS. Markings can be made on the

questionnaires.

9. Make sure that questionnaires have the complete number of pages.

10. Only Mongol Pencil No. 2 should be used. Shading should not be too light nor too heavy. Avoid erasures as this may cause machine validation issues.

11. There will be a one-hour lunch break from 11:30am to 12:30pm. Packed lunch will be

served. Those with special diets (vegan, vegetarian, halal etc.) can indicate in their application form and/or coordinate with PAFP secretariat.

12. Examinees should make sure that they occupy the same seat number in Part 2.

13. Examinees are allowed to leave the room only for personal necessities and shall be

accompanied by a proctor.

14. Any attempt to communicate with a co-examinee while the examination is ongoing is presumed cheating. Any concern should be directed to the proctor.

15. All test permits will be collected and surrendered at the registration table at the end of the

exam.

II. THE ORAL EXAMINATIONS

The Objective Structured Clinical Examination (OSCE) aims to evaluate the skills and behavior of the examinee in situations which reflect the competencies of a Family Physician in clinical settings. The oral examination is focused on the performance of required tasks and procedures needed to be a health care provider, educator, counselor, manager, and social mobilizer, whenever possible. Depending on the number of examinees, two or 3 sets of OSCE stations will be conducted simultaneously in 2 or 3 separate rooms. The examinees will be grouped in advanced according to the rules set by the Specialty Board. Most if not all stations will utilize simulated patients. Each

8

station will be ten (10) minutes: 2 minutes to read the case prior to entering the cubicle, then eight (8) minutes to perform the task(s) at hand. This year, an international external auditor from the United Kingdom will be observing

the conduct of the OSCE. She will observe the behavior of the examiners, simulated patients and processes employed in general, not the examinee. Hence, her presence will not impact the performance ratings of the examinees. Day 1: Seven (7) Focused (F) OSCE Stations + 1 rest station

Station F1: Clinical Skills: Focused History Taking Station F2: Clinical Skills: Physical Examination skills Station F3: Clinical Procedure Skills: Performing a clinical procedure Station F4: Clinical Management Decision Skills: Diagnostics in a clinical case Station F5: Clinical Management Decision Skills: Pharmacologic and non-

pharmacologic Management in a clinical case Station F6 & F7: Family Medicine Skills: Family Management and interventions Station 8: Rest station Day 2: Seven (7) Integrated (I) Case OSCE stations + 1 rest station Stations I1 to I7: Integrated cases: Representative clinical scenarios encountered in actual

practice Station 8: Rest station Example of an Integrated Case:

Your patient, Tim Horton, aged 45, comes in because of pain in his right big toe. You are not given any other information. You must assess and manage the patient. You have eight minutes.

A. CONDUCT OF THE OSCE

1. All examinees must be in proper attire: Comfortable smart casual attire and comfortable shoes. No shorts, no mini-skirts, no slippers will be allowed. Blazers and sweaters may come in handy.

2. All personal belongings including mobile phones, wrist watch, and unnecessary accessories must be kept in their bags, which will all be placed in the front area of the room. Cellular phones should be turned off. A big clock will be displayed in the testing rooms.

3. Powered off cellular phones will be presented to the proctors prior to safekeeping in the examinees’ bags.

4. Examinees should report to their assigned rooms at least 60 minutes before the start of

the examination. Examinees will be divided into groups and all examinees should stay in the designated holding areas.

5. The examinee must present their TEST PERMIT and a valid government ID (PRC card,

Driver’s License, Passport).

6. The examinee must bring only their test permit at the stations. The examiner in every station will sign the test permit.

7. Medical references and other reading materials are NOT allowed in the holding area.

8. Toilet break is only allowed while the examinee is in the holding area.

9. The examinee will find a series of rooms known as ‘stations’. There will be seven (7) stations on Days 1 & 2. Stations are manned by an examiner with simulated patients /

9

actors. Each station requires the examinee to undertake a set of tasks. The examinee is expected to perform all the tasks as instructed and shall be graded accordingly using a rating scale.

10. A group of 7 examinees according to the master list will comprise one batch or cycle. Each

examinee will be assigned a station. Hence, one may not begin with Station 1, but the flow of movement from station to station will be consecutive (e.g. Station 2 Station 3 Station 4 etc)

11. Before entering a station, the examinee will sit on the “waiting” chair. Here, the examinee

has two (2) minutes to read the case and, compose his/her thoughts. Notes can be written on the scratch papers provided attached to the testing permit. Another copy of the case and instructions will also be available inside the station.

12. At the end of the 2-minute period, a bell will ring to signal the examinee to enter the station proper. Read the case and tasks again if necessary. Perform the tasks required within eight (8) minutes. A rating scale will be used to evaluate the performance of the examinee in each station. Questions can only be directed to the examiner if specifically stated in the instructions or when deemed necessary.

13. The bell will ring at the end of 8 minutes to signal the examinee to stop and exit the station proper. At this point, the examinee should proceed to the “waiting” chair of the next station. If the examinee finishes the tasks before 8 minutes, he/she must stay put inside the station proper. Casual conversation with the examiner or the patient during this time is not allowed.

14. The examinee should continue in this manner until all the stations have been completed. The OSCE is then considered finished.

15. A REST station will be encountered after Station 7.

16. Any attempt to communicate with a co-examinee while they are going through the stations

is presumed cheating. 17. The examinee shall surrender the test permit (together with the scratch papers) to the

area coordinator after finishing all the OSCE stations. The examinee shall also accomplish the feedback / evaluation form.

18. For this year, after completing the feedback/evaluation form, the examinees may be

gathered by the external auditor for additional queries.

19. The Chair of the Specialty Board reserves the right to change any OSCE case if there is a breach or leakage of information or to modify the process at any given time when deemed necessary.

10

III. POLICIES ON THE EXAMINATIONS

1. An eligible examinee has the option to take one (oral alone or written alone) or both exams (written and oral) in the same year after complying with the requirements.

2. Passing the written examination is NO longer a pre-requisite for taking the Oral Examination.

3. Examinees who passed only one exam are given three (3) consecutive years to take and pass the remaining exam.

4. Examinees who failed to pass both exams within the 3-year period will invalidate the result of the exam that was already passed. They shall also be required to take the refresher course offered by FaMED (Foundation of Family Medicine Educators, Inc.). The certificate of attendance in the refresher course and compliance of the CME/CPD credit requirement are needed to be eligible to take the exams again and subjected to the same 3-year validity period if they pass only one exam.

5. Only those who take both exams for the first time in the same year will be eligible to be considered as the board topnotcher.

6. After registering for the examination, the examinee agrees to abide with all the policies and procedures stipulated in the primer and the consent form.

7. In case of failure to take the exam for no valid reasons (validity to be decided by the chair), the examination fees shall be subject to the “no refund” and forfeiture policy. After deducting the cost of the review materials and mailing cost, 50% will be refunded if canceled within 7 days after the deadline; and no more refund thereafter.

8. Any form of cheating or dishonesty will disqualify those found guilty. The Specialty Board may declare a failure of the whole exam if there is massive cheating, breach or leakage of information of the questions. In such case, another exam will be re-scheduled.

9. The Chairman of the Commission on Specialty Board of Examiners shall recommend to the PAFP National Board the examinees who have passed both written and oral within the same year or within the prescribed 3-year period.

10. The National Board of Directors shall officially endorse the candidates for the title of Diplomate in Family Medicine to be conferred during the Annual Convention.

11. The successful candidates will only be officially notified upon approval by the National Board of Directors.

12. The decision of the Commission on Specialty Board and the National Board of Directors are considered final and executory.

IV. RELEASE OF RESULTS

For a fair and just conduct of the examination process, the Board of Examiners will set a mean passing level (MPL) and perform item analysis of the test questions. These shall serve as a guide to assess the validity, reliability and outcome of the examinations.

Successful examinees will be posted on the PAFP website and Facebook Page using the Examinee Number indicated on their testing permits. Hence, it is important that the examinee remembers and notes down his/her examinee number. Official letters indicating the results of the exams (passed or failed) will then be sent to all examinees by the Commission on Specialty Board. No more verbal or telephone inquiries on the results of the exams will be entertained by the PAFP Secretariat.

A formative feedback may be given to those who did not pass the examinations only when

requested in writing and approved by the Specialty Board.

Prepared by:

Ma. Teresa Tricia Guison-Bautista, M.D. Chair, Commission on Specialty Board, 2017

11

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS

#2244 Taft Avenue, Malate, 1004 Manila

Tel. No. 516-2900/405-0140; Tel./Fax: 254-5646

Globe: 09175486550 Smart: 09088666124 Sun: 09328528743

E-mail Address: secretariat@thepafp.org

APPLICATION FOR DIPLOMATE EXAMINATIONS Deadline of application form and payment for Written: September 30, 2017, Saturday

Deadline of application form and payment for Orals: November 11, 2017, Saturday

THE CHAIR Specialty Board of Examiners Philippine Academy of Family Physicians Please be informed that

I am taking both written and oral examinations Php 4,000 Mode of Payment

Cash

Cheque No.___________

Bank deposit __________

I am taking only the written examination Php 2,000

I am taking only the oral examination Php 2,000

I am not taking the examination -----

Account name: PAFP through any of the branch of the following banks: BDO S/A No. 004580325004; BPI S/A No. 1623-03116-7; MBTC S/A No. 509-7-50990454-1. After deposit has been made, please send the bank deposit slip either by email secretariat@thepafp.org.

CONSENT

No-show during examination: In case of failure to take the exam for no valid reasons, the examination fees shall be subject to the “no refund” and forfeiture policy. After deducting the all the operational costs (materials, mail etc), 50% will be refunded if canceled within seven (7) days after the set deadline of payments; and no more refund thereafter.

Article XII, Section 11: Any personal inquiry or questions regarding the results of the examination must be made in writing addressed to the Chair within a month after receiving the examination results; otherwise, inquiries beyond the allowed period will no longer be entertained.

Article XII, Section 14: The decision of the CSBEFM and the National Board is final and executory.

Article XV, Section 3: Any issue raised by an examinee regarding the conduct and results of the examination will be evaluated by the Chair and/or members of the Specialty Board and shall try to resolve the matter in their level. Any issue that remains unresolved will be elevated to the PAFP National Board for final action.

Article XVI, Section 1: The Chair of the Specialty Board is the only person authorized to release

the results of the examination after the presentation to the National Board. Proper procedure for dissemination shall be followed.

Article XVI, Section 2: Requests for results from any examinee for formative feedback purposes only will be attended to if a written request is made within 30 days and after the Specialty Board Officers have agreed to the request. I have read and fully understood the implementing rules and regulations of the Specialty Board Examinations. Print Name and Signature: _______________________________________________

Chapter / Institution: _____________________________________________________

Mailing Address: ________________________________________________________

Home / Mobile Nos. _____________________________________________________

Email Address:_________________________________________________________

Special needs or diet / requested, if any (vegetarian, vegan, halal):__________________

12

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS EXAMINEE NO. _______

SPECIALTY BOARD EXAMINATIONS

ORAL EXAMINATION PERMIT December 2, 2017, Sat, 9:00 am

December 3, 2017, Sun, 9:00 am

Please arrive one hour before the examinations.

Permit to be filled up and submitted together with the application form.

It will be claimed upon registration on the day of the examination.

NAME (Surname, First, Middle Initial)______________________________________________________________

CHAPTER/TRAINING INSTITUTION: ____________________________________________________________

MAILING ADDRESS:___________________________________________________________________________

______________________________________________________________________________________________

CLINIC/HOSPITAL & ADDRESS_________________________________________________________________

TEL. NO. : ________________________MOBILE NO. _______________________________________________

PRC NO. __________________ PMA NO. ________________ E-MAIL: _________________________________

Verified by:

____________________________

Examiner

- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - - - - - -

PHILIPPINE ACADEMY OF FAMILY PHYSICIANS EXAMINEE NO. ________

SPECIALTY BOARD EXAMINATIONS

WRITTEN EXAMINATION PERMIT October 22, 2017, Sunday

9:00 am to 3:00 pm

Permit to be filled up and submitted together with the application form.

It will be claimed upon registration on the day of the examination.

NAME (Surname, First, Middle Initial)______________________________________________________________

CHAPTER/TRAINING INSTITUTION: ____________________________________________________________

MAILING ADDRESS:___________________________________________________________________________

______________________________________________________________________________________________

CLINIC/HOSPITAL & ADDRESS_________________________________________________________________

TEL. NO. : ________________________MOBILE NO. _______________________________________________

PRC NO. __________________ PMA NO. ________________ E-MAIL: _________________________________

Verified by:

____________________________

Examiner

PHOTO

PHOTO

13

ENDORSEMENT FROM DEPARTMENT CHAIRMAN, TRAINING OFFICER (For Residents) ENDORSEMENT FROM CHAPTER PRESIDENT (For CME Track)

Requirement for Taking the Specialty Board Examinations in Family Medicine

Written Examination: October 22, 2017 Oral Examinations: December 2-3, 2017

CHAIRMAN’S ENDORSEMENT

I hereby endorse the application of DR. __________________________________________ to take the written / oral diplomate examinations in Family Medicine. Chairman (Name and Signature) _____________________________________________ Institution _________________________________________ Date ___________________

TRAINING OFFICER’S ENDORSEMENT I hereby endorse the application of DR. __________________________________________ to take the written / oral diplomate examinations in Family Medicine. Training Officer (Name and Signature) _________________________________________ Institution ______________________________________ Date ______________________

CHAPTER PRESIDENT’S ENDORSEMENT (For CME Track) I hereby endorse the application of DR. __________________________________________ to take the written / oral diplomate examinations in Family Medicine. President (Name and Signature) ______________________________________________ Chapter ________________________________________ Date ______________________

14

15

SPECIALTY BOARD OF EXAMINERS

2017-2018

Ma. Teresa Tricia Bautista, MD Chair

Marie Ruth A. Echavez, MD Vice-Chair

Ellen May G. Biboso, MD Secretary

Irmina Concepcion C. Beltran, MD Regular

Vivien Fe F. Fadrilan-Camacho, MD Regular

Polly Chua-Chan, MD Regular

Ma. Cecilia Cuaresma-Cruz, MD Regular

Violeta C. Rendon, MD Regular

Imelda Q. Tiglao, MD Regular

Marocel C. Montillano, MD Regular

Mae Lynn M. Acebuque, MD Regular

Josephine Yu-Cubillan, MD Regular

16

Aida D. Capulong, MD Regular

Aeesha Y. Pingli, MD Regular

Evelyn A. Siao-Brigino, MD Regular

Dax M. Tidula, MD Associate

Alma Sheila S. San Miguel, MD Associate

Andresul A. Labis, MD Associate

Djhoanna Aguirre-Pedro, MD Associate

Laricelle Feliciano-Paguican, MD Associate

Ma. Nerissa D. Gonzales, MD Associate