Archive for March 19th, 2015

My Experience: Fachsprachenprüfung in der Ärztekammer in Münster (Medical German Language Test)

Like always: Please post any questions or additional information public here in this post (comments boxes are at the end of this page) not in a private message. I really do not have time only to help one person at a time! Here will all to see and participate!

 

Sequence before doing this exam:

– 03.06.2013: I got my meical degree (MBBS) from Mutah University, Karak Jordan.

– 01.07.2013: I began learning the German language in Jordan (My experience in learning the German language here: “Ten months from zero to B2 Goethe Certificate outside Germany”, http://amanfrommoab.com/2014/07/23/experience-ten-months-zero-b2-goethe-certificate-outside-germany.

– 10.07.2013: I began my internship year in Jordan.

– 29.04.214: I got B2 Level from Goethe-Institute in Jordan (77,5) but contined learning German in order to reach the C1 level and to pass Telc’s B2-C1 Medical Exam. But most importantly, to imrpove my language because this is, with Approbation and working experience, the most important factor in getting a job in Germany.

– July 2014: I finished my internship year.

– October 2014:
– – I came to Germany and started a B2-C1 medical German course and C1 courses (One general and the other to prepare for Goethe’s C1-Exam.

— I did a one week Hospitation in psychiatry. Unfortuantely, I could not do more. I was restricted to the language course. Not doing a Hospitation was a great advantage because I spent three months at home not being able to interact with Germans and living with Arab colleagues. Finding accomodation in WGs (Wohnung Gemeinschaften, i.e., shared accomoation) with Germans is very hard if you only plan to stay in a city for less than three months. In addition, finding such accomodation requires a lot of interviews and waiting.

— I applied for Approbation at middle October. My documents had problems with the legalization. I received a mail three weeks later informing me about the mistakes. I corrected them and my papers were then sent to Gutachten (Middle November). My total Approbation experience is here.

– October and November: I had a lot of time because the courses were not intensive enough. I tried to attend conferences, scientific days, and lectures related to my wanted specialty and I suceeded. Most importantly, I attended a conference of the largest German society for psychiatry (DGPPN, official website) and that helped me to make contacts and to tremendously imrpove my knowledge about psychiatry in Germany. I came to know about such events from visiting the websites of univeristies, hospitals and that of the DGPPN.

– Early Dececmber 2014: I did Goethe’s C1 exam. But was distressed that the results need at least six weeks to appear. I waited about two months to get my certificate. I passed with 82.5. The preparation course for the C1 exam helped me a lot. It is really amazing.

– After attending the important psychiatry conference of the DGPPN, I sent seven printed applications for a job in Psychiatry in the District Governemtn of Arnsbeg. I got two interviews. I was accepted to beging working with Berufserlaubnis (i.e., before getting my Approbation).

– January 2015: Due to new laws, and because my medical degree was judged equal to that in Germany, I was then to do the Fachsprachnprüfung in the Ärztekammer in Münster. I could not get a Berufserlaubnis.

– 28.02.2015: I did the Fachsprachenprüfung and passed it. It was not easy. I will get my Approbation in about 10 days.

– 18.03.2015: I did the exam on 28.02.2015 and got my approbation 18 days later. They required from me to send a German Führungszeugnis (This document costs 13 Euro and one can get from the Rat Haus in the place where he is Angemeldet), a new Straffrehit und a new Ärztliche Bescheinigung (These two documents are in the website of the District Government of Arnsberg. Download them. You simply sign the first and the other one needs to be filled by a doctor. The last two documents need to be sent again when they are older than three months at the time of issuing the Approbation. I am in Germany since less than 6 months. However, I was asked to send the Führungszeugnis (Because in their leaflet, it states that this document need to be sent when the doctor is in Germany since at least six months). I politely complained to the responsible employee about this document and the previous two documents because these requiremnts are not present in the published leaflet. After some discussion, the employee thanked me and I think that she said that they would consider adding this information in the website.

More details about the above documents in this post: “My Experience and Required Documents: Applying for Approbation in Bezirksregierung Arnsberg (Updated on 10.02.2015)”, www.amanfrommoab.com/2014/10/21/experience-applying-approbation-bezirksregierung-arnsberg-2014-10-21/.

Less than 10 minutes after passing the Fachsprachenprüfung in front of the building of the Ärztekammer in Münster. Wishing the same for you! - Jameel Hijazeen جميل حجازين

Less than 10 minutes after passing the Fachsprachenprüfung in front of the building of the Ärztekammer in Münster. Wishing the same for you!

 

• The exam:

– This is the official webpage of the exam: www.aekwl.de/index.php?id=5346.

Which doctors do this exam?

– Graduates of the European Union and doctors from outside of the European Union who applied for Approbation in the District Governemnt of Arnsberg, Detmold and Münster and whose medical certificates are judged equal to those of Germany’s medical schools (Gleichwertigkeit bekommen).

– You cannot simply apply to do this exam if you did not apply for Approbation in one of these authorites. See a detailed example for Arnsberg here.

How much does the exam cost?

– 300 Euro. You transfer the money to the account of the Ärztekammer. You can do that with online banking from your PC. I did that with my account at the Deutsche Bank. This takes less than 10 minutes.

How can I register for this exam?

After your meical degree is judged equal (gleich), you will get an E-Mail from the Ärztekammer telling you that you can register the exam and giving you a list of possible appointments, a bank account to transfer the money, and asking you to send them in a reply email: Short CV, a scanned copy of your B2-Certificate, and a proof of the money transfer (I transferred the money online and I sent them a PDF version of the transfer order from my Deutsche Bank online account) and to specify two dates in which you can take the exam.

After sending this email, they will reply telling you of the date of your exam and that they would contact you about 10 days before your exam in order to let you know at what time you will do the exam.

If you have an Einstellungszusage then you can get an earlier appointment (as early as two-three weeks). It is best that the hospital contacts the Ärztekammer with an email.

What happens if you failed this exam?

– You can repeat the exam. A limit for the repetitions is not specified. Simply because about all doctors passed this exam in the last years. Recently, the exam is hard and many now fail in the first time. However, I never heard or read about people who failed more than two times. [Update 21.03.2015: Yesterday, I met an egyptian doctor who failed this exam for a second time! I do not think it is hard now to fail the exam two times!].

How much do you need to wait before you could repeat the exam?

– “Man soll mindestens drei Moanten warten”. A doctor who failed the exam told me that this was written on a paper telling him of his result. But now, because the doctors who need a Berufserlaubnis in Arnsberg are required also to pass this exam, then the waiting list is long. At the end of March, for example, two colleagues of mine were told that they need to wait until early may to do the exam.

To repeat the exam, the doctor who failed need to contact firstly the District Government in order that they in their turn notify the Ärztekammer to allow for the doctor to register again for the exam. The employees sometimes make this slow so that the doctor who failed would learn more German. For example, an employee in Arnsberg told a doctor who failed the exam that she would not allow him to do the exam again before he sends her a proof that he took a German medical language course.  As a result, the whole process is slow and according to what I read and heard, at least three months would pass before being able to do the exam again.

Where and when is the exam held?

– In the Ärztekammer Westfalen-Lippe. Website and location on Google Maps. The exam is most often held on a Saturday.

There is a train station that is at a walking distance of about 8-10 minutes from the Ärztekammer. It is called “Münster Zentrum Nord“. Taking a Taxi from the Hauptbahnhof in Münster costs about 8-10 Euros. Taking the train from Münster Hauptbahnhof to this station costs around 2,5 Euro.

Duration of the exam?

– The exam lasts officially one hour. But for some, it lasted about 70 Minutes and for others 1.5 hours. The last happened with a colleague of mine from my hospital who did not do so good in the history taking part. The examining doctors then told him that they would ask him medical information in order to give him a second chance. According to my friend, the questions about mediccal knowledge lasted about 30 minutes and then they told him: “For the history that you took, you do not deserve to pass the exam. But because you medical knowledge is good, we will give you the Approbation!”.

The exam:

Fachsprachenprüfung Münster

– It is divided into three parts. The first part is history taking for 20 Minutes. There is a committe of three doctors, or two doctors and a secretary. One doctor plays the role of a patient. You write the history on blank papers. You are all comfortablly sitting in a room and you are offered some thing to drink!

After you take the histroy, you are taken to another room to write it. You have the options either to type if on PC or on a specific paper. Here is the paper:

[su_document url=”https://amanfrommoab.files.wordpress.com/2015/03/2e546-sprachtest-muster-anamnesebogen1.pdf” height=”860″]

For those who would like to type, you will type on a similar form like the paper above. It is an interactive PDF file. I chose to type because I type quickly (in German around 65 words per minute) and on PC you can correct mistakes. The doctor warned me that not many doctors do that and that I do not have a lot of time. I chose that nonetheless and later I think that the doctor liked it because he told the others in a little bit impressed way: “Yes, he typed it. Not many doctors do that!”. Yes, does the interactive PDF file shows you mistakes in grammar and spelling? No! It is not like Microsoft Word and I can easily imaging that are certainly not allowed to use Microsoft Word in the exam to check what you wrote.

Writing about the physical examination after writing the history is not required because you simply do not do a physical examination in the exam.

After writing/typing the history, you go back to the committee to discuss the history. You are asked questions like:

– “Can you summarize the history”

– “The patient is the hospital since yesterday, what did you do to him?”

– “What is your differential diagnoses and provisional diagnosis”

– “What is the treatment?”

– “What investigations do you want to do?”

– Not for all doctors, but many are asked to do Aufklärung, i.e., explanation of a medical procedure or operation to the patient. For example, endoskopie, koloskopie, appenziktomie, etc. You can find a lot of resouces in Google. For example, “Aufklärung Koloskopie“. Also see a document below by a Jordanian doctor which also contains Aufkärungen (they are a little bit short but they can give you an idea about what is important to say in the exam).

Now, medical information is asked about. Although this exam  is not a knowledge exam, but such information are asked about in general. Details not required. Not all committees do so but many doctors are now faced with knowledge questions. Some say, this would not determine of you fail or pass and that the most important part of the exam is history-taking. If the history taking is excellent, and you answered more than half of the Lateinsisch-Deutsch words translation at the end of the exam, then you can pass.

Most often asked about cases:

Recently, they are not being restricts to these. One important thing to note is that your case is most likely a part of your specialty or in which specialty you did a Hospitation.

  • Kopf: Schlaganfall + Kopfschmerzen (D.Dx. Migräne & Meningitis)
  • Hals: Halsschmerzen (Halswirbelsäule Syndrome)
  • Brustkorb: Brustschmerzen (MI) + Bronchial Karzinom + Husten und Fieber
  • Bauch:
    • o Oberbauchschmerzen (Gastritis, Ulcus, akute Appendizitis, akute Cholezystitis
    • o Unterbauchschmerzen rechts (akute Appendizitis)
    • o Unterbauchschmerzen links (akut Divertikulitis)
  • Rücken: Rückenschmerzen
  • Untere Extremität: (Beinschmerzen bzw. –schwellung) tiefe Venenthrombose + Peripherele Arterielle Verschlusskrankheit.
  • Kniegelenkschmerzen oder Gelenkschmerzen oder Sprunggelenkfraktur oder -torsion.

 

Challenging questions:

An important skill in the histroy-taking is answering challenging questions (Like in the USMLE). For example:

– A patient has pain in chest. His father died because of lung cancer. He asks you, “Docotor, I will die! My father had this pain and he had cancer and died!”. The following is an example of a patient who has right upper abdominal pain and tells you suddenly in the exam that she thinks that she has liver cancer.

– Ich habe Angst, weil ich denke, dass ich Leberkrebs habe.
– Warum denken Sie so? (Haben Sie die Ergebnisse von Untersuchungen? Hat ein Arzt solche Diagnose Ihnen gegeben?)
– Nur so… Mein Vater hat auch rechte Überbauchschmerzen. – Ich verstehe Ihre Angste Frau Müller. Es ist eine Mögichkeit, dass rechtsüberbauch schmerzen durch Lieberkrebs verursacht können. Aber das ist sehr selten. Auf hand des Anamnesegeprch so weit, das ist sehr unwahrscheinlich und ich habe andere Diagnosen im Kopf. Aber ich werde Ihre Sorge sehr ernst nehmen. Wir machen jezt das Anamnesegespräch und danch die körperliche Untersuchung fertig und danach verornene ich ein paar Untershcuhng um die Ursache Ihrer Schmerzen zu finden und Lieberkrebs auszuschließen.

Oder:

Pat: Herr Doktor. Ich werde sterben. Ich glaube, ich habe Lieberkrebs!

Dr: Krebs? Warum denken Sie so Fr./Hr.?

Pat.: Ich habe im Internet gelesen und meine Symptome sind ähnliche wie die Symptome von Lieberkrebs.

Dr: Ich verstehe. Es ist richtig, dass Krebs Symptome wie Ihrer verursachen könnte, aber auf Grund was sie bis jetzt zu mir beschildert haben, das ist eher unwahrscheinlich Aber danke das Sie das zu mir erwähnt haben. Ich werde das bestimmt in Betracht ziehn. In der Anamnese jetzt und später in der körperlichen Untersuchung und Untersuchungen werde ich sicher diese Diagnose aus- oder einschließen.Wenn nötigt werde ich eben nach der Meinung des Chefs fragen. Aber beruhigen Sie sich bitte und machen Sie sich keine Sorge! Jetzt können wir vielleicht das Anamnesegespräch weiter führen um die richtige Diagnose zu erreichen. OK? Also … Wo sind wir stehen geblieben (Where did we stop/Arabic: WEEN KONA?)

– A patient has a strong abdominal pain. He does not want to allow you to continue the history before your giving him an analgesic. Suggested answer from me (it is a little bite long):

Es tut mir sehr Leid Fau Müller. Ich verstehe, dass Sie viele Schmerzen haben. Das ist bestimmt unangenehm. Aber haben Sie bitte ein bisschen Geduld. Wir können nicht Bauchschmerzen behandeln, bevor wir die Ursache Schmerzen wissen. Das heißt, wir stellen zuerst eine Diagnose und gemäß dieser Diagnose können wir Sie behandeln. Damit wir die richtige Diagnose erreichen können, müssen wir jetzt das Anamnesegesprächt weiter machen. Es dauert nicht lnage. Danach mache ich eine körperliche Untersuchung und verordne ein paar Untersuchung und bildgebende Verfahren. Alles in Ordnung? Wo waren wir stehen geblieben? Also… Die Schmerzen sind nicht dauerhaft da… uzw.

 

– A patient starts telling you that he is afraid of his disease and that he cannot concentrate. He does not allow you to take the history.

– A patient starts talking excessively about things not related to his disease. You need to bring him back to the topic.

– A patient is afraid to start taking Warfarin and asks you: “I heard that this medication has a lot of side effects. I do not want to take this drug” or “does it really have a lot of side effects?”. A german medical language teacher of mine told us that a doctor faile the exam as a result of the above question. The doctor began her answer with: “Yes, this medication has a lot of side effects” and then certainly went on to explain about the “nice” complications of Warfarin. The examining doctors told her that she failed because she caused the patient a lot of stress and fears.

I could not find resources in German to prepare myself for that. There are materials in Englisch for the USMLE CS exam.

– Flash cards – Step 2 CS difficult patients

– You can dig more in Google… Google search for “answering challenging questions usmle“.

A little material that I prepared about the above:

[su_document url=”https://amanfrommoab.files.wordpress.com/2015/03/591d7-berc3bchigung-und-arbeitsplan.docx” height=”860″]

 

• During taking the history, never ever use latin terms with the patient. Use only the german translation. And during presenting the case to the doctor, never ever use German words, use lateinsich terms. See the explanation about the last part of the exam at the end of this post.

 

A short template that I prepared for taking the history: 

Ask only these questions and you will cover everything. Repeat the sequence in this template, or simply modify it or develop your own. The idea is that you always take the history in a certain sequence so that with time you would never forget to ask about a part of the histroy (e.g., forget to ask about allergies, vaccinations, fever, weight, apetite, etc.). In Macleod’s Book of Clinical Examination, I think I once read about a beautiful idea regarding the correct sequence of the clinical examination. Should one examine the hands firstly or the head? Or maybe the lower limb firstly?

“There is no correct sequence of the clinial examination. The correct sequence is YOUR SEQUENCE. Just develop your own sequence and always stick to it!”

 

[su_document url=”http://amanfrommoab.com/wp-content/uploads/2015/03/Patientenprofil.docx” height=”860″]

 

A video explaining taking the history in German as required by the Ärztekammer in Münster (also applies to most other authorities): Click here please!

 

• Last part of the exam: Translating from Lateinisch to Deutsch

You are giving a list of 10-12 Words which are in lateinisch and you are to give the German equivalents. For example:

– Appendiziktomie – Blinddarmentfernung (oder genauer: Wurmfortsatzentfernung)

– Thyroid – Schilddrüse

– Diabetes – Zuckerkrnakheit

– Extension – strecken

– Antiemetic – Medikamment geggen Übelkeit

– Myokardium – Herzmuskel

– Endometritis – Gebäremutterschlemihautentzündung

– Endoskopie – Magenspiegelung

– Abdomensongorafie – Bauchultraschalluntersuchung

– CT – Computertomografie – Querschnitttomografie

– MRT – Magneticresonancetomografie – Kirnspintomografie

– Basiloma – weißter Hautumor

– Herzinssufiziene – Herzschawche

– Thromobztopenia, spinal kanal, Hematom, Hemoptysis, Antazid, Thrombus, Lungenembolie, Nullipara, etc.

For this part of the exam, there is a book by Dr. Nabeel Farhan, the founder of the Patientenkommunikationtest und head of the Freiburg International Academy. This book contains at the beginning very useful information related to histroy taking and then contains more than 70 pages of translations of German-English words. It is very useful and most doctors I know read it. The book is titled: “Medizinische Fachsprachenfortbildung für ausländische Ärzte“. I would also suggest simplzy reading German health news and using Google Chrome Add-Ons for immediate translattions (see the full details and instructions in this post of mine: “The Most Interesting and Quiskest Way to Learn a Lot of German Vocabulay and Pass Goethe’s B2 Exam“). This is a slower method for learning but is more intersting and the information learnt are certainly better understood than simply memorizing translations like in a dictionary. I think that the best method is combining the two methods and Farhan’s book is certainly a must.

 

Fianally, the following post in the Facebook Group “Egyptian Doctors for Germany” contains the written experiences of at least 10 doctors. This include the histories and the Begriffe. I totally recommend reading it. It would help you extremely, especially if you knowa Arabic:
https://www.facebook.com/groups/377408505663230/permalink/800039526733457/ 

 

Update 04.07.2016:

In this post is a great summary of the needed material for the Fachsprachenprüfung! It is really amazing! It contains almost all things! If I am to do the exam, then I would probably would not need a lot more than to read this summary. Of course, the more you learn, the better, but this summary really contains everything. It is prepared by an Egyptian doctor called “Muhamad  Jamal  Ataya”. I do not know him personally. I found a link to this great summary in a post in the group “Egyptian Doctors for Germany”.

https://www.facebook.com/groups/FIA.Egyptian/1121646134568321/