什麼是 CIPS？
CIPS 全名是 Certified Interventional Pain Sonologist，是世界疼痛醫學機構（WIP, World Institute of Pain）所舉辦的超音波介入性治療的認證考試。目前全世界通過認證的醫師只有一百多位，台灣從 2016 年起陸續有好幾位優秀的醫師（2016, 2017）取得資格。
為什麼想報名？
CIPS 是考試程序更嚴謹的國際超音波認證，因為一直有在國內外超音波工作坊教學，能有更多的國際認證資格當然是最好。CIPS 報名費用相當昂貴要 2500 美金，之前要考必須飛到國外。這次居然可以在台灣考試，所以就決定忍痛刷卡報名了。
報名方式
可以紙本或線上報名，過程相當繁瑣，如果不是真的有心報考的人，可能在報名時就知難而退。因為要填寫及上傳的資料相當多，所以如果無法一次完成，線上報名程序可以暫存。比較困難的是報名需要有至少十二個月的疼痛醫學相關訓練的證明，這部分我是請台大北護分院的張凱閔醫師和吳威廷醫師幫忙寫推薦信。
考試方式
分為筆試和術科。筆試（佔20%）為單選題100題，考試時間為兩小時。內容以臨床和解剖知識為主，有一點 ultrasound physics 的內容，但不像 RMSK 考的那麼多。
術科包含四關的大體實際操作（佔60%）和一關的口試（佔20%）。大體實際操作包含下方圖上的四大項目（每大項目考一題），在考試報名程序時會要你填寫各項治療的經驗，如果真的完全沒經驗就寫 0，據說實際考試時就不會考這項刁難你（只是據說...）。四關大體操作總時間最多為一小時。
口試時間為 30 分鐘，有一位假病人，另外還有兩位考官。一開始會給你一張病人簡短的病史，最多可以看五分鐘的時間，之後考官就開始挑戰你，總共有大約十題關於診斷和治療的問題，考驗你的思考流程、理學檢查以及超音波技巧。
考試準備及經驗分享
WIP 官網其實有考試參考資料（我也是打這篇文章的當下才看到）。不過就算之前知道平常太忙也沒有時間看，所以其實是單純以實力應戰（自信！）。
術科考試時除了把該執行的超音波導引注射在大體上做好，還要記得口頭描述：超音波下怎麼找 target、周圍有哪些解剖構造、是不是懂得調整機器設定（depth, frequency, focus, gain…）、注射前的消毒、打開 Doppler 以避開周圍較危險的血管、入針方式（例如：in-plane, lateral-to-medial）等，總之就是所有你會的全部秀出來，完成後和考官說，考官就會給分了。
口試我被考到的題目是創傷後單側上肢近端無力的病人，最後的診斷是 brachial plexus upper trunk injury，還考了 waiter's tip 的姿勢。過程就是拿出自己平常看病人的本領，然後一路過關斬將，其實還挺有趣的。
最後非常感謝台大北護分院張凱閔醫師和吳威廷醫師的考前經驗分享，讓我不是在完全不清楚的狀況下去考試。另外平常擔任超音波醫學會的工作坊講師（USMSIT, NMUSIT）時聽的課程也幫助很大。最後感謝戰友蘇炯睿醫師和劉炳塘醫師考試時的互相鼓勵。恭喜大家都順利通過了！
There are references helpful for the examination on WIP website. The content of the theoretical examination is mainly on the anatomy and the clinical problem. There are some questions regarding the US physics which might be kind of hard for clinicians, but not many. So it would not be a problem to pass the theoretical exam.
For the practical examination, in addition to performing the assigned US-guided technique on the cadaver, you need to orally describe the following simultaneously: how to locate the target, what important anatomic structures are around, how to adjust the machine setting (including depth, frequency, focal point, gain...), stating disinfection before you put the needle in, turning on the Doppler to avoid critical vessels (although you can never see a pulsating vessel on the cadaver; it is better if you can name the critical vessels to avoid), the approach method (e.g. in-plane, lateral to medial). In short, you show the examiners ALL YOU KNOW. When you are done, you tell the examiners "this is my final needle position", and the examiners will award a score for the performed procedure.
特別感謝
最後非常感謝台大北護分院張凱閔醫師和吳威廷醫師的考前經驗分享，讓我不是在完全不清楚的狀況下去考試。另外平常擔任超音波醫學會的工作坊講師（USMSIT, NMUSIT）時聽的課程也幫助很大。最後感謝戰友蘇炯睿醫師和劉炳塘醫師考試時的互相鼓勵。恭喜大家都順利通過了！
CIPS exam experience sharing
How to apply
There is detailed information about CIPS examination on its website. For the examination application, it is easier to apply online. The process is really time-consuming. You have to fill in lots of information and upload lots of documents, of which the most important is the proof that you have engaged in 12-month post-residency training of pain medicine (I asked Prof. Ke-Vin Chang and Dr. Wei-Ting Wu to write recommendation letters for me as the proof).
About the test
- Theoretical examination (20%): 100 four-option multiple-choice questions. Examinees have two hours to respond.
- Practical examination (60%): two examiners are in presence. The examinee is required to perform 4 procedures on a cadaver in sixty minutes. One procedure of each of the four regions are assigned (the picture below). While you are filling the online application, you will be asked to answer your experience in these procedures. It is said (not sure) that if you have little experience in that procedure, you type "0", and then the examiners will not ask you to do that in the practical examination.
- Oral examination (20%): there will be one live model as the patient. Two examiners will give you 5 minutes to review a short case history. Then the examiners will challenge you with up to 10 questions to test your thinking process, physical examination, and ultrasound (US) skills (on the model).
Examination preparation and experience sharing
There are references helpful for the examination on WIP website. The content of the theoretical examination is mainly on the anatomy and the clinical problem. There are some questions regarding the US physics which might be kind of hard for clinicians, but not many. So it would not be a problem to pass the theoretical exam.
For the practical examination, in addition to performing the assigned US-guided technique on the cadaver, you need to orally describe the following simultaneously: how to locate the target, what important anatomic structures are around, how to adjust the machine setting (including depth, frequency, focal point, gain...), stating disinfection before you put the needle in, turning on the Doppler to avoid critical vessels (although you can never see a pulsating vessel on the cadaver; it is better if you can name the critical vessels to avoid), the approach method (e.g. in-plane, lateral to medial). In short, you show the examiners ALL YOU KNOW. When you are done, you tell the examiners "this is my final needle position", and the examiners will award a score for the performed procedure.
In my oral examination, the scenario was a patient with proximal upper limb weakness after a trauma. The final diagnosis was brachial plexus upper trunk injury. The examiners also tested me the typical posture "the waiter's tip" of this kind of patient. Anyway, you have to come up with your housekeeping skills to encounter the challenges they give you. The process was actually interesting.
