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2026年全國醫(yī)學英語水平考試（METS四級）精選模擬試題及答案四
1). Why and When to Consider Taking a Family Medicine Board Review Course■As with most medical specialties， there has been controversy over the past decade regarding changes to the maintenance of certification process for board-certified family medicine physicians (MC-FP) and， in particular， changes to the American Board of Family Medicine′s high stakes board exam process.Beginning in 2006， the ABF：■·Computerized and began offering its exam at an increased number of locations and times than in the past； this essentially required a major transition in the underlying testing theory and scoring process as well as an expansion in the exam′s question bank to enable the auto-generation of different exam versions that would be both secure and consistent in terms of knowledge-assessment integrity.■·Undertook a major overhaul of its exam blueprint， expanding from eight topic areas to 14， including population-based care and patient-based systems， plus eight additional modules from which test takers may choose the two they believe most salient to their clinical experience.■These changes were followed by a deep， yet short-lived decline in exam pass rates.And， while the decline was attributed ultimately to a different cause一namely the ABFM′s 2007 extension of board certification tenure from seven to 10 years (with conditions) - other trends have helped to perpetuate the idea that the exam process has become increasingly challenging for family medicine physicians.For example， the evolving structure of care delivery一in particular the dramatic increase in hospitalists as well as strong， steady growth in rates at which primary care physicians refer patients to specialists for clinical diagnosis and treatment - has reduced family medicine physicians′direct exposure to wider varieties of clinical cases， increasing the challenges of staying current with medical knowledge compared with physicians practicing in narrower specialty areas.■Family medicine physicians also practice in a much wider variety of clinical settings.For example， a PCP working for a large group practice in a wealthy suburb that encompasses separate OB， pediatric， and other subspecialties， might have a much narrower breadth of direct clinical experience from which to build new medical knowledge over time.They may also be less consistently exposed to cases more typically seen in poor， more ethnically diverse inner-city settings.Meanwhile， a PCP working for10 years in a rural private practice might see a greater variety of cases， but would be less likely to be in regular communication and sharing with other physicians and specialists.■While the addition of selectable exam modules seems intended to address real-world variability in family medicine practice， FM physicians are still challenged to keep up with ever expanding and changing arrays of medical knowledge across 14 specialty areas，quite a number of which they may never touch in daily practice.So， given these added challenges for family medicine physicians， what is the best way to go about preparing for the high -stakes ABFM recertification exam?■Top Advice for ABFM Exam Prep■Preparation leads to confidence， and confidence leads to success， says Dr.Mark Nadeau， a clinical professor and residency director in the Department of Family and Community Medicine at the University of Texas Health Science Center San Antonio，who has passed the ABFM exam on five separate occasions over the course of his career and now serves also as a senior reviewer with NEJM Knowledge+ Family Medicine Board Review.(For the full story of how Dr.Nadeau has learned to approach successful board- exam preparation， check out ABFM Exam Prep： Make Time and Make a Plan.)■Question banks (both online and print) have also become hugely popular， especially among younger physicians， because the activity of answering questions is often supported by mobile technology and can be worked into small increments of spare time during each day.In choosing question banks， focus on ones that offer plenty of practice answering clinically focused， exam-style questions that require high-level cognitive tasks such as application， analysis， and strategy versus just definition or understanding.Consider also taking advantage of adaptive learning technology (utilized by platforms such as NEJM Knowledge+) to zero in rapidly on weak spots.And be sure to complete practice questions in roughly the same distribution as the exam blueprint， as this will help in pinpointing specific knowledge gaps and directing more focused follow-up study for family physicians with major time constraints.■When to Consider Taking a Family Medicine Board Review Course■Materials set forth by board review course providers - including location-based，CD/DVD， and online- only programs一suggest that broad family medicine review courses might be best suited for physicians who：■·Have left exam prep until very late in their recertification cycles■·Are not especially disciplined about studying independently■·Are not typically strong test takers■·Have yet to experience computer-based versions of the exam■·Do not make a regular habit of keeping current with general medical knowledge via journals， conferences， peer networking， question banks， self-assessment tools， and so forth■·Have daily responsibilities such as child or elder care that can make it difficult to carve out.focused time for self directed study■·Practice family medicine in relative isolation (rural， private practice) or among patient populations lacking in ethnic， age， economic， or other forms of diversity■·Show downwardly trending test scores over time (a function of distance from academic settings and regular study)■·Have taken practice tests or utilized question banks and have performed poorly across the board (versus in just a few specific areas)■Choose Carefully■Board prep tools have weak and strong contenders， so careful research is always needed in deciding how to invest one′s time and money on specific board-review offerings.■Many review courses and other resources can be purchased conveniently online， but checking original publication dates for content as well as content revision frequencies is a must to ensure they are up to date with advances in medical knowledge (but not so u-to-date， that it overshoots the exam revision cycle) and up to date with changes in how the ABFM structures its exam to assesses knowledge.■While it is a reasonable assumption that family medicine board review courses have been developed using the ABFM exam blueprint 一meaning they portion course time appropriately across the breadth of subject areas covered in the exam一this is not a given and should always be verified when weighing family medicine board review course options.■A big positive for many family medicine board review courses is that一in addition to medical knowledge一they teach specific test.taking strategies， including how to rapidly deconstruct and decode exam questions.Family medicine review courses may also provide key insights into how questions are developed for the exam， how the exam is structured and scored， why it is important to answer every question (even by guessing)，and specific strategies for making best-possible guesses.■Family medicine board review courses may also train physicians to work more effectively in timed and computer based testing environments.When taking the actual exam， one has approximately 60 seconds to read， digest and answer each question； due to exam scoring methods， it is always best to answer every question.Practicing questions repeatedly within realistic time constraints can go a long way to relieving test-takers′anxiety.■While many family medicine review courses offer money-back guarantees， they are not as fail-safe as exam pass rates suggest.At the end of the day， each family medicine physician must make a clear and honest assessment of his or her own learning styles，capacities for retaining information and testing， and career -path priorities.■Please join our ongoing conversation about best practices for family medicine board exam review by sharing your own experiences with review courses in the comments below.Resources from the review courses( )
A.can all be bought online
B.must be up to date with public concern
C.have to be reviewed very frequently
D.need to keep up with the ABFM

正確答案：D
2). (一)■Alternative Therapies■1In recent years millions of Americans have turned to chiropractic， acupuncture，homeopathy， biofeedback， visualization and crystal healing， as alternatives to conventional medicine， or have “mixed and matched” conventional therapy with other， seemingly incompatible healing options.In 1990， Americans made 388million visits to primary care physicians within the medical “establishment”一and425 million visits to providers of nonconventional therapies.The highest use of alternative approaches was reported by relatively well educated and affluent whites from 25 to 49 years of age.Alternative therapies can be divided into three basic categories：botanical healing， hands-on therapies， and mind-body techniques.Some schools of practice， such as naturopathy， macrobiotics， and Ayurvedic medicine (a 4，000-year-old Indian healing tradition) rely on more than one form and sometimes advocate changes in diet or exercise patterns as well.Some alternative practices are derived from mainstream： medicine as practiced in other parts of the world， while others stem from contemporary “New Age” thinking.■2 Alternative therapy， in fact， is reshaping conventional medicine.Some medical schools offer courses ，on nonconventional medical practices and have begun to reexamine techniques once dismissed as； quackery.It is not unusual to find traditional cancer therapy being supplemented by relaxation exercises and support groups， or to see studies in leading medical journals on the impact of yoga or biofeedback on coronary artery disease， or to encounter best-sellers written by prominent physicians about the influence of laughter or hope on the immune system.■3Many physicians question the more extravagant claims of alternative therapies.They warn that these practices， if not downright dangerous in their own right， may keep people from seeking effective treatment.But it is becoming harder to deny that at least some alternative techniques work for some patients一even if medical science cannot explain exactly how.Furthermore， the growing acceptance of alternative therapies has led some critics of mainstream medicine to perceive it as the harbinger of a medical revolution.They predict that Western medicine someday will evolve from its narrow biochemical model to a “biopsychosocial”one that incorporates holistic thinking： a perception一sometimes regarded as a traditionally feminine one一that the body is an integrated unity and that emotional， spiritual， social， and environmental factors are as crucial in determining illness as physical trauma or biochemical events.While acknowledging that viruses play a role in inducing colds， alternative healers may also consider stress in the workplace， mental depression， and inadequate diet equally important.Before this century such thinking was common in conventional medicine.The fact that many traditional doctors have begun to reincorporate these ideas into their studies and practices reflects the success of alternative therapy advocates， as well as the frustration that many patients feel with conventional medical care.■4Conventional biomedicine has been particularly powerful in treating critical injuries and infectious diseases一broken arms or diphtheria， for example - and its stunning successes account for the relative decline in alternative therapies earlier in the twentieth century.But in recent decades， as many of our society′s pressing medical problems have shifted from infectious diseases to chronic conditions such as cancer， coronary artery disease， multiple sclerosis， back pain，and diabetes， biomedicine has been somewhat less effective.Critics， many of whom are baby boomers who grew up questioning authority， add that biomedicine has also been deficient in treating everyday ailments and in maintaining health..The holistic approach， with its emphasis on individual circumstances， provides an alternative for those patients who are frustrated by these limitations and by physicians who， they feel， regard them not as whole human beings but as body parts.■5Other people are attracted to alternative therapies because they deemphasize drugs， surgery， and technology.“Natural” approaches to good health such as herbs， lifestyle changes， healthful diets， massage and psychotherapy appeal to patients who want to participate more in their own health care.And in this age of exploding medical costs， few can afford to ignore the potential savings that may come from emphasizing wellness over disease and prevention over treatment-an emphasis common among alternative practitioner.■6 The most obvious distinctions between alternative and conventional care are less emphasis on well- defined educational standards required of practitioners；an emphasis on holistic or biopsychosocial explanations for illness， in contrast with the biomedical model that underlies conventional medicine； and different standards of scientific proof.■7Whereas a few successful cases may “prove” the efficacy of a therapy to an alternative healer， medical scientists disregard such anecdotal evidence.They argue that a certain number of patients are bound to get well with or without treatment.Studying just a few cases leaves open the possibility that the “cure” was the result of blind chance or the placebo effect一a phenomenon in which the patient′s belief that she is being treated effectively is enough to make the treatment actually work.The gold standard in conventional medicine is the clinical trial -a randomized study of comparable groups of patients， some of whom receive the treatment being studied and some of whom receive an inactive placebo.In“double-blind” clinical trials， neither the patients nor the health care providers administering either therapy or placebo know which patients are receiving what until the results are revealed at the end of the study.Only this kind of controlled trial can rule out the effects of chance， from the point of view of conventional research.■8 From the holistic perspective， by contrast， traditional diseases are merely the symptoms of underlying spiritual or natural imbalances， which can vary from individual to individual.This explains why some alternative healers advocate remedies that have been disproved by large -scale clinical trials： if each patient′s experience of illness is a product of individual diet， lifestyle， history， mental state， and so on， then a treatment that works for one sick person does not necessarily work for another， and certainly might not work for a whole group of people in a randomized trial.Alternative practitioners argue that they treat the underlying cause of disease， while conventional medicine treats only its symptoms.Conventional medicine counters by claiming just the opposite， since biomedicine regards the true causes of disease， whether physical or emotional， to be the bacteria， tumors，biochemical imbalances， physical trauma， and the like that they study in their clinical trials.■(二)■During these decades， alternative therapies (chiropractic， acupuncture， homeopathy，biofeedback， visualization， crystal healing， etc.) have become one of the healing options of millions of Americans.The offer of ( ) medical practice courses from some medical schools indicates that alternative therapy is rebuilding conventional medicine.The increasing ( )of alternative therapies has led some critics of mainstream traditional medicine to perceive it as the forerunner of a medical( ) Conventional biomedicine becomes less effective confronting certain( )diseases.Further， traditional drug， surgery and technology are not( )by patients.Alternative practitioners claim that contrary to traditional biomedicine， they cure the underlying cause of disease， other than symptoms.Consensus is never ( ) .choose the most suitable subheading from list A-J for Paragraph 5 ( )
A.Critics on the effect of chance about alternative therapy
B.Deficiency of conventional biomedicine
C.The reconstruction of conventional medicine
D.Reported disadvantages of questionnaires conducted among doctors
E.The introduction and forms of alternative therapy
F.Distinctions between alternative and conventional care
G.The application of mind-body techniques
H.Incorporation of holistic thinking in conventional medical care
I.Conflicts on curing causes and symptoms
J.The appeal of “Natural” approaches

正確答案：J