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* Archer CCS Strategies discussion
  iara2 - 08/13/17 20:30
  I am compiling a thread for previous forum posts here that discussed Archer CCS strategies in detail. These seem to be very useful but scattered in forum posts. I am starting one single thread here. I will post link to the source as well. Please post if you find any and please feel free to contribute to this thread.  
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* Re:Archer CCS Strategies discussion
  iara2 - 08/13/17 20:32
Archer CCS tip #1
Anything that you manually type in to the blank box is not picked up and scored by software.
1. Diagnosis is not scored
2. Reason for consultation that you type in the box is not scored but you must satte reason for consultation by selecting and placing an order
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* Re:Archer CCS Strategies discussion
  iara2 - 08/13/17 20:38
  Archer CCS strategy #2
Make sure you Monitor not just order tests. Monitoring efficacy and safety of your interventions is very highly scored on the exam. Monitoring is both active and passive. Passive monitoring runs in the background based on the generic orders you placed at the beginning of the case. We get scored for this.
Monitoring is also both immediate as well as "Later" Later monitoring is done by calendar option. Very crucial to use Calendar option on 2 min screen to do Later monitoring.

Here is the source post :
" yes, you should keep monitoring orders in the initial set itself so they keep running in the background and keep fetching you score automatically. Dr.Red (Archer) says in his CCS that Monitoring is very important and high score goes to different sections of monitoring. You should monitor efficacy of drug or procedure and side effects of drug
for example, ordering cxr after putting chest tube in tension pneumothorax is monitoring the effect of that intervention - chest tube.
While you have to order such monitoring after intervention, some clinical and lab monitoring can occur in the background automatically if you set a frequency
examples : monitoring in altered mental status - Neurochecks every 2 hours
monitoring septic shock : continuous BP , Arterial line, CVP monitor q2hrs; mixed venous oximetry q2hrs
monitoring shock patients on pressor: put arterial line and select continuous BP monitoring
Monitoring DKA : glucose q1hr and BMP q4hours
So, you just put these type of orders along with your initial order set and they keep running in background so you advance clock and gets you score for monitoring ..

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* Re:Archer CCS Strategies discussion
  valencia - 08/13/17 20:41
  Ohhh...these are so good and clear. Please keep posting. Are not these all in archer CCS videos?
I bought that but have not started yet, are these all included there.
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* Re:Archer CCS Strategies discussion
  iara2 - 08/13/17 21:45
  yes they are all in archer videos but I feel discussing will reinforce our understanding better. If you know anymore strategies and case management, please add under this thread.
If you browse old posts on this forum, there's tremendous pool of tips and cases. Trying to compile them in one thread.
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* Re:Archer CCS Strategies discussion
  valencia - 08/20/17 20:02
  iara, can you post more? I am also oing Archer ccs now and can participate  
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* Re:Archer CCS Strategies discussion
  iara2 - 08/25/17 21:17
  Strategy #3
Consultants give a real response on the exam. UW does not tell about sequencing of orders and did not incorporate this sequence in to their software algorithm. Exam step 3 software is cleverly designed to change surgeon's responses based on sequencing of your orders. You can practice the following example on NBME exam software and see how surgeon's response changes.
Per demonstration shown on Archer CCS video. Step 3 software tests us if we are capable of meeting Surgery criteria before calling a Surgeon. If you do a surgery on a patient who does not meet criteria, it will fail us because we are removing an organ from a patient or invading a patient who does not need it. With regard to what Archer showed, he gives a clear example in aortic dissection case on the step 3 software how surgeon accepts the case when criteria is met ( CT scan results show ascending dissection and then we should sequence consult order). In the same case, he calls surgery consult before ordering a CT and the surgeon says "no recommendation" . He calls surgeon after ordering CT and after result comes in for the CT, then same surgeon accepts and says "patient will be scheduled for surgery". So, it is important to sequence orders to meet surgical criteria first and then call surgeon if required. The criteria for surgery in dissection is the location - ascending aorta - CT needs to be read before calling a surgeon.
Source : SDN forums
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* Re:Archer CCS Strategies discussion
  picu - 08/26/17 19:52
  Excellent topic! Please do share more guys! Thanks  
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* Re:Archer CCS Strategies discussion
  valencia - 09/29/17 00:07
  iara2, any more additions to this thread?  
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* Re:Archer CCS Strategies discussion
  ib1983 - 09/29/17 17:58
  Stimulated Time

I also started listening to Archer. and your stimulated time is very important and you will scored for that heavily specially n ER cases. so use your time wisely there. People confuse Real time and stimulated Time. Real time is what is given to us to solve the case 20 min or 10 min. But our stimulated time varies based on case given. So office case of essential HTN. we should be handling for atleast more than 6 months or so. Where as Case of Aortic Dissection you might not advance the clock more than few hours.

Iara you can talk more about stimulated time. I thought thats where i was weak when i started doing U world cases i couldnt understand how much clock i should movve
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* Re:Archer CCS Strategies discussion
  valencia - 10/03/17 23:22
  Thanks great points ib1983  
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