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* regarding counseling
 #845779  
  drangel2014 - 11/21/17 14:02
 
  can someone tell me do we counsel in the last 5 min?

eg. pregnancy the counseling is so long in uw do we all that? also eg. if someone doesnt smoke do we still counsel them on smoking?

and also which other steps should we take in the last 5 mins? ..
 
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* Re:regarding counseling
#3353235
  tklerts - 11/21/17 14:21
 
  Focused counseling. If patient doesnt smoke, no need to counsel about smoking.

You have 2 mins NOT 5 minutes. It used to be 5 but they cut it down to 2 MINUTES.

Only do counseling pertinent to that case. If patient has gonorrhea, treat partner. Most of these counseling tips are obtained by practicing cases and actually seeing what they recommend for counseling in UW.

Ive found ccscases.com useful. They actually give you a SCORED feedback, unlike Uworld. However, they dont account for monitoring, location and sequencing. You could move patients to the wrong place and still get a good score, for example.

You dont need to counsel so much for pregnancy. Maybe give folic acid or multivitamins. Sometimes if I dont know what to counsel, Ill just type pregnancy and see if there is anything pregnancy related counseling listed in the choices of orders.

The main thing they want to see is counseling focused on the case. Dont go off using this RATED SEX mnemonic if its not pertinent. If patient smokes, counsel about stop smoking, IF patient drinks alcohol, counsel about stop drinking alcohol.

You only have 2 MINUTES. It will go by fast and you need to click out of the 2 minute box to enter all your 2 minute orders/counseling and go to the final diagnosis box to enter diagnosis (although this is not graded).

You have to practice a lot like I have. After going through a lot of cases will you know what orders are most commonly used for counseling, what to counsel for each case. You may not remember everything and miss an order here or there but just get the main counseling orders down, click enter to submit your 2 minute orders and get out of there.

2 minute orders should include counseling the patient, reassure patient, vaccinations (dTap, varicella (age>60), pneumococcal (age>65 or certain conditions require pneumococcal), influenza every year for person above 3 years old I believe (not sure, need to look that up), pap smear, colonoscopy at a later time for those age >50 years old, mammography, DEXA scan for later time in those with osteoporosis.

Review Kaplans preventive medicine chapter for all the preventive measures you should take based on age.

smoking, alcohol, illicit drug use, avoid alcohol when using metronidazole, are other 2 minute orders. THere are others but I dont have time to write them all out. Its all in the main sources ofr CCS. UWorld, Crush CCS and Archer CCS. You need to practice.

CCScases.com is good. I learned to input all those vaccination orders mentioned above form using their software and Ive been practicing a long ass time. There are 100 cases on there and you need to go through all of them and knock CCS out of the freaking park (stars in the far right to higher performance). When you practice a lot everything becomes automatic so when you are at the exam at Day 2, its like playing a video game and you are trying to get as many points as possible.

Good luck!
 
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* Re:regarding counseling
#3353236
  tklerts - 11/21/17 14:24
 
  Counseling orders are listed for every case in every main source out there. FOr pregnancy, go look at Crush CCS or UWorld CCS. At the end of case, they will tell you what you need to enter. DO that for all the conditions.

Crap Ive gone through Uworld CCS 3-5 times and CCScases.com 100 cases like once will go through once again.

Im ready to start my own CCS course lol.
 
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* Re:regarding counseling
#3353237
  drangel2014 - 11/21/17 14:25
 
  awesome advice thx alot!!!

and in the last 2 minutes.. i should cancel ivs etc?. and give my final orders right? ..

thx again
 
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* Re:regarding counseling
#3353238
  tklerts - 11/21/17 14:31
 
  cancel based on the simulated time. If patient has pneumonia and has only been in the hospital for 8 hours you keep the patient on iv nss still. Canceling orders is based on simuulated time and what orders would the patient be on if he was in the hospital at that particular smulated time and with that particular condition. If patient is inpatient and you get updates patient is doing well and ready to go home (vitals pulse ox is normal). THen cancel IV Nss. You just have to use your judgement based on the simulated time and the condition of the patient and what disease the patient was in this hospital for  
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* Re:regarding counseling
#3353343
  drangel2014 - 11/21/17 17:54
 
  Thx a lot

N how do I change an iv into oral ??
 
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