CCS experience during the actual exam - docryuy

[ArchivalUser]

Just finished my 2 day step 3 exam.. Im so weirded out with the CCS cases i had. WHat does it mean if the cases end really really fast? Does it mean you covered everything that's why it ended? I would like to think that the actual cases would not end very abruptly if you did 1 step wrong -- they give you chance to do something about it, right? Coz I'm thinking, since my cases ended really quick, I did something really really bad ?

Practicing the uworld CCS was totally different from the actual exam. What I noticed in Uworld is that, when you do things right, the patient will actually tell you that he/she feels Fine, and is better before the case ends. But in the real exam, they end very abruptly, you dont even know if what you did was right because the patient never tells you that he/she is fine / relieved. Sometimes, I requested a lot of things , and even before I get results from all the things I requested, the case STOPS.

Like for example, I ordered a surgical procedure for a particular patient and it is due at 18:00, when I am about to advance the clock to 18:00, the cases ends. I dont know if the surgery I ordered was wrong ? or should I assume that since it ended right away, I got the right management and will not proceed until the post op period -- because in Uworld, it would actuallly say something like "intra op findings reveal blah blah blah, patient tolerated procedure well" and then that's the time it will end.

please shed light since I'm in the brink of depression. I dont want to go through the entire ordeal of step 3 again =(

[ArchivalUser]

Hey there,,its done...you worked hard..so relax , go have some fun and see the result in three weeks.

ITS DONE, ITS the PAST...Live in the PRESENT. Deal with the outcome when it arrives.
TRUST that you did everything you could have.

[ArchivalUser]

thanks! yeah , thats what im trying to think right now.

[ArchivalUser]

i believe u did the right thing if case ends early ..

[ArchivalUser]

i had the same feeling with my cases ending quickly, i felt i didn't get around to managing cases well, despite having worked with usmleworld ccs for 3 mts! pretty much daily-and having made notes on what led to a pt getting better-I have a poor opinion of usmleworld ccs as there is no feedback and you can't even print out the actual steps to managing pts in their interactive site, so i wrote out the cases just as you saw them on the screens, all 50 or whatever it is of them! I missed passing by 8 points by this ccs portion, i took it a few weeks ago, i am now looking at some other sources to prepare, i hear usmleconsult.com gives you feedback on what orders you have submitted and which ones you missed...i also noticed that ppl on this site recommend dr red's and archers'...not sure if they are the same thing or how helpful they are...too expensive this whole step 3 prep! I intend to retake soon-good luck to you! i hope you made it past the finish line...

[ArchivalUser]

oh my, sorry to hear that mariebanos. so that means, you have to pass the CCS portion alone, and not cumulative together with the whole MCQ thing on day 1 and 2? i mean, u have to have a minimum passing score of the CCS portion even if its only 20% of the entire grade of step 3?

Oh no.. =( i think i have to prepare myself now.

i think i was only confident in managing 3-4 cases out of the 9. is it an "all or none" grade for the cases? its either u did everything wrong or everything right?

this is reallly frustrating..

[ArchivalUser]

let me give my opinion hope this will help u understand if u did the right thing or not.

One of the biggest mistake that most of us will do, is ordering stuff and never advance the clock to see those results, we keeping order after one screen or seeing one abnormal test results.....and when u keep ordering without advancing, then the screen or case might end.

so in ur case, if u did ur orders and u viewed ur results and then u order procedure, and the case end, u mostly did the right thing and case ended bec it was completed and u did good .

Most cases in real exam end within an average of 10 minutes. the fastest one that end in 5 mins are diverticulitis and intussusception.

I believe the possible ways u will know if patient is feeling better in 2 ways:
1. temperature drop
2. when u advance clock after treatment like 2-3 hrs and sometime 6 hrs after giving treatment and then go back and do interval f/u, then u will see a patient response saying he is feeling better or pain is decreased or temperature is dropping or pt saying hope this procedure will improve his symptoms...etc

as a rule, after giving a medication, u need to expect improvement after 24 hrs , so the rule of thumb here....advance the clock 2-4 hrs at a time and check vitals and interval hx. if patient is still the same, just advance like another 4-6 hrs....u r advancing to check about ur treatment or medication if it is working. if u r doing the right thing, advancing can help you....in my exam with one specific case, i was advancing like 6hrs at a time , it took me like 3 days till the patient felt better.

another issue or problem u might encounter in real exam:
Stay on order sheet when u advance so u can see the pending orders and see if u get the results u need to make ur diagnosis....never advance and advance without pending order bec they case will end, the computer think that u r advance just to end the case....the trick to avoid, order vitals q1 or q2 and then cancel the vitals as u exit the case.

If u have done the basic order, then it is ok to mess up 2-3 cases and u r still pass if u do well on ur mcq....i have a lot of friends who messed up 2-3 cases and they pass...so relax about this case if this ur only issue, u will still take credit for the basic ordering.

if u need any additional information, just send me a message

Enjoy ur time till u get results and i am sure u did well

[ArchivalUser]

cases ending is not the criteria.
We should monitor the criteria for response after putting an order or a step. The criteria for response can be improvement in vitals or improvement in patient symptoms or improvement in labs. In stead of advancing the clock too far , we should check the criteria for response to see if we are going in right direction and if the patient is improving. Advancing clock too far if the patient is unstable and with out knowing if things are improving, can end the case because may crash if we go too far in simulated time. Criteria for each case is different. In Dr.red workshop, he tells how to check each criteria and intervals , these are diferent for office and ER cases. He groups THEM under broad categories of SHOCK, RESP FAILURE, encephalopathy in ER Cases and sets criteria...for example checking neurochecks in a coma patient to see if things improve with our treatment. If neurochecks are not improving and when it is deemed irreversible, he asks us to intubate immediately - like example : TCA toxicity case.
So i think we should keep an eye on patient progress through out the case and change our management at each step depending on the case response. UW or usmleconsult does not explain this monitoring or does not give feedbacks because they are softwares. It is imp to know these tricks and practice them on exam primum software.

[ArchivalUser]

thanks for the insights guys.

I think I failed BIG TIME. I never received any interval history from the patient saying they're fine. =(

I have some cases wherein there are still some pending labs and procedures undone -- and then the case ends.

[ArchivalUser]

docruy, u will be ok, do not worry
actually you will not always receive interval history that they are fine. We have to go back to physical screen and check the interval history to get it as a follow up