Almost all my CCS cases ended early... did I do it right?

[Eyeball Tickler]

On the real thing, almost all my cases ended early... especially the 20 minute ones. Most of them had patients "feeling better" and in ones that didn't feel better some procedure or intervention was scheduled because it was a chronic issue or an issue that required a surgical intervention. Is this a sign that CCS has gone okay? I'm just really anxious. Thanks.

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[Ismet]

Yes

 

[steveme]

Case ending time does not really matter. It is important to see if you have met the monitoring criteria and vitals/ monitoring parameter updates were showing improvement

 

[VCorp]

On the real thing, almost all my cases ended early... especially the 20 minute ones. Most of them had patients "feeling better" and in ones that didn't feel better some procedure or intervention was scheduled because it was a chronic issue or an issue that required a surgical intervention. Is this a sign that CCS has gone okay? I'm just really anxious. Thanks.

How'd you prepare it you don't mind me asking and for how long?

 

[pre med 2014]

On the real thing, almost all my cases ended early... especially the 20 minute ones. Most of them had patients "feeling better" and in ones that didn't feel better some procedure or intervention was scheduled because it was a chronic issue or an issue that required a surgical intervention. Is this a sign that CCS has gone okay? I'm just really anxious. Thanks.

I am wondering sort of the same thing. Are your surgical cases ending before you get the result of the surgery? On the volvulus reduction and ascending aortic aneurysm cases I can't seem to get the software to update me on the result of the surgery. I look over the explanations and keep re-launching the case making sure I order everything right in sequence.

I'm pretty confident pre-op prep and consult cardiac surg for ascending aortic aneurysm repair is correct. But it would be nice to see the surgical result. Besides in the explanations it says once the patient completes surgery, do interval histories q12hrs in the ward, continue monitor ecg, pulse ox, bp, etc... but in the actual software it just ends as soon as I try to advance the clock to the aortic repair??

 

[VCorp]

I am wondering sort of the same thing. Are your surgical cases ending before you get the result of the surgery? On the volvulus reduction and ascending aortic aneurysm cases I can't seem to get the software to update me on the result of the surgery. I look over the explanations and keep re-launching the case making sure I order everything right in sequence.

I'm pretty confident pre-op prep and consult cardiac surg for ascending aortic aneurysm repair is correct. But it would be nice to see the surgical result. Besides in the explanations it says once the patient completes surgery, do interval histories q12hrs in the ward, continue monitor ecg, pulse ox, bp, etc... but in the actual software it just ends as soon as I try to advance the clock to the aortic repair??

I'm surprised they had volvulus as a CCS case on the real exam.

 

[pre med 2014]

I'm surprised they had volvulus as a CCS case on the real exam.

I'm not talking about real thing, talking about the free 6 and UW CCS

this keeps happening, just did another case of eclampsia, feel like I did everything right (hydralizine, mag sulfate) schedule delivery, etc... but it just ended the case before it let me see result of a successful vaginal delivery.

for the ascending aneurysm one I wonder if its not letting me get past the surg if I end up having it scheduled over 2 hours after initial presentation??

 

[steveme]

I'm not talking about real thing, talking about the free 6 and UW CCS

this keeps happening, just did another case of eclampsia, feel like I did everything right (hydralizine, mag sulfate) schedule delivery, etc... but it just ended the case before it let me see result of a successful vaginal delivery.

for the ascending aneurysm one I wonder if its not letting me get past the surg if I end up having it scheduled over 2 hours after initial presentation??

If you are referring to cases ending like this and not allowing to call a surgical consult on UW CCS, please remember that these are some critical errors on UW CCS software. These will not happen on NBME USMLE Exam software. I have seen a demonstration on ********** on the exam software and the cases do not block you at surgical consult like UW CCS does. If you meet criteria for surgery, patient gets accepted and you get the surgery acceptance message.
The criteria for surgery in ascending aorta aneurysm is to make sure you do CT Chest/ TEE to confirm location , advance clock to get results of CT before you call a Surgeon. Once that criteria is met surgeon accepts. If that criteria not met, you will not get acceptance message. This is very clearly demonstrated in ********** how algorithm changes when you do get or do not get CT chest

 

[PGY1RESIDENTLOVESMEDICINE]

Hey

On the real thing, almost all my cases ended early... especially the 20 minute ones. Most of them had patients "feeling better" and in ones that didn't feel better some procedure or intervention was scheduled because it was a chronic issue or an issue that required a surgical intervention. Is this a sign that CCS has gone okay? I'm just really anxious. Thanks.

Did you end up passing, the same thing happened to me today. I'm so stressed out!

 

[affa89-cs]

Hey


Did you end up passing, the same thing happened to me today. I'm so stressed out!

same here super stressed .. gave day 2 today and ccs killed me.. i think

 

[Eyeball Tickler]

Hey


Did you end up passing, the same thing happened to me today. I'm so stressed out!

Yes

 

[PGY1RESIDENTLOVESMEDICINE]

Yes

Congrats! Hope I passed too!

 

[lekarsz_90]

I keep misspelling words when I go to order tests. makes me nervous when I get anxious and can't think of what to order any advice as I am preparing?

 

[gujuDoc]

I keep misspelling words when I go to order tests. makes me nervous when I get anxious and can't think of what to order any advice as I am preparing?

try to learn the short cuts for pulling up these orders. Like writing urine for all urine studies instead of spelling each one out, or stool for all stool studies. or H. Pylori for h. pylori related tests. etc.

Use iva for iv access, nss for normal saline maybe, first three letters of anything usually helps pull up the list of anything that starts with those first 3 letters. oxy for oxygen etc.

 

[gujuDoc]

Hey


Did you end up passing, the same thing happened to me today. I'm so stressed out!

Same thing happened to me too. I think they say that if you did the main things they wanted u to do this happens.

 

[pre med 2014]

I also had a bunch of cases ending early on the real deal and most of those that did had "patient is getting better" so i'll take that to mean I was in the general ballpark of what they were going for and stopped the case early. Fingers crossed I passed.

 

[VCorp]

I also had a bunch of cases ending early on the real deal and most of those that did had "patient is getting better" so i'll take that to mean I was in the general ballpark of what they were going for and stopped the case early. Fingers crossed I passed.

very nice. i've just started using CCS regularly and most of my 20 minute cases are finishing up within 5-6 minutes. I've done around 8 cases so far, and I've noticed the patients end up getting better, but I'm missing additional steps to order. For instance in case 7 or 8 which was about the vaginal discharge, the patient clearly had candida. I ordered:

- cbc with diff
- bmp
- vaginal ph
- vaginal KOH
- pap smear
- patient counseling

vaginal ph and KOH helped to confirm C albicans. ordered fluconazole. patient was better. however, looking at the scoring sheet they also had other tests which they ordered such as:

- vaginal culture
- forget the others, lol

@steveme
@Unty

 

[pre med 2014]

update: passed CCS safely above the borderline margin (albeit with a wide confidence interval, likely because I did bad on the 10min cases... or at least I think I did). I was finishing all my 20 min cases way too fast like in 5-10min. But for the 10min cases it seemed like I ran out of time too fast and cases seemed more complex needing more orders and changes in location, etc.... If your 20 min cases are ending early it's ok the main thing is recognizing the hints, if it says the patient feeling hopeful the medications will help improve his condition then continue with your plan of management that's a hint you're doing something right. If it says patient is trying to leave the office or some weird 'red flaggish' statement like that that could be a hint you are going down the wrong path. Pause the clock and rethink your differential and course of action