Step 3 CCS

[jaguars10101]

Just took Step 3 last week,.

For the cases I was completely shocked. Many of the cases ended within minutes (even one of the 18 minute cases ended in a few minutes). I assume they ended early because I did enough to manage the patient correctly, is that correct?

Also, for almost all of the cases, I did not enter a final diagnosis. I used that final 2 minute screen to enter in final orders. Do you fail if you do not enter in a final diagnosis?

Also, can someone who passed step 3 (or knows someone who passed step 3) without writing the final diagnosis for the majority of the CCS cases comment? Thanks!

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[Rock2168]

Just took Step 3 last week,.

For the cases I was completely shocked. Many of the cases ended within minutes (even one of the 18 minute cases ended in a few minutes). I assume they ended early because I did enough to manage the patient correctly, is that correct?

Also, for almost all of the cases, I did not enter a final diagnosis. I used that final 2 minute screen to enter in final orders. Do you fail if you do not enter in a final diagnosis?

Also, can someone who passed step 3 (or knows someone who passed step 3) without writing the final diagnosis for the majority of the CCS cases comment? Thanks!

The cases will end early for two reasons. It will end early for good performance if you've met the major goals of the case. But, it can end early for poor performance on a case. You should be able to tell when this happens because messages will pop up saying the patient is worsening.

According to Dr Red from the ********** prep, the final diagnosis is not graded.

I wish you the best on your score.

 

[Button Nose]

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[toskabab]

Let us know how you did...

 

[gogosoon]

I skimmed through UW CCS and didn't realize that for ER patients you need to get iv o2 monitor before obtaining history and physical.
Is it automatic fail if you get history and physical first before you get iv o2 monitor for ER patients?
I've placed them AFTER H&P not before for all ER patients whether crashing or not.

 

[toskabab]

I don't think there is an automatic fail unless you do something overtly stupid like a colonoscopy on a child who presents with acute respiratory wheezing. Even then it will be a fail on just that case, you still have 12 cases to make up for it. But to answer your question, it really depends on if the patient is stable or not. If they come in with obvious respiratory/cardiac distress and unstable vitals and you make them sit around for 15 minutes while you poke at their body parts, chances are it will cost you points. In most cases it may be appropriate to do a routine iva, pulse ox, bp monitor and maybe cardiac monitor first and then do a focused exam. In some cases, such as acute chest pain, severe respiratory distress, or massive hemorrhage you may need to do even more appropriate emergency investigation and/or intervention before doing any physical examination at all. It all depends on the presentation and severity of the patient.

 

[yayforscrambling]

For someone who hasn't done much CCS studying (i.e. basically nothing), would a Saturday and Sunday be enough to hit uworld's CCS cases adequately?

My test day 1 is Friday. Was thinking of just doing CCS (and maybe some biostats) for all of Saturday and Sunday. Test day 2 is Monday.

Please let me know if you think I'm nuts.

 

[toskabab]

For someone who hasn't done much CCS studying (i.e. basically nothing), would a Saturday and Sunday be enough to hit uworld's CCS cases adequately?

My test day 1 is Friday. Was thinking of just doing CCS (and maybe some biostats) for all of Saturday and Sunday. Test day 2 is Monday.

Please let me know if you think I'm nuts.

Yes, you're nuts! But I envy your stamina. I have a very short attention span, get bored easily, and also had to work during my exam period. I needed at least 2 weeks.

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[yayforscrambling]

Yes, you're nuts! But I envy your stamina. I have a very short attention span, get bored easily, and also had to work during my exam period. I needed at least 2 weeks.

Sent from my SCH-I605 using Tapatalk

dude i'm so unbelievably burnt out that I can't bring myself to give two $hits about CCS or biostats. On on top of that, biostats is always my lowest section. I just want to get this thing over with SO bad.

Maybe I'm just subconsciously lying to myself to make myself feel better, but I feel like I can go through uworld's CCS cases twice over that weekend while sitting in the hotel room with literally nothing else to do.

I guess I am nuts.

I used to be normal before medical school for what it's worth.

 

[menicke]

I skimmed through UW CCS and didn't realize that for ER patients you need to get iv o2 monitor before obtaining history and physical.
Is it automatic fail if you get history and physical first before you get iv o2 monitor for ER patients?
I've placed them AFTER H&P not before for all ER patients whether crashing or not.

It is not a generic thing. Not everyone needs oxygen and IV immediately in the ER. It depends on their vitals and stability. For most ER cases that present with unstable vitals or severe pain, place stabilizing orders immediately and then do a brief physical examination. ********** gives a simple to remember protocol for unstable cases - start with stabilizing orders Oxy, IVA, CARD, Vitals q1hr, Cardiac Monitor. After these, you do a 2 minute physical in most Shock or respiratory Failure cases. A 2 min exam includes CVS and Respiratory. The exam of these two systems gives a clue regarding most etiologies of shock or respiratory failure.
Pain is also considered as 5th vital. If patient comes with severe pain of > 8 over 10, go to order sheet first and use IV pain medication before you do a physical exam.

If a patient is in distress, you need to find out why? is he unstable? how was the focused physical examination? any clinical clues on focused exam? Let us say a patient came with chest pain and sob and if your chest exam showed absent breath sounds, you would be addressing his distress by putting a tube thoracostomy in 5 minutes of simulated time... you would not wait for conclusive test like CXR that only comes after 30 minutes. If you waited, the case is a fail. You will need to keep SIMULATED TIME very low in the unstable ER cases.
This is just one example. Several other scenarios may show up but the presentation varies and there are always clues that will prompt you to intervene early in extremely distressed patients -- finding those early clues is crucial and they vary from case to case.

********** videos mention these thought provoking different scenarios that can come up just on 2 min physical exam :
Chest pain with absent breath sounds - pneumothorax - intervene with chest tube without waiting for a CXR ( takes 5 minutes simulated time )
Chest pain with pulsus paradoxus, hypotension - cardiac tamponade --- intervene with pericardiocentesis without waiting for 2D-Echo ( takes 10 minutes simulated time)
Chest pain and SOB with crepitations on chest exam -- consider pulmonary edema and left ventricular MI --- obtain EKG. If STEMI is seen, proceed with cardiac cath ...takes less than an hour ( Keep door to balloon time less than 90 mins)
Chest pain with normal physical, low pulse ox, tachycardia...cxr normal...consider Pulmonary Embolism --- Start empiric LMWH ...takes less than 30 mins....and then wait for confirmatory test such as Spiral CT

So, it is not a fail if you did not put those initial O2 and IV access but it would be a fail if you did not do " that life saving intervention" within the most appropriate simulated time. Here are the golden words I recall from Archer : Doing redundant full physical exam before life saving interventions and waiting for redundant confirmatory tests before a life saving intervention unnecessarily prolongs patient simulated time putting his health in a precarious situation and leads to a failure.
This simple statement helps to understand this whole CCS gig in the ER