ending case

[jok200]

Sorry but i am having trouble with the ccs software? What does it look like when the case ends properly? Does the "you have 5 minutes thing pop up" or does the case simply say, case ends? I follow uworlds decision tree exactly and the 5 minute pop up still shows up ?? I have been trying to figure out what is going on?


thanks-

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[Gute]

you always end with the 5 min screen for the final orders whether it sends you there well before you only have 5 min left or not.

 

[haresh]

Sorry but i am having trouble with the ccs software? What does it look like when the case ends properly? Does the "you have 5 minutes thing pop up" or does the case simply say, case ends? I follow uworlds decision tree exactly and the 5 minute pop up still shows up ?? I have been trying to figure out what is going on?


thanks-

I just came to know another fact. Your 5 min screen can pop up anytime depending on when the algorithm ends the case. But once the 5 minute screen comes, we should first note the simulated time on the 5 min screen at the bottom left hand corner. Simulated time will further dictate whether we should discontinue or change any orders. An example given for this on a website elsewhere: If an acute St elevation MI case presented to the ER, you will complete all acute medical management and order cardiac catheterization. Then if case ends and 5 min screen pops up , that does not mean that case is ready for discharge. Check the simulated time. If it is still less than one day ( most often, cases end with in 24 hours in ER scenarios); do not change any IV medication orders or do not make any discharge preparation. Simulated time is the "time since the patient was first seen by you"
Some people discontinue IV medications etc with out understanding the "simulated time" principle and this causes loss of score because software calculates it as mismanagement ( cancelling life saving drugs prematurely). UW does not explain any of these issues.

 

[haresh]

How do we know if the case ending fast is good or bad when doing a case on the exam?

This is what i found on the web:

Case ending can be good or bad. Most times it is good, only way we can know is by checking if our patient's symptoms improved or not before the case ended.


In pneumothorax case 1 on demo usmle software - try to advance clock by 12 hours with out putting chest tube. The case ends in 5 minutes of real time. Here case ended because patient crashed and we get zero for that case. In case 5, try to send patient home after some initial treatment and schedule follow up in 3 days, the case ends in just 5 mins of real time. So case can end even when we completely mess up the case. The only way to know if we messed up or if we did well is by checking on our patient progress after treating them.
We can check the patient progress by interval history, checking vitals for many cases. In some cases like DKA, follow up labs like BMP every 2 hours will give us patient's progress. In cases ike hypothyroidism, following TSH 6 weeks later will give us the adequacy of treatment and patient's progress. As long as you did these follow ups and you confirmed that your patient or patient's labs were improving prior to the case ending notification, you will be fine and will get a great score. But the idea that many people have "that case ending soon is always good" is not always true as mentioned in above examples.

 

[jok200]

Okay... I think i am finally starting to understand this process. So as far as uworld goes from reading what people have been posting it seems that simply try to memorize the scenarios is not the ideal way to go, am I right? I gather that trying to understand the management concept so as to be able to apply it to another scenario is the best may to approach the situation? Correct or misguided?

thanks again guys-

 

[haresh]

Okay... I think i am finally starting to understand this process. So as far as uworld goes from reading what people have been posting it seems that simply try to memorize the scenarios is not the ideal way to go, am I right? I gather that trying to understand the management concept so as to be able to apply it to another scenario is the best may to approach the situation? Correct or misguided?

thanks again guys-

jok200, that is the exact problem i had with UW. No concept, no explanation on how to check progress in the ccs case, no respect to patient time (simulated time) in the ER scenarios, no guidance and above all, fatal errors. The whole concept is wrong in UW software. Practice the cases on the orientation software at usmle.org