Fun with Step III

[Red Runner]

So I am getting ready to take Step III and finally got around to working on that practice CD they send you. I find the multiple choice stuff straightforward of course... the computer based case simulation is interesting. I find myself finishing the cases and wondering what the hel* is left to do and then remember - oh yeah, i'm supposed to move them somewhere and take care of them there. Arghh, primary care. The dx and initial tx are done... Then of course, there are all the little things like smoking cessation, pain relief, diets, asthma teaching, etc. that you take for granted but get you points.

Does anyone have any recs? Any special tricks that you have heard earn extra points? Any weird tests you had to order on your test? Not to worried bout it but having to take care of my patient without seeing them is strange. We in EM tend to depend a lot on our gestalt the instant we walk in the room to tell us sick/not-sick and where to go next.

Back to the case simulations...

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[GeneralVeers]

So I am getting ready to take Step III and finally got around to working on that practice CD they send you. I find the multiple choice stuff straightforward of course... the computer based case simulation is interesting. I find myself finishing the cases and wondering what the hel* is left to do and then remember - oh yeah, i'm supposed to move them somewhere and take care of them there. Arghh, primary care. The dx and initial tx are done... Then of course, there are all the little things like smoking cessation, pain relief, diets, asthma teaching, etc. that you take for granted but get you points.

Does anyone have any recs? Any special tricks that you have heard earn extra points? Any weird tests you had to order on your test? Not to worried bout it but having to take care of my patient without seeing them is strange. We in EM tend to depend a lot on our gestalt the instant we walk in the room to tell us sick/not-sick and where to go next.

Back to the case simulations...

I found the cases to be relatively easy, as most were primarily Emergency Medicine. Don't forget things like "smoking cessation counseling" and "depression counseling" in your workups.

I personally think Step III is pointless. Most of the questions are applicable only to primary care Family Practice physicians. By the time most residents take this test, they've had a year or more in their chosen specialty. Why does a pediatrics resident need to review adult hypertension prevention? Why does a dermatology resident need to know about menopause and birth control?

If they're going to insist upon having Step III during residency training, then it should be a specialty-based exam, with some key general medicine thrown in.

 

[dchristismi]

Along the lines of smoking cessation, if you type in "counsel" (or just "c" actually), you get a long alphabetized list of a smorgasboard of counseling options. "Stop" works as well, but apparently while you counsel someone to quit smoking, you tell them to stop smoking crack.

Saved time for me, although the cases are pretty quick if you're on the right track.

Danielle

 

[Sweet Tea]

Tip #1) Red, PUT DOWN THE BEER.

 

[Dr.Evil1]

It is actually fun to go through the step 3 CD and try to kill the (fake) patients. The guy with the tension pneumo on the CD is fun to try to get PFTs on, or give heparin or lytics. Actually they give you a LONG time before the guy really crumps.

Truthfully I have heard that all that stuff matters relatively little. I think that you get the big points for correct acute management and final diagnosis. If you want some info on the finer points of the test then I would advise that you read the preview section in First Aid. Mind you, don't buy the book. Just either check it out from the library for an hour or read it at the bookstore. I did this for about 30 min and felt much more comfortable going in.

 

[R - Dizzle]

When I took it 2 months ago, there was a case where a 18 yo F came in with h/o asthma, presented in resp. distress, RR ~55/min. As I was going through the case, I gave here A/A nebs. The next thing that popped up was that "her respirations have shallowed." WTF! Does that mean she's improving or does that mean that she's tiring from work of breathing? So I set up for intubation and tried it, but it said "she refuses intubation." Ok. 2 seconds later, "pt feels better." Hindsight, should have rechecked vitals before tubing.

Needless to say, I totally messed this up but I did still passed the exam.

 

[Red Runner]

Tip #1) Red, PUT DOWN THE BEER.

So maybe I had a few beers while I did the CD... I still managed to keep the patients alive.... although I did provide some sub-optimal primary care...

 

[Museless]

I personally think Step III is pointless. Most of the questions are applicable only to primary care Family Practice physicians. By the time most residents take this test, they've had a year or more in their chosen specialty. Why does a pediatrics resident need to review adult hypertension prevention? Why does a dermatology resident need to know about menopause and birth control?

In my naive opinion... as I'm but a humble resident and thus have yet to be out in the "real world"...

because a pediatrician is a doctor, the dermatologist is a doctor, and the public expects certain things of those that hold the MD degree and state licensure. It's not like they need to know the minutiae, just the "big picture" like htn (huge problem) and menopause and birth control. Not so bad, really, and things docs should know no matter what they practice... especially since the state licensure is to "practice medicine and surgery" and not to "practice pediatrics" or "practice dermatology".

 

[deleted109597]

In my naive opinion... as I'm but a humble resident and thus have yet to be out in the "real world"...

because a pediatrician is a doctor, the dermatologist is a doctor, and the public expects certain things of those that hold the MD degree and state licensure. It's not like they need to know the minutiae, just the "big picture" like htn (huge problem) and menopause and birth control. Not so bad, really, and things docs should know no matter what they practice... especially since the state licensure is to "practice medicine and surgery" and not to "practice pediatrics" or "practice dermatology".

Well, the problem is that you do it right after medical school usually, so the fact that you graduated the "liberal arts" style of teaching of medical school before the specialty specific residency, everyone should pass it.

Also, with BC, my answer is "try this one, and if you don't like the side effects, try this one". I won't be prescribing BC unless I live in an area where the pharmacists won't hand out plan B due to whatever. If the HTN isn't urgent or emergent, it isn't something I want to handle. Menopause also isn't something I worry too much about, just like fibromyalgia, restless legs, or any other non-emergent conditions. Yes, I will learn enough about them to disposition them, but I won't worry about long term management of any of them.

I guarantee you that when the flight attendants ask "Is there a doctor on the plane?", the psychiatrists don't jump up and run to the chest pain patient. The longer you are a specialist, the less stuff you don't specialize in you remember.

 

[Red Runner]

Well, I finished Step III yesterday. About what I expected. I did provide some suboptimal care to a few primary care patients on the cases but I provided some great EM care for the ED cases.