Help me pass

[Lostin_space]

I found out I failed step 3 by 3 points, one of my worst nightmares. Studied long and hard, did Q bank numerous times, did most of CCS cases. Vast majority of CCs cases ended early, and I could not continue working on them when I took the exam yet my score report shows I did horrible on them.

I'm debating whether I should quit residency or re-take this. Feel very heart broken about the whole thing and not sure how to get past this.

any suggestions? My spouse is saying to re take it sooner rather than later and instead of studying everything focusing on weak areas. However I don't know how to confront this test again, and how to take up studying.

Please advise me. I feel desperate, lost, and utmost dejection at this time. I feel I've made the worst mistake of my life by going into Medicine. So much time spent on trying to achieve something worthwhile to have it blow up in my face.

---

Members don't see this ad.

 

[NotAProgDirector]

From my viewpoint, your anxiety is getting the best of you. This is not the end of the road. It's Step 3, and once you pass it no one will care about it any more. If your PD thought you were a failure, they would have simply dropped you and not promoted you.

So, my thoughts:

1. Get help for your anxiety. On your thread, you weren't excited by this thought. You told me that you have always had anxiety and been able to work through it. And I don't doubt that. But now, something is different. Your anxiety is making you consider poor options -- like quitting medicine over this. You've "fallen down". You need to get back up on your feet, dust yourself off, and get moving again. But you're unlikely to be able to do so without help.

2. You failed by 3 points. Let's think about that, statistically, for a minute. Chances are, if you took it again right now with the knowledge you currently have, you could score 3 points more just by luck alone. I don't recommend that option, but the point is that the amount of improvement you need is very, very small.

3. I will bet you that just getting your anxiety under control, with nothing else, will get you to pass this exam.

4. If after reading all this you still feel that your anxiety isn't a real problem, I want you to consider the fact that you may not be able to see that it's a problem. So, even if you're sure it's not a problem, you could very well be wrong. And you have little to lose by getting help.

5. Getting help doesn't create some huge problem getting a license, etc. One of my resident had a manic/psychotic break and was psych hospitalized for 2 weeks, and she still was able to get a competitive fellowship. Lots of physicians get help for depression/anxiety, and it's not a big deal. A few states may force you to fill out some additional paperwork. Big deal -- either you do it, or choose to live/work elsewhere.

From a very practical standpoint, you need to:

A. Get help for your anxiety
B. Plan to take Step 3 again in about 6 months. By then, your anxiety should be under control.
C. Continue with your residency (unless the person helping you manage your anxiety thinks you need a medical LOA)
D. Perhaps take a very short LOA from your residency, no more than 2-3 weeks, to study right before Step 3
E. Get help focusing your studying. Again, I expect that your anxiety adversely affected your performance enough that just getting it under control will help you pass. But it's best to attack from all angles. Perhaps some sort of board review course, or if you did poorly on the cases, some sort of help with that.

 

[Lostin_space]

From my viewpoint, your anxiety is getting the best of you. This is not the end of the road. It's Step 3, and once you pass it no one will care about it any more. If your PD thought you were a failure, they would have simply dropped you and not promoted you.

So, my thoughts:

1. Get help for your anxiety. On your thread, you weren't excited by this thought. You told me that you have always had anxiety and been able to work through it. And I don't doubt that. But now, something is different. Your anxiety is making you consider poor options -- like quitting medicine over this. You've "fallen down". You need to get back up on your feet, dust yourself off, and get moving again. But you're unlikely to be able to do so without help.

2. You failed by 3 points. Let's think about that, statistically, for a minute. Chances are, if you took it again right now with the knowledge you currently have, you could score 3 points more just by luck alone. I don't recommend that option, but the point is that the amount of improvement you need is very, very small.

3. I will bet you that just getting your anxiety under control, with nothing else, will get you to pass this exam.

4. If after reading all this you still feel that your anxiety isn't a real problem, I want you to consider the fact that you may not be able to see that it's a problem. So, even if you're sure it's not a problem, you could very well be wrong. And you have little to lose by getting help.

5. Getting help doesn't create some huge problem getting a license, etc. One of my resident had a manic/psychotic break and was psych hospitalized for 2 weeks, and she still was able to get a competitive fellowship. Lots of physicians get help for depression/anxiety, and it's not a big deal. A few states may force you to fill out some additional paperwork. Big deal -- either you do it, or choose to live/work elsewhere.

From a very practical standpoint, you need to:

A. Get help for your anxiety
B. Plan to take Step 3 again in about 6 months. By then, your anxiety should be under control.
C. Continue with your residency (unless the person helping you manage your anxiety thinks you need a medical LOA)
D. Perhaps take a very short LOA from your residency, no more than 2-3 weeks, to study right before Step 3
E. Get help focusing your studying. Again, I expect that your anxiety adversely affected your performance enough that just getting it under control will help you pass. But it's best to attack from all angles. Perhaps some sort of board review course, or if you did poorly on the cases, some sort of help with that.

I was thinking of maybe taking it next month? I feel that 6 months may be too long? I'm concerned about forgetting everything. I don't disagree that I have anxiety issues, I just feel that a lot of it is situational, as in things like what happened with failing this exam. Even if I got anti anxiety meds I don't know how to confront this setback. I was thinking of maybe taking a month of LOA at the beginning of the year to focus my brain and try to pass this thing. Just sucks because I was stocked about starting the next year, my cool rotations, planned research, and now its down the garbage.
I feel in the dumps. Sorry for the emotionality, I truly feel like it's been for naught. My chances at a competitive fellowship are gone, my PD probably thinks I'm a complete loser (surprised I did not get canned or reprimanded), as it's technically a requirement to go into the 3rd yr. This sucks.

 

[Tapepsi]

First off, I'm very sorry. A fellow resident and close friend of mine just found out she failed as well by 2 points. Both her step 1 and 2 scores were in the 230's so failing can happen to anyone. As someone who personally took this exam last month, I don't care what anyone says it's the worst of the steps because of how long it is (my mind was mush at the end.)

Doing Qbank questions multiple times isn't as helpful as thoroughly reading the answer explanations and making sure you understand the concepts behind them (including the wrong answers). You can learn 2-4 concepts just by reading one question's explanations alone!

It's hard to know how to give advice when I don't know which of your areas were weak. If stats was bad or even borderline I suggest you buy UW Biostats package as a refresher course. There were a TON of stats questions on day 1 I personally wish I would have bought the UW package. Also when you take the test write down the equations at the intro screen so you'll be ready when a stats question pops up.

Additional resources I used were First Aid for Step 3 and Master the Boards 3. My method was I would read a subject in one and the same subject in the other. That way I felt like if one book had a gap of knowledge with regards to a topic the other would fill it. I read both books twice. Sounds like overkill I know (and truth be told MTB was probably more helpful) and I don't know how much it impacted my score but I did pass with 222 so I would have done the same thing all over again. I'm also a really bad test taker (Step 1 - 201, Step 2 - 217) so this I feel was the best I could do and I'm ok with that. Lol

As far as CCS goes I recommend doing all the UW cases again (make sure you read the explanations!) and then read the free online neeraj's strategy for step 3. It gives very helpful tips. CCS cases go by FAST so you need to have a method to the madness and remember that always always always take care of your patient! If they're in pain, give them pain meds, if they're NPO and there's no contraindication give fluids, etc... It's not necessarily finding the diagnosis that's important but how you work them up and manage them along the way. Also make sure to not let them trick you! Don't CT abdomen a pregnant woman or CT contrast someone in acute renal failure. They're testing your clinical judgment so be prepared to get some curveballs. Do not underestimate this section it's worth 25% of your exam and can definitely tip the score over the passing side if you do well on it.

Hopefully some of this is helpful. You CAN do this you've made it this far and you're so close. Build yourself back up. Part of this exam is having confidence in yourself and in the moment refusing to let the exam overwhelm you. You can worry about feeling like you failed the exam all you want after you take it but during the test tell yourself you WILL pass.

Good luck man and I have faith that you will overcome this obstacle.

 

[Lostin_space]

First off, I'm very sorry. A fellow resident and close friend of mine just found out she failed as well by 2 points. Both her step 1 and 2 scores were in the 230's so failing can happen to anyone. As someone who personally took this exam last month, I don't care what anyone says it's the worst of the steps because of how long it is (my mind was mush at the end.)

Doing Qbank questions multiple times isn't as helpful as thoroughly reading the answer explanations and making sure you understand the concepts behind them (including the wrong answers). You can learn 2-4 concepts just by reading one question's explanations alone!

It's hard to know how to give advice when I don't know which of your areas were weak. If stats was bad or even borderline I suggest you buy UW Biostats package as a refresher course. There were a TON of stats questions on day 1 I personally wish I would have bought the UW package. Also when you take the test write down the equations at the intro screen so you'll be ready when a stats question pops up.

Additional resources I used were First Aid for Step 3 and Master the Boards 3. My method was I would read a subject in one and the same subject in the other. That way I felt like if one book had a gap of knowledge with regards to a topic the other would fill it. I read both books twice. Sounds like overkill I know (and truth be told MTB was probably more helpful) and I don't know how much it impacted my score but I did pass with 222 so I would have done the same thing all over again. I'm also a really bad test taker (Step 1 - 201, Step 2 - 217) so this I feel was the best I could do and I'm ok with that. Lol

As far as CCS goes I recommend doing all the UW cases again (make sure you read the explanations!) and then read the free online neeraj's strategy for step 3. It gives very helpful tips. CCS cases go by FAST so you need to have a method to the madness and remember that always always always take care of your patient! If they're in pain, give them pain meds, if they're NPO and there's no contraindication give fluids, etc... It's not necessarily finding the diagnosis that's important but how you work them up and manage them along the way. Also make sure to not let them trick you! Don't CT abdomen a pregnant woman or CT contrast someone in acute renal failure. They're testing your clinical judgment so be prepared to get some curveballs. Do not underestimate this section it's worth 25% of your exam and can definitely tip the score over the passing side if you do well on it.

Hopefully some of this is helpful. You CAN do this you've made it this far and you're so close. Build yourself back up. Part of this exam is having confidence in yourself and in the moment refusing to let the exam overwhelm you. You can worry about feeling like you failed the exam all you want after you take it but during the test tell yourself you WILL pass.

Good luck man and I have faith that you will overcome this obstacle.

Would you recommend I mostly focus on weaker areas vs. trying to study the whole thing again? I feel taht would be overwhelming and obviously I have limited time. I don't know if I did something wrong on the CCS cases - most of them finished within minutes! I thought that was good. Like there was a surgical case, I ordered the surgery and bam! the 2 minute warning came into effect. I had to hit "exit" into most of them though because after the 2 minute thing the case would not go away. WAs that wrong? Also I do think stats was a tough subject for me because I did not understand or have time to do some of the quesetions, even though I did all the biostats in U world. What is a good source for studying biostats? I have been suggested to mostly concentrate on the weak areas vs studying everything. I think I will ask my program for a LOA to get my head in the game. Also my computer crashed during the exam. I have contacted USMLE about it. I wonder if that would have any effect?

 

[Tapepsi]

Would you recommend I mostly focus on weaker areas vs. trying to study the whole thing again? I feel taht would be overwhelming and obviously I have limited time. I don't know if I did something wrong on the CCS cases - most of them finished within minutes! I thought that was good. Like there was a surgical case, I ordered the surgery and bam! the 2 minute warning came into effect. I had to hit "exit" into most of them though because after the 2 minute thing the case would not go away. WAs that wrong? Also I do think stats was a tough subject for me because I did not understand or have time to do some of the quesetions, even though I did all the biostats in U world. What is a good source for studying biostats? I have been suggested to mostly concentrate on the weak areas vs studying everything. I think I will ask my program for a LOA to get my head in the game. Also my computer crashed during the exam. I have contacted USMLE about it. I wonder if that would have any effect?

If you feel like you really have retained all of that info after 3 weeks then I guess focusing on weak areas would be better (but I would still at least briefly review every category). I did a memory dump after the exam so I personally would have to review most of it again. Just remember though you want to increase your chances of passing this time so jumping right back in and taking it may not be a good idea. At the 2 minutes screen put in all your finishing orders/counseling and then hit end (because it won't let you enter the diagnosis unless you hit end before 2 minutes is up). If you're referring to the next blank screen that you have to hit end again then yeah not sure what that was about.
From what I've heard the UW biostats/epidemiology package is good and would be worth buying (keep in mind this is different than just doing the stats questions in the UW Qbank).

Also that sucks about your computer crashing! That would have definitely impacted me mentally and hopefully they do get back to you if the program crashing could have internally screwed up your score in some sort of way.

Also again I recommend neeraj guide to CCS. I remember an ortho resident printing it out for me and saying "It's gold". I scored best in CCS (didn't get an asterix but it was well above the shaded bar far off to the right).

 

[SO4LR6]

Keep your head up! If medicine is really what you wanna do in life, you've come too far to give up and let Step 3 defeat you!

My advise is to crush the CCS and I agree with using Neeraj's study guide in conjunction with doing the UW cases; that will be your best bet to pass. Your cases closed quickly, but if you skipped portions of the work-up and went directly to the treatment, that may have cost you major points. From what I've heard (and this could just be rumors but makes sense to me), even if you were to get perfect scores on the remaining portion of the Step but failed the CCS portion, they will not give you a higher score than 195 (passing is 196). If anyone passed Step 3 despite doing poorly on CCS, please correct that notion.

 

[js99]

Does anyone know how to get a copy of Neeraj guide to CCS? I wasn't able to find working links when I searched for it. Thank you in advance.

 

[CaribbeanMD]

Neeraj_s_CCS_notes.pdf

I was able to download it through this link.