Step III last 5 mintues

[jok200]

Advertisement - Members don't see this ad

In uworld step 3 for ccs cases when I look under clock management and it says "final orders" is that what I was supposed to write down when the 5 minute mark popped up and said write any other orders before exiting the case?


thanks again-

 

[OveractiveBrain]

In uworld step 3 for ccs cases when I look under clock management and it says "final orders" is that what I was supposed to write down when the 5 minute mark popped up and said write any other orders before exiting the case?


thanks again-

If you are taking the case out that far you've missed something and done something wrong. This is you last chance to save the case. you probably don't know the answer by now (else you would have already done the proper intervention and the case would have ended), so go broad. Shoot wide, but don't do anything dangerous.

If you have done everything right, the case will end early, without you doing anything. At this point, you should enter in NO ADDITIONAL ORDERS.
If the case ends early (not you ending it early) you have either already succeeded or you have killed the patient. Either way, no additional info is necessary.

 

[jok200]

Okay... I worked a case with uti and did EVERYTHING PERFECTLY, yet it still went to "5 mintues" left and I worked through the case in less than 60 seconds of real world time? So i have no idea what your talking about when the 5 mintues pops up? Is it normal for that 5 mintues thing to pop up or does it only occur when you are doing something incorrectly? I love how their are NO DIRECTIONS, INSTRUCTIONS how to use this software and it is completely unlike any question bank and you are simply supposed to learn by asking questions on random forums... the "art" of medicine huh.

 

[jok200]

Can you tell me what it is supposed to look like when the case ends properly, specifically what pops up, closes and what is said? I am learning to use this software and it is cumbersome at this point, but I know will become easier.

Thanks again for the help-

 

[jok200]

How do you input that "patient needs to followup in 2 weeks or 6 months?" or is it implied, I am confused on this?

thanks-

 

[jok200]

Okay... I think i have it now. I just finished a case in less than 7 minutes of simulated time it went to you have 5 mintues left pop up. I have been looking online and it seems that when that happens and the patient is getting better it means that you are doing the appropriate management and the case ends. My question is when the case ends does it always go to that 5 min pop up because from what I have been reading it does.

thanks -

 

[haresh]

Okay... I worked a case with uti and did EVERYTHING PERFECTLY, yet it still went to "5 mintues" left and I worked through the case in less than 60 seconds of real world time? So i have no idea what your talking about when the 5 mintues pops up? Is it normal for that 5 mintues thing to pop up or does it only occur when you are doing something incorrectly? I love how their are NO DIRECTIONS, INSTRUCTIONS how to use this software and it is completely unlike any question bank and you are simply supposed to learn by asking questions on random forums... the "art" of medicine huh.

Jok200, that software is nonsense. No instructions on what to put on 5 min screen. No instructions on managing simulated time. Then you have "overactive" suggesting that "it is bad if the case does not end early"! and he says "no additional orders on 5 min screen if case ended early"! Do we need more confusion than this?

Do some google search and check other forums also. There is valuable info on how to approach the CCS cases ( The correct way is much different than the way UW does). Here is some info I found:

About "case ending" : The case ends based on whether you met the requirements with in certain designated simulated time ( patient time). If you met the requirements, the case will end and it is good ending. If you do not meet the requirements, the case will let you advance the clock until simulated time reaches a dangerous point where even when you put correct treatment it is considered as a life threatening treatment delay. So at that dangerous point in simulated time the case will end ....if no treatment was made by that simulated time - case is a fail. If treatment was delayed until that point - case is average. If the treatment is done early much before this danger simulated time as done in a good ER , case is excellent.

Practice this case on orientation primum software:
For example, in pneumotorax case if you put chest tube at 45 minutes... you delayed but your case is average and after that case ends when simulated time hits that point. You get average score
If you put chest tube in 5 minutes, case will let you go on until 45 minutes and it will end there. You get excellent score
If you let the case go until 45 mins with out putting chest tube and does not put it even then, patients vitals will crash ( so 45 minutes is considered as a critical point in the life of this patient with tension pneumo) . 5 minutes screen will pop up and simulated time shows up as 45 minutes. You realize your mistake at least now and put in the chest tube. You will get below average score...very low score but something better than nothing!
If you let the case go until 45 mins with out putting chest tube and does not put it even then, patients vitals will crash - 5 minutes screen will pop up and simulated time shows up as 45 minutes. You DO NOT realize your mistake at least at that time and DO NOT put in the chest tube even on 5 min screen. This case will be a total failure. Nada, zero score! "

So, you can save the case even on 5 min screen but will get only a little score when compared to saving him with in 5 mins of presentation.


Next issues is "What can be done on 5 min screen?"

Adjusting orders on 5 min screen: on 5 min screen, you should base your judgement based on simulated time shown when you are on 5 min screen. Do not base judgement on real time. For example if a elderly patient has pneumonia and we start IV antibiotics on day 1, our aim is normally to advance the clock to day 2, see if he is afebrile and then switch IV antibiotics to PO and make arrangements for discharge. However, if the case ended when you are trying to advance the clock to day 2, very important thing is that we should check simulated time on 5 min screen. Even though we advanced the clock to day 2, if the case ended before that advance occurred, simulated time may still show day 1 on 5 min screen. So, in this example case, we should check simulated time when you are on 5 min screen. If it shows day 1, leave everything as it is i.e; do not switch IV to po etc. If simulated time shows day 2 or more and if patient afebrile > 24 hrs, switch IV antibiotics to PO .

What you can not do on 5-minute screen?
You cant change location or obtain results
If you did not have time to put your essential treatment orders or procedural orders and the case ended , put them now
Discontinue unnecessary orders at this time
Add discharge home medications if simulated time and patient criteria meet discharge requirements.
If patient is ready to go home, switch IV meds to oral
Do counseling
Enter diet orders.
Enter age appropriate and disease appropriate vaccines if not entered before

VERY IMPORTANT ( you can do the following actions only on 5 min screen) Using "Later" option on 5 minute screen enter the follwoing after the calender pops up. These can not be done on active screen because there is no "later" option during active case until 5 min screen pops up. If follow up tests are not ordered for pertinent cases, it reduces the score. Not doing follow-up tests will be regarded as though we are treating the patient but not following the response to the therapy or toxic effects ( This is scored under separate section "Follow up care" in USMLE step 3. Score report will show this different section used in scoring) . Do the following using "LATER" option:
- Enter follow-up tests for a later date pertinent to the case scenario i.e; following drug toxic effects (LFTs, cbc etc), following the drug efficacy (lipid panel, INR monitoring etc), following disease activity ( follow up TSH etc)
- Enter elective screening tests for a LATER date in an inpatient i.e; colonoscopy, pap smear, mammogram

 

[jok200]

thanks for all the help this makes a hell of a lot more sense then what i was being told... that being said when I complete cases on uworld every case reaches 5 minute window, even when i input the data the way uworld wishes me to, does the 5 minute window popping up mean something was missed or does it pop up all the time?


thanks for all the help

 

[haresh]

thanks for all the help this makes a hell of a lot more sense then what i was being told... that being said when I complete cases on uworld every case reaches 5 minute window, even when i input the data the way uworld wishes me to, does the 5 minute window popping up mean something was missed or does it pop up all the time?


thanks for all the help

thanks jok200, at least you appreciate my point. The problem here is no one helps with details rather than endorsing an error-filled UWorld software for selfish reasons. None of the above important points are taught in UWorld

 

[jok200]

Ok... how much "simulated time" are you alloted to complete the case and how much "real world time" I have heard different things from different people so I am trying to confirm?

thanks again

 

[jok200]

starting to get the idea of the software but, having difficulty figuring what to write in the final orders, as far as canceling? Cases end abruptly in the middle of management so I am unsure on what to cancel? or should i just not cancel anything to be on the safe side?


thanks-

 

[Knicks]

wow, this **** is confusing as hell....

surprised there's no sticky FAQ detailing how to go about using this software.

 

[Knicks]

Okay... I worked a case with uti and did EVERYTHING PERFECTLY, yet it still went to "5 mintues" left and I worked through the case in less than 60 seconds of real world time? So i have no idea what your talking about when the 5 mintues pops up? Is it normal for that 5 mintues thing to pop up or does it only occur when you are doing something incorrectly? I love how their are NO DIRECTIONS, INSTRUCTIONS how to use this software and it is completely unlike any question bank and you are simply supposed to learn by asking questions on random forums... the "art" of medicine huh.

Any helpful suggestions regarding the bolded portion?

really disheartening