Cpt.Hook Hamate

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I just completed my Step 3 exam this past weekend. I don't feel well about my performance at all. It was a difficult exam. Maybe more difficult than step 1 (at least I had enough time to think through the questions on that one)

I spent 2 months preparing for the exam. I mostly spent about 3 hours once I got home in the evening reading Crush or doing qbanks questions. That all I did. Once I read through Crush Step 3 once, I started USMLEWorld. I completed 100% of the questions and got 58% of them correct as a cumulative.

After taking Step 3, I am not sure if UW was even a good source for the exam. The vignettes tend to be much longer in Step 3 and they have those 2-4 part questions that once you complete the previous question, you are no longer able to go back to change your answer once you advance to the next question. UW didn't have those restrictions. Also, UW had no images for the qbank questions while Step 3 has many including those with audio.


First day:

The first day I felt really horrible by the end of the day. I had a lot of OBGYN, pulmonary, cardiology, and peds questions (listed in order of descending amount). My biggest problem is that I did not have enough time to read and think through a whole gang of questions. For at least 2-3 questions per block, I either quickly skimmed or just randomly chose an answer. It was so frustrating to read those long vignettes. There was no block where I just felt really good about after finishing it.


Second Day:


Although I felt better than previous day regarding the blocks, I still had to randomly answer 1-2 questions per block. It seem as no matter how hard I tried to read fast or think through the questions efficiently, there simply was not enough time to provide adequate thought on many of the questions. If I tried to think too much on any question, it seems as if I paid for it by running out of time. I was forced to pick up a strategy involving skipping and marking all biostat questions and saving them for the end of the block. Thankfully, there was not many of them because I never got the chance to read through about 75% of them. I though I could make up by a good CCS performance but even that caused me to nervously fumble through it considering I placed so much weight on it to give me a fighting chance of passing the exam.


CCS:

It was really too bad but there was some situations that I really had to think for too long to recall what I am supposed to do for the situation.


Case 1st: An emergency cardiac case. I knew what do when she first walked in the door and how to treat her problem for the most part. I did everything right and was surprised when I went right into counseling the patient and the update told me that she was too ill too cooperate and that she still had chest pain. I was thinking "what in the hell I am supposed to do no! She is supposed to be getting better. I placed the right consults. There was only one possible solution that I could think of which was invasive so I chose it and the case ended. Not sure what that meant.

Case 2. An emergency cardiac case. I did the right set up and the right procedure with improved her symptoms but she still complained of pain but there was an obvious reason to have the pain even though I gave her good pain meds and did a procedure that saved her from an immediate life-threatening illness. I even placed the right consults. The case ended early without me getting a chance to admit her to the hospital.



Case 3. An OBYGYN case. I felt I managed it well and the patients symptoms completely resolved. Case ended in maybe 5 to 8 minutes.


Case 4. An endocrine case. I felt I managed it well and it was very straight-forward. She improved in the case ended in maybe 10 minutes.


Case 5. A psyche case. So much was going on with this lady but I stuck with the big picture and she improved. The case ended in about 15 minutes.



Case 6. An Heme/onc case. I felt my initial work up an decisions were excellent but once I found out what the illness was, I picked the wrong medication and was too aggressive with some of the treatment. I never even found out what was the outcome of the case or got a patient update. I figured I bombed it.


Case 7: An ID case. It was straight-forward and I managed it quickly and correctly save for leaving out a couple of standard studies but the patient improved and the case ended in about 5-10 minutes.


Case 8. An Heme/Onc case. I found out what was wrong quickly with the patient quickly. I placed the patient on the right med to treat the problem but failed to do something very crucial and that was to D/C the med that was causing the problem. I suspected a secondary problem and was awaiting for some crucial lab results to get better insight on what to do from there but I screwed up by not d/cing not d/cing a reading that I ordered for every hour while I was running out of time. I never found out the secondary issue. This was the only case that the clock ran out on.


Case 9. I feel so bad and ashamed from screwing this case up that I won't go into much detail. I will just say that I knew what to do exactly every step of the way but I made one huge critical mistake. I chose the wrong form of the medication that he needed. This mistake, I am almost certain, negated every thing else I did right in the case. This is mainly because the standards subsequent treatment depends on that the initial medication form was ordered correctly.
 

FirstMANdown

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Hey Captain Hook Hamate,

Thank you for sharing your post. From what I gather you have experienced the same frustration as almost all folks do when they take this exam. In terms of the cases, don't worry too much about it, especially the case where you had all the steps down but did not treat with the right medication as the finally of the case. From what I have heard on the scoring system for the Step 3 CCS portion is that each and every case is graded by each step you do, so in other words you may loose lets say at the most 5 pts for wrong treatment but can still get 95 pts if everything up to that point was correct. I think If you knew the diagnosis and took logical steps to manage the patient you should do fine. Everyone makes mistakes on these CCS cases, some even completely beef 1 or 2 cases and still score above the average for the CCS scoring system. Im telling you, don't worry it will probably work out better than you think. Also, some CCS cases I heard in terms of patients getting worse after appropriate treatment happens very frequently. This does not mean you missed up. Relax, on a golden weekend have a cold brew, kick your feet up and know that you managed these patients with the best care possible, and thats all that counts anyways. I wish you the best on your upcoming score. :):thumbup::luck::xf:
 
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Cpt.Hook Hamate

Cpt.Hook Hamate

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Thanks, Firstmandown. I really appreciate the encouraging words. I am trying not to be whiny about the whole thing but it was major frustration. I really was disappointed how I handled those CCS cases since the one I screwed up big time on was a "give me."

I guess there is nothing I can do but accept your advice. Beating myself up won't change the outcome. I spent so much time with USMLEworld and I really wonder if I should have went with Kaplan in hindsight.When I first used UW for step 2, I was so delighted how similar the questions were but it seems as if they didn't even bother to make them close to Step 3 questions. Man, I really need to pass this thing so I can Moonlight up the wahzoo and not to mention to be able to show that I passed the damn thing for Fellowship.
 
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Cpt.Hook Hamate

Cpt.Hook Hamate

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I passed the freakin *&%$#@ punk @$$ *$#@! of a test! Good bye USMLE forever! I am so glad to have this series of exam out of my life! I got my passing score and my fellowship spot and now I am golden!


I don't know if I can really even give any advice for taking Step 3. It seem like no matter how much I knew or studied, the damn thing just gave me trouble. At least I can say if you are getting a 58% on USMLEworld, you are likely to pass. Other than that, good luck on tackling that beast. In my opinion, Step 3 was probably a bit more tough than Step 1 but there are many who disagree with me but it doesn't matter any more. It is all behind me now.
 

FirstMANdown

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I passed the freakin *&%$#@ punk @$$ *$#@! of a test! Good bye USMLE forever! I am so glad to have this series of exam out of my life! I got my passing score and my fellowship spot and now I am golden!


I don't know if I can really even give any advice for taking Step 3. It seem like no matter how much I knew or studied, the damn thing just gave me trouble. At least I can say if you are getting a 58% on USMLEworld, you are likely to pass. Other than that, good luck on tackling that beast. In my opinion, Step 3 was probably a bit more tough than Step 1 but there are many who disagree with me but it doesn't matter any more. It is all behind me now.
Congrats man!!!! That is diffenatly a reason to have 5 or 6 cold ones :D Hey Hamate, did you ever take the UW assessment exam? if so how was your score compared to it? were they even close?
I my self got the exam next week. Hope I can pass this bad boy. Got 59% on UW mcq's but you know how that goes. Just hope I don't get blasted on the real one. This is my second go around with it :( Hit me back when your sober!:thumbup::cool::D
 
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Cpt.Hook Hamate

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Hey, Firstmandown. Thanks for the cheers. I am so happy to get those annoying steps out of the way. At first, I was sort of cool with studying for it because I thought "well, this will only help me to be a more knowledgeable physician" but that wore off after a while with those annoying qbank questions.


With a 59%, I think you will pass. I think the major thing about Step 3 is managing the clock. That is the biggest hurdle. Of course, the questions can be quite vague. I didn't use any self-assessment exams. My thought was "if every one seem to agree that a UW score is a 58% is enough to pass, why would I need a self-exam test to basically tell me something similar...that I might pass with a certain score. I never was the self-assessment exam kind of person when it came to the USMLE. I felt that the qbanks were enough self-assessment for me.


I wish you the best of luck, man, and I would bet my money that you will pass the exam this time considering your UW average. I got a 58% and passed although it was a much lower score than my step 1 and 2 exams, I don't care. I just wanted the exam out of my way.

The last part of my preparation for Step 3 was practicing managing the clock and I was getting through all of the questions with reading them thoroughly and having enough time to think but in the real exam, all out that went out of the window and I still passed. So if I can manage the clock well in in UW and get a 58% and screw up in the real exam and still pass, I am sure your 59% is a good indicator.
 

FirstMANdown

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Hey, Firstmandown. Thanks for the cheers. I am so happy to get those annoying steps out of the way. At first, I was sort of cool with studying for it because I thought "well, this will only help me to be a more knowledgeable physician" but that wore off after a while with those annoying qbank questions.


With a 59%, I think you will pass. I think the major thing about Step 3 is managing the clock. That is the biggest hurdle. Of course, the questions can be quite vague. I didn't use any self-assessment exams. My thought was "if every one seem to agree that a UW score is a 58% is enough to pass, why would I need a self-exam test to basically tell me something similar...that I might pass with a certain score. I never was the self-assessment exam kind of person when it came to the USMLE. I felt that the qbanks were enough self-assessment for me.


I wish you the best of luck, man, and I would bet my money that you will pass the exam this time considering your UW average. I got a 58% and passed although it was a much lower score than my step 1 and 2 exams, I don't care. I just wanted the exam out of my way.

The last part of my preparation for Step 3 was practicing managing the clock and I was getting through all of the questions with reading them thoroughly and having enough time to think but in the real exam, all out that went out of the window and I still passed. So if I can manage the clock well in in UW and get a 58% and screw up in the real exam and still pass, I am sure your 59% is a good indicator.
Thanks Catain Hook Hamate,

I feel encouraged. The big day is the day after tomorrow. Hope things work out statistically as they did on my practice run. With these type of exams you never know. I hit you up after the exam and let you in on my take of it. Love, peace & hair grease! :thumbup:
 

Terex

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Thanks Catain Hook Hamate,

I feel encouraged. The big day is the day after tomorrow. Hope things work out statistically as they did on my practice run. With these type of exams you never know. I hit you up after the exam and let you in on my take of it. Love, peace & hair grease! :thumbup:
GOOD LUCK man;);)
 

peeludr

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Congrats!!!i gave my exam a week back i felt exactly the same after coming out of the exam.I was worried and started searching all forums.I found ur experience very encouraging.I screwd up on most of my ccs cases.I'm hoping that I pass this test too.Congrats again.way to go....:luck:
 

FirstMANdown

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Hey all,

Finished taking the exam on August 18th & 19th. Needless to say it was a long 2 days. However, I felt really good about the exam. Thought most of the questions were more or less straight forward and was able to finish all my CCS cases before time ran out. Could have done better though in terms of efficiency but hey, I did no harm to the patient and they all got better. Felt that some of the cases ended a bit prematurely, but all the main orders were in before hand so I guess I wont worry about it too much.
Questions and concepts seemed to come straight out of the combo of UW, Kaplan-qbank and Premier Review notes. At least it seemed that way. A lot of people I have been getting feedback from, when they say they felt good about the exam they generally fail it and when people say the exam went horrible those are the ones who pass it...so I don't know what to think. I felt like I did decent on the exam. Hope this ain't no bad sign. Oh well, the rest is in the hands of God, I did my part already. Should get results back on Sept. 9th 2009. I will halla at you guys at that time. If anyone has questions please feel free to ask me anytime. Peace,

FirstMANdown


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FirstMANdown

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Got results back this past wednesday. I Passsssssssssssssssssed!! Yes! I am happppyyyyy! Good luck to you all, and good by USMLE forever.

---------------->Score: 196(80) :))))







-----------------:soexcited::highfive::woot::zip::soexcited::laugh:------->:banana:-------->:diebanana:(banana=USMLE)
 
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Cpt.Hook Hamate

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Congratulations!! I am very glad to hear the good news. I occasionally checked back on this forum to follow-up on your results. Enjoy!
 

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Had to weigh in with my tale of hope for all the prospective Step 3 takers out there:

FOURTH year pathology resident here. I studied for about 1 mo. for the exam doing mainly UW questions (finished 100% in tutor mode, 63% cumulative) and used Kaplan Master the Boards and First Aid. Would look stuff up in Cecil's if I really didn't understand something (by the way, lots of tables in Cecil's are pretty high yield).

In the days before the test I was more nervous than I have ever been before an exam. The volume seemed so huge and I hadn't done clinical medicine in three years. I was extremely anxious.

During the first day, I pretty much flipped out as question after question was so detailed, so ambiguously worded and some, so complex, that I pretty much assumed failure after completing the first three blocks. All I thought about (instead of the rest of the questions) was not graduating the residency, not being able to attend my already-scheduled fellowship and the professional embarrassment I would endure having to face all my colleagues, attendings and attendings from my fellowship after having failed the exam. I was sick to my stomach for the rest of the day and had to force myself to eat dinner later that night.

During the night I could only sleep for four hours due to the anxiety. The second day was not as bad though; shorter blocks and the CCS cases made the day easier. However, I still felt extremely bad about my performance and felt fairly certain I had failed. Three weeks later.......PASS.

TIPS:
1.) Subject matter was evenly represented. There IS surgery on this exam and the MCQ surgery questions are not trivial (so, if using FA, supplement with another book for surgery info). Also, know your EKGs; had several of them (and they weren't easy ST-elevation MI or Torsades tracings, either).
2.) Time is a MAJOR factor, especially on the inpatient sections (non-stop, looooong vignettes with highly detailed info). On one or two sections I actually left 3 or 4 blank at the end because I ran out of time. For longer vignettes I would skip to the end and find out what they were asking first, then go and speed-read through the vignette. Don't get caught up reading through sentences with vital signs or heart monitor readings, look only at the numbers.
3.) Doing questions is the way to go; USMLE world was O.K. and there were some direct hits on the exam. However, alot of the exam questions seemed more difficult because the USMLE is excellent at giving you just enough information to make two (or three) answer choices seem equally plausible. You can hurt yourself spending excessive time deliberating. Don't know about Kaplan Qbank but a path resident colleague used it and was happy with his performance.
4.) For CCS, either First Aid or USMLE World CCS cases should cover your bases.
5.) Remember, you are (much) more likely to pass this exam than not.
6.) I've been looking under a microscope or looking at patients who've failed clinical management (i.e. corpses) for three years. If I can pass it, so can you. Best of luck, guys.


Aaaannnddd, I'm done.
 

rolling wheal

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the original post here is great. I read this many times before and after i took the exam. My experience was exactly the same. I ran out of time on all but one subtest. the stems were much longer than either of the first two steps. CCS was easy and an easy way to rack up points. in the end though, i did fine... 209. very happy to be done all steps. key is don't get down on yourself during the exam because it's tough for everyone. And don't sweat it if afterwards you feel like you failed. I think one section I quessed on the last 6 because i ran out of time. Most of them i guess on 2 or 3 questions due to time. only once in all 11 tests did i finish on-time. hope this helps someone.
 

pmpkn219

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I generally don't have a problem with time, although on 2 MC blocks I was very close to the wire. My strategy is usually Flag ones I'm unsure of after giving them a little thought (but not obsessing), sometimes I choose a tentative answer, sometimes I just cross out choices I'm not considering. Then I always have time to recheck the flagged ones, which can be 2-10 per block, depending how certain I feel!

On step3, I had those 2 blocks where I couldn't give the flagged questions the attention I normally can, and that was a little unnerving to me. I definitely made sure to Answer every one anyway, even if I didn't think the second time through, just clicked.

I was anxious about CCS because I've gotten so used to MC style questions. I thought the UW CCS bank was helpful though, to keep me from drawing a total mind blank and forgetting something terribly important (like an EKG). I also read Crush Step3 2 times (highlighted the 2nd time), and reskimmed the highlighting the night befor ethe test. And I completed all the UWorld QBank for the MC and CCS style questions. I bought the 60-day membership and did about one 48-question block a night to start, then ramped up the speed towards the finish. I think I did Qbank for about 50 days total, and had started a couple chapters in Crush before I did the questions. I also marked all the Qbank questions that said **Extremely high yield for Step3** and looked those over a day or two before the first day of the test (I took a Mon/Tuesday schedule)

I did almost kill a guy with upper back pain and no h/o trauma, who turned out to be dissecting his aorta. That sucked! Luckily it was like case 6 of 9, so I was in the home-stretch. It's a tough test, but not too horrible. I thought the nature of the questions was pretty similar to Step2, although having each block being a specified "environment" was different... perhaps helpful? The most important thing is, if you know your stuff, don't let the test psych you out. You can cripple yourself just fretting over past things. Once the block is over just breathe and move forward, try not to let it affect your ongoing state of mind (easier said than done, I know)

I took my test in September of intern year because I'm doing Peds. It has already been about 14 months since I was on a non-child service (had a very Peds heavy 4th year), and I knew my general/adult knowledge was waning faster than I'd like. My intern year started pretty light, so I took advantage and got this beast out of my way... I am happy with how the scheduling worked out, no regrets. I got a 242/99, with the only stars crossing into "borderline" being my CCS bar (thanks to dissection-guy, no doubt)
 
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FirstMANdown

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It is so encouraging to read all the cool advice you guys had in regards to your USMLE Step 3 experience and then some. I only hope there are fellow residents out there that get the chance to read these valuable postings. I have to say, guys like you all and past threads have really made it more believable for me to have conquered this Step 3 exam and the likes. Good fortune to you all and God bless. Peace out. :cool::thumbup: :biglove:(thats what its all about)


"In my mind, I knew he would be somebody...cause he's a BAD ASS!!"
-Pulp Fiction






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RadOncDoc21

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Congrats to all of you guys who have gone through this journey!

I have to say it does feel good knowing I'm not the only person leaving the testing center with some serious doubt. I just completed day 2 and all I can say is that I just want to pass.... :).

I went in thinking I could score a 220 and be ok... let me tell you after day 1, I thought about not showing up for day 2. Day 2 felt a little easier but after getting a few answer choices in a row wrong (the ones you can't change)... I couldn't help but think of when I should schedule my retake. I actually had over 10-15 mini conversations in my head and had to rush a few times just trying to finish all of the question blocks. Altogether, the CCS cases were not that bad (I think). I used the last screen to do all of my follow-up and counseling recommendations with outpatient meds and management, however I'm not sure if we were suppose to do all that.

Thanks again to all who of those who have posted prior to me and for sharing their own personal experiences... I'm just hoping (praying) for the best... hopefully my update will be good news.

To all of those who are preparing for Step 3, good luck!

-R
 

RadOncDoc21

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Passed... 211/88... Thank God I passed and done with the USMLE! :)