First year radiology resident here (PGY1, doing a prelim year in medicine).
I took my Step 3 last Tuesday and Wednesday, and walked out of the exam thinking I did ok. Then, out of curiosity, I read a little more about the CCS and found some disturbing information.
Admittedly, my preparation for it was quite casual. I did all of the UWorld cases once, and then read the approach to the case, where it tells you what management is optimal and what is detrimental. To be honest (and Im quite ashamed to say this), I didnt read the time management part where it tells you specifically what things to order and when. For some idiotic reason, I went into the exam convinced of two things: 1. that I could wing it, and 2. that it was simply testing your ability to diagnose a health problem and render the big treatment components.
So, on the actual CCS, for example, I had a heart failure exacerbation. I put the guy on oxygen, pulse ox, and cardiac monitor. Did a focused exam (should have ordered labs before the exam, but thats another blunder on my part). Ordered stat EKG, stat labs, stat CXR, stat cardiac enzymes, stat echo, got the echo result, Lasix (cant remember if I ordered continuous or bolus), etc. etc. Admitted the guy to the ICU, ordered a cardiology consult, and did a little more management here and there (i.e. in addition to the orders that carried over from the ED). Q4 vitals, daily labs, nitrates, hydralazine, and thats about it. This particular case ended at around 14 minutes of real time. I dont believe the guy died.
Last Friday, I stumbled across the recommended orders for a case like this, and I was flabbergasted!
There were orders for raising the HOB to 30-degrees, to order low salt diet, fluid restriction, subcutaneous heparin, SCDs, dietary counseling, measuring the UOP, daily weights, and..and..and, about two dozen other orders that youd ordinarily put in when admitting someone to the ICU.
The point is that I was looking at this exam from the standpoint of having to address only the big picture. I did this with all my cases.
Of the 12 cases I had, I ran out of time on one of them only. Eleven of them finished early. One of them finished as late as 16 minutes. Three or four of them around 14 minutes. And the rest of them around 10 minutes. I had two of them finish under 4 minutes.
So what Im wondering is this: how important are the little orders, i.e. the adjuct (but necessary) components of managing a condition? Obviously, if the cases ended early and the patient didnt die, the National Board of Medical Examiners felt I knew what it took to pass that case....or did they? Somehow I cant help but worry about not being hit hard for forgetting to order HOB to 30-degrees on that heart failure patient, despite the fact that the cases ended early and the guy (if Im not mistaken) didnt die.
Should I be planning on retaking this test? Or am I solid? To be frank, Im not only ashamed about my initial nonchalance about the nitty gritty regarding this CCS portion, Im quite worried now about how I did.
I took my Step 3 last Tuesday and Wednesday, and walked out of the exam thinking I did ok. Then, out of curiosity, I read a little more about the CCS and found some disturbing information.
Admittedly, my preparation for it was quite casual. I did all of the UWorld cases once, and then read the approach to the case, where it tells you what management is optimal and what is detrimental. To be honest (and Im quite ashamed to say this), I didnt read the time management part where it tells you specifically what things to order and when. For some idiotic reason, I went into the exam convinced of two things: 1. that I could wing it, and 2. that it was simply testing your ability to diagnose a health problem and render the big treatment components.
So, on the actual CCS, for example, I had a heart failure exacerbation. I put the guy on oxygen, pulse ox, and cardiac monitor. Did a focused exam (should have ordered labs before the exam, but thats another blunder on my part). Ordered stat EKG, stat labs, stat CXR, stat cardiac enzymes, stat echo, got the echo result, Lasix (cant remember if I ordered continuous or bolus), etc. etc. Admitted the guy to the ICU, ordered a cardiology consult, and did a little more management here and there (i.e. in addition to the orders that carried over from the ED). Q4 vitals, daily labs, nitrates, hydralazine, and thats about it. This particular case ended at around 14 minutes of real time. I dont believe the guy died.
Last Friday, I stumbled across the recommended orders for a case like this, and I was flabbergasted!
There were orders for raising the HOB to 30-degrees, to order low salt diet, fluid restriction, subcutaneous heparin, SCDs, dietary counseling, measuring the UOP, daily weights, and..and..and, about two dozen other orders that youd ordinarily put in when admitting someone to the ICU.
The point is that I was looking at this exam from the standpoint of having to address only the big picture. I did this with all my cases.
Of the 12 cases I had, I ran out of time on one of them only. Eleven of them finished early. One of them finished as late as 16 minutes. Three or four of them around 14 minutes. And the rest of them around 10 minutes. I had two of them finish under 4 minutes.
So what Im wondering is this: how important are the little orders, i.e. the adjuct (but necessary) components of managing a condition? Obviously, if the cases ended early and the patient didnt die, the National Board of Medical Examiners felt I knew what it took to pass that case....or did they? Somehow I cant help but worry about not being hit hard for forgetting to order HOB to 30-degrees on that heart failure patient, despite the fact that the cases ended early and the guy (if Im not mistaken) didnt die.
Should I be planning on retaking this test? Or am I solid? To be frank, Im not only ashamed about my initial nonchalance about the nitty gritty regarding this CCS portion, Im quite worried now about how I did.
