Overwhelmed

[Lostin_space]

I will be taking step 3 this month and I feel incredibly overwhelmed! I'm an AMG, I have never failed any standarized test, but I feel that I will fail this thing. I feel overwhelmed by the amount of information there is to master, by the stupid CCS cases, and feel my entire career will come crashing down after all of this hard work. I have studied to the point that I have no clue what I know and don't know - have studied far more than most people, and have gone over the material and what not but I keep forgetting things and feel exhausted. I have almost felt like just quitting and throwing it all away!

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[primadonna22274]

You will not fail. Nobody fails step 3. Well, almost nobody. How did you do on step 2? That's usually predictive for step 3.
Studying is good but you've been doing this stuff presumably all year as a PGY1. Talk to your PD or upper levels for some encouragement. If you're that worried, your performance will suffer just from anxiety.
Propranolol works...as does hypnosis, and guided imagery. I had some wicked test anxiety M1 after a couple exam failures. Terrified me. Saw one of our faculty who taught me self-hypnosis...it worked (and believe me I am as skeptical as anyone). Have sailed through a couple hundred exams since then and only ABFM boards to go next spring.
Good luck.

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[Lostin_space]

You will not fail. Nobody fails step 3. Well, almost nobody. How did you do on step 2? That's usually predictive for step 3.
Studying is good but you've been doing this stuff presumably all year as a PGY1. Talk to your PD or upper levels for some encouragement. If you're that worried, your performance will suffer just from anxiety.
Propranolol works...as does hypnosis, and guided imagery. I had some wicked test anxiety M1 after a couple exam failures. Terrified me. Saw one of our faculty who taught me self-hypnosis...it worked (and believe me I am as skeptical as anyone). Have sailed through a couple hundred exams since then and only ABFM boards to go next spring.
Good luck.

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I did a medicine intern year but Im beyond PGY1 now so a lot of stuff is forgotten. I'm so incredibly anxious. Thanks for the good vibes. I passed step 2, not with flying colors, but not in danger zone. So scared. I wish I had some propanolol.

 

[ProfMD]

Don't worry about it. Step 3 is a piece of cake compared to Steps 1 and 2. As long as you studied, you'll be fine. The cas scenarios, as I recall, are fairly straightforward.

 

[Lostin_space]

Don't worry about it. Step 3 is a piece of cake compared to Steps 1 and 2. As long as you studied, you'll be fine. The cas scenarios, as I recall, are fairly straightforward.

I hope you are right. I am so overwhelmed it's crazy. I also felt like quitting my residency program as I thought, hey I'm going to fail this thing and all that work will be pointless. I know it sounds crazy. I really want to take this and be done with this, and hope for the best.

 

[Doctor Bagel]

Don't worry about it. Step 3 is a piece of cake compared to Steps 1 and 2. As long as you studied, you'll be fine. The cas scenarios, as I recall, are fairly straightforward.

Maybe not reassuring, but my step 3 score was a good 30 points lower than my step 1/2 scores. Not being in a primary care specialty definitely made it harder, but I passed by a good margin without studying a ton (although I did study and would have failed had I not). I actually do know people who have failed it without failing any other steps.

With that said, I think the op is OK, but I also think the easiness of step 3 gets exaggerated by people in specialties that are well covered on the exam.

 

[Doctor Bagel]

I hope you are right. I am so overwhelmed it's crazy. I also felt like quitting my residency program as I thought, hey I'm going to fail this thing and all that work will be pointless. I know it sounds crazy. I really want to take this and be done with this, and hope for the best.

So failing would suck, but it wouldn't result in anything happening except having to retake it.

 

[ProfMD]

Maybe not reassuring, but my step 3 score was a good 30 points lower than my step 1/2 scores. Not being in a primary care specialty definitely made it harder, but I passed by a good margin without studying a ton (although I did study and would have failed had I not). I actually do know people who have failed it without failing any other steps.

With that said, I think the op is OK, but I also think the easiness of step 3 gets exaggerated by people in specialties that are well covered on the exam.

I am in a surgical specialty - definitely had to study.

It's also good to remember that no one will ever care about the score as long as you pass.

 

[ProfMD]

So failing would suck, but it wouldn't result in anything happening except having to retake it.

This is very true - important to keep in mind.

Worst that happens is you retake it.

 

[Doctor Bagel]

I am in a surgical specialty - definitely had to study.

It's also good to remember that no one will ever care about the score as long as you pass.

This is the upside of step 3, and you're right that the scenarios were pretty easy. I still don't remember it being a super easy test, though.

 

[dozitgetchahi]

I am in a surgical specialty - definitely had to study.

It's also good to remember that no one will ever care about the score as long as you pass.

Yes. Some factors that help with step 3 are a) you had no time to study? Nobody else did either b) nobody really cares about the score c) residents of all stripes are in the same boat, and many of these residents are in specialties that don't focus on what's on the exam.

For these reasons, the curve for step 3 is way less aggressive than it was for steps 1 and 2. It's easier to pass and do well. Some people still fail, but that's not easy to do.

 

[atomi]

In my opinion step 3 was the worst of three exams. It's a grueling 2-day test. The questions are hard, long, and difficult to finish. The simulated cases are weird and throw you curve balls. You leave having no idea how well you did.

That said, the minimum passing score is very low, well below that for step 2 CK. And unlike step 1, it doesn't matter how well you do as long as you pass.

It doesn't take much to pass the test; however. If you did a medicine internship, you should be able to pass with minimal, if any, studying. Just familiarize yourself with the simulated case format and you should score around 200 at least. If you're shooting for 260+ for whatever reason, well I have no idea how the hell you do that. If you did a non-medicine intern year or are far out from internship, you will need to study.

Bottom line, take this at the end of your intern year. That's when the test is designed to be taken. Do not take it at the beginning of intern year. Do not take it 2 years after intern year when your program is threatening to kick you out unless you take it. Either of those scenarios will result in you having to prepare significantly more than you should for this silly exam.

 

[ThoracicGuy]

In my opinion step 3 was the worst of three exams. It's a grueling 2-day test. The questions are hard, long, and difficult to finish. The simulated cases are weird and throw you curve balls. You leave having no idea how well you did.

That said, the minimum passing score is very low, well below that for step 2 CK. And unlike step 1, it doesn't matter how well you do as long as you pass.

It doesn't take much to pass the test; however. If you did a medicine internship, you should be able to pass with minimal, if any, studying. Just familiarize yourself with the simulated case format and you should score around 200 at least. If you're shooting for 260+ for whatever reason, well I have no idea how the hell you do that. If you did a non-medicine intern year or are far out from internship, you will need to study.

Bottom line, take this at the end of your intern year. That's when the test is designed to be taken. Do not take it at the beginning of intern year. Do not take it 2 years after intern year when your program is threatening to kick you out unless you take it. Either of those scenarios will result in you having to prepare significantly more than you should for this silly exam.

I took the exam in my fifth year of residency... (2 clinical + 2 research years). I spent the week prior to the exam studying. I passed.

 

[Lostin_space]

I took the exam in my fifth year of residency... (2 clinical + 2 research years). I spent the week prior to the exam studying. I passed.

I either did really well or really bad on this thing, especially the CCS cases. A good number of my CCS cases kind of finished much earlier than they were supposed to? Like some of them said there was 20 minutes for them, but after like 4 or 5 minutes, I got a message saying this case will finish in 2 minutes - put final orders/diagnosis. Is that normal?

 

[Raryn]

I either did really well or really bad on this thing, especially the CCS cases. A good number of my CCS cases kind of finished much earlier than they were supposed to? Like some of them said there was 20 minutes for them, but after like 4 or 5 minutes, I got a message saying this case will finish in 2 minutes - put final orders/diagnosis. Is that normal?

Yes. Very normal. Happened to me on about half my cases, similar my coresidents.

 

[ThoracicGuy]

I either did really well or really bad on this thing, especially the CCS cases. A good number of my CCS cases kind of finished much earlier than they were supposed to? Like some of them said there was 20 minutes for them, but after like 4 or 5 minutes, I got a message saying this case will finish in 2 minutes - put final orders/diagnosis. Is that normal?

I had one that I have no idea what they wanted. I only got one that was semi surgery related. I couldn't do the surgery, only call the consult.

 

[gutonc]

I either did really well or really bad on this thing, especially the CCS cases. A good number of my CCS cases kind of finished much earlier than they were supposed to? Like some of them said there was 20 minutes for them, but after like 4 or 5 minutes, I got a message saying this case will finish in 2 minutes - put final orders/diagnosis. Is that normal?

I only had one clear cut case. That one ran the full 20 minutes. The others were ones where I had only the vaguest idea of what was going on. They typically cut me off after 5 minutes.

I scored 20+ points higher than CK and 40 points higher than Step 1.

 

[Lostin_space]

Yes. Very normal. Happened to me on about half my cases, similar my coresidents.

Is that a good or bad thing? on some i felt like I totally blew it. is it because they figure you are in the right direction or because you've done too poorly? and what if you get the diagnosis wrong? on some there was nothing to put in for final orders either. i really freaked out on the first few ones. i had a ton of peds cases, and most of them things i had not seen! it was crazy

 

[Lostin_space]

I only had one clear cut case. That one ran the full 20 minutes. The others were ones where I had only the vaguest idea of what was going on. They typically cut me off after 5 minutes.

I scored 20+ points higher than CK and 40 points higher than Step 1.

that's good. i knew most of them except one where i had no idea what they wanted me to do. like i think i got all the surgery ones right, and i knew the diagnosis for a bunch of them but i did the appropriate management on some of them and they told me - the pt's mother is hopeful the pt. will feel better wthe treatment. and every time i kept furthering the clock it said the same thing! and it was the right management! or i figured the diagnoses based on the testing and i scheduled them for the appropriate consulting service. but then i got the 2 minutes on that one and i could put final orders, but for example i could not send them home from the ED or the clinic since the only thing i could do is put final orders, which typically just included counseling and things like that.

 

[Raryn]

Is that a good or bad thing? on some i felt like I totally blew it. is it because they figure you are in the right direction or because you've done too poorly? and what if you get the diagnosis wrong? on some there was nothing to put in for final orders either. i really freaked out on the first few ones. i had a ton of peds cases, and most of them things i had not seen! it was crazy

It's a fine thing. All of us passed.

Oh, and if I recall correctly, the free text final diagnosis wasn't even graded.

 

[Lostin_space]

It's a fine thing. All of us passed.

Oh, and if I recall correctly, the free text final diagnosis wasn't even graded.

then i don't know how i did. becuase for some the management was super short - like pt. comes in w/this complaint, i ordered a few labs, some of them were super straight forward like if i have an ectopic, ordered US, consult ob and bam! it's done. not much done. is the process or the final outcome graded? is it a person grading this or is the system grading this?

 

[Raryn]

then i don't know how i did. becuase for some the management was super short - like pt. comes in w/this complaint, i ordered a few labs, some of them were super straight forward like if i have an ectopic, ordered US, consult ob and bam! it's done. not much done. is the process or the final outcome graded? is it a person grading this or is the system grading this?

The system is grading it. The process of how you approached the case is what matters.

 

[Lostin_space]

The system is grading it. The process of how you approached the case is what matters.

I see. what if i ordered a things that were not correct or things that were rejected by the pt? so if the case finishes early, you've passed the case? or does the case ending early not mean anything? i'm freaking out bc i think i made a bunch of mistakes - sadly in part bc i freaked. i knew what most of the cases were ad would know how to manage them in real life but i did not navigate things well. some were also dumb - like i gave the correct medication to the pt. , pt's condition not worsening, and pt's mother saying she hopes things will improve. then it end. what the heck?

 

[gutonc]

I see. what if i ordered a things that were not correct or things that were rejected by the pt? so if the case finishes early, you've passed the case? or does the case ending early not mean anything? i'm freaking out bc i think i made a bunch of mistakes - sadly in part bc i freaked. i knew what most of the cases were ad would know how to manage them in real life but i did not navigate things well. some were also dumb - like i gave the correct medication to the pt. , pt's condition not worsening, and pt's mother saying she hopes things will improve. then it end. what the heck?

Dude...knock it the hell off! You're being insane. The test is over. You more than likely passed. Go have a beer...or eleventeen.

 

[Lostin_space]

Dude...knock it the hell off! You're being insane. The test is over. You more than likely passed. Go have a beer...or eleventeen.

I'm sorry I feel soooo incredibly anxious. I feel like i failed miserably. I have a tremendous amount of anxiety - I wish I could be unconscious until 3 weeks from now when the test results are released. If I failed I'm quitting residency. I coudln't do this again. I don't know what to do with myself until the results are back.

 

[rokshana]

I'm sorry I feel soooo incredibly anxious. I feel like i failed miserably. I have a tremendous amount of anxiety - I wish I could be unconscious until 3 weeks from now when the test results are released. If I failed I'm quitting residency. I coudln't do this again. I don't know what to do with myself until the results are back.

seriously? what are you going to do when you have to take the test for board certification...which will be significantly harder than step III...

you fail it...you take it again...maybe take a board review class, then take it...it really not that big a deal...

 

[DokterMom]

...Propranolol works...as does hypnosis, and guided imagery. I had some wicked test anxiety M1 after a couple exam failures. Terrified me. Saw one of our faculty who taught me self-hypnosis...it worked (and believe me I am as skeptical as anyone). Have sailed through a couple hundred exams since then and only ABFM boards to go next spring.

Just chiming in to second the self-hypnosis suggestion. When your runaway mind is the antagonist, learning to tame it works wonders. Truly worth a serious try --

 

[NotAProgDirector]

Looking at all of your posts, it seems you have an anxiety problem. You should try to get this addressed. Else, assuming you pass Step 3, it will only be a matter of time until the next hurdle presents itself, and you end up in this "anxiety spiral" again. Also, it's important that your anxiety doesn't become so severe that it actually affects your performance -- that can lead to a feedback cycle of anxiety --> poor performance --> meeting with PD --> closer scrutiny of your work --> more anxiety --> repeat.

You should go and get help.

 

[Lostin_space]

Looking at all of your posts, it seems you have an anxiety problem. You should try to get this addressed. Else, assuming you pass Step 3, it will only be a matter of time until the next hurdle presents itself, and you end up in this "anxiety spiral" again. Also, it's important that your anxiety doesn't become so severe that it actually affects your performance -- that can lead to a feedback cycle of anxiety --> poor performance --> meeting with PD --> closer scrutiny of your work --> more anxiety --> repeat.

You should go and get help.

You are correct in the statement that I have an anxiety issue, in particular about test taking and things like that. Not sure there is much to do about it really. Maybe if I was not in such a punitive profession it would not be an issue. *sigh*
Well the step has been taken. I guess I'll wait and see.

 

[NotAProgDirector]

You are correct in the statement that I have an anxiety issue, in particular about test taking and things like that. Not sure there is much to do about it really. Maybe if I was not in such a punitive profession it would not be an issue. *sigh*
Well the step has been taken. I guess I'll wait and see.

There absolutely are things to be done about it. That's exactly my point.

So do me, and yourself, a favor. Print out this thread. Make an appointment to see a physician. Hand them the thread, say that you are Lostin_space, and you need help.

 

[Lostin_space]

There absolutely are things to be done about it. That's exactly my point.

So do me, and yourself, a favor. Print out this thread. Make an appointment to see a physician. Hand them the thread, say that you are Lostin_space, and you need help.

Well you know, I have gotten through undergrad with flying colors, med school and grad school, and numerous years of residency with flying colors. So clearly I have managed my anxiety quite well. I'm not perfect and I have my faults and issues like everyone else. But I think it's a little harsh to make it seem like I'm a hot mess. If I was an entire hot mess I would have never have gotten to the point where I am now. So sure, I am more anxious than average, but I have also had much more to deal with than average people - both in and outside of Medicine. The only thing to do about anxiety is 1-deal with the specifics, in this case, taking Step 3. I have clearly gotten through MCAT, step 1, step 2ck, cs, hopefully step 3, and probably hundreds of exams in between. 2- Taking some anxiolytic now and then. Other than that, not much to do. And I certainly don't want to be out to be an anxious mess by fellow physician.
Would it be better if I had less anxiety? Absolutely. But given the punitive nature of Medicine do I want a record saying - you have "issues" - no. Particularly given that I have gotten through so much already, and done so successfully.
Point of this forum, at least for me, is to be able to vent in peace without concerns about judgment or anything. *sigh*

 

[girlofgrace7]

Lost in Space, the point isn't that you can't do it without medical help. The point is that you're making life harder on yourself than it needs to be. I've had anxiety issues for as long as I can remember and was always against telling my doctor because I didn't want to start an SSRI and feel like I couldn't fix it on my own. During second year of residency, I finally realized I was on edge more often than not, and my sleep kept being interrupted by dreams of the hospital, phantom pages, and insomnia. Residency is hard enough without having to deal with extra anxiety or depression. I finally asked my doctor to put me on an SSRI, and even though I still have higher stress levels than some people, I'm getting adequate sleep, my muscles aren't so tight, I'm better able to organize and evaluate workups, and I'm less snappy with loved ones (also, my evals from attendings have gotten better as they now comment on how pleasant I am to work with and have stopped noting a presumed lack of confidence). Plenty of physicians are on SSRIs or other medications for anxiety/depression. If you do it on your terms, it isn't going to affect your work record (no one has to ever know except you and your doctors). However, if your anxiety affects your work performance and it is recognized, then it will go on your record... either in the form of less-positive evals or in the form of referrals to a therapist, etc.

Step 3 was stressful and I came out afraid I had failed since many cases ended very early, but I was pleasantly surprised by my score. Best of luck!

 

[DokterMom]

No one is calling you a failure @Lostin_space. Maybe you can get through your residency without seeking professional help or taking medication. And as you say, you've clearly done very well so far despite your anxiety.

But pretend for a moment that the person in question is not you. That the person with painful anxiety levels is not a medical resident but is rather in some other high-pressure top-of-their-game job. You wouldn't hesitate to prescribe anti-anxiety medications and/or therapy, and you'd regard that person as short-sighted and self-destructive if they refused to take any sort of concrete steps to deal with the problem.

Or if that doesn't work, pretend that your problem is borderline high blood sugar or blood pressure. Sure, you can manage it most of the time without medication. Except when you can't. And you know what kinds of damage can result from long-term inadequately-treated high blood sugar or blood pressure.

Don't be that person. Take preventative steps before things get out of hand and you crash and burn. Invest pro-actively in your own health and consider it not as a sign of weakness, but rather as a sign of wisdom.

 

[primadonna22274]

Agree wholeheartedly with the sages above. Lost, your entire post screams ANXIETY DISORDER. Maybe it's just around high-stakes exams, but really, why torture yourself? Life doesn't get less stressful. I spent my 20s and most of my 30s being nearly crippled by anxiety. At 36 I decided there had to be more to life and just decided to go for it. At 42, life is better all around and I am happier...I care for my patients more easily and they don't drain all my energy like they used to before I got a handle on my own mental health..just think about it.
We want the best for you. Honest.

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[rjdiii]

Really?? Smacks of trollism.


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[shoal]

board exams were far more stressful for me then all of the other exams. dont know why as the stakes were the lowest. good luck to you lost... id take the advicd to heart.

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[Crayola227]

I took the exam in my fifth year of residency... (2 clinical + 2 research years). I spent the week prior to the exam studying. I passed.

lol like how long ago was that?

 

[Crayola227]

Looking at all of your posts, it seems you have an anxiety problem. You should try to get this addressed. Else, assuming you pass Step 3, it will only be a matter of time until the next hurdle presents itself, and you end up in this "anxiety spiral" again. Also, it's important that your anxiety doesn't become so severe that it actually affects your performance -- that can lead to a feedback cycle of anxiety --> poor performance --> meeting with PD --> closer scrutiny of your work --> more anxiety --> repeat.

You should go and get help.

QFT

 

[ThoracicGuy]

lol like how long ago was that?

About ten years ago or so.

 

[Slack3r]

Question: for switching fields, do people actually care about the Step 3 score?

 

[Lostin_space]

Well my worst fear came true - 3 weeks later and I failed step 3 by a few points - 3 to be exact. I feel completely devastated. I don't know what to do. I dont' think I have the mental energy to re-take this. Sadly it was mostly the CCS cases. Although most of them ended early, somehow I did poorly on them and they are not re-checked.
any advice?

 

[rokshana]

Well my worst fear came true - 3 weeks later and I failed step 3 by a few points - 3 to be exact. I feel completely devastated. I don't know what to do. I dont' think I have the mental energy to re-take this. Sadly it was mostly the CCS cases. Although most of them ended early, somehow I did poorly on them and they are not re-checked.
any advice?

talk to your PD, figure out a plan of action...maybe a review course, then take it again.

best to address your anxiety issues (test taking and otherwise), ideally before taking step III again.

unless you are at a place that requires step III passed before promotion to the next pgy level, you just need to pass it before you graduate.

 

[Lostin_space]

talk to your PD, figure out a plan of action...maybe a review course, then take it again.

best to address your anxiety issues (test taking and otherwise), ideally before taking step III again.

unless you are at a place that requires step III passed before promotion to the next pgy level, you just need to pass it before you graduate.

I did talk to PD and technically they do require it prior to promotion but they have promoted me regardless. I have been told to take it again. I understand the technical aspects of what to do in theory I just feel devastated. I studied extensively for his and it took me months! Sadly had I taken it before without the change in score pass I would have passed it. I really don't know how to emotionally do this and my chances at a pain fellowship are now gone which is what I had my heart set on. With that dream gone, not sure what I'm working towards. My heart is beyond broken.

 

[PsyDGurl]

I did talk to PD and technically they do require it prior to promotion but they have promoted me regardless. I have been told to take it again. I understand the technical aspects of what to do in theory I just feel devastated. I studied extensively for his and it took me months! Sadly had I taken it before without the change in score pass I would have passed it. I really don't know how to emotionally do this and my chances at a pain fellowship are now gone which is what I had my heart set on. With that dream gone, not sure what I'm working towards. My heart is beyond broken.

So sorry to hear that after all that effort, your exam ended with a disappointing result. I'm sure all of us on SDN can identify with that from one time or another in our training. Sounds like you studied hard for this one. Anxiety can have huge impacts on our performance. Don't let it get the best of you - sounds like you're meant to be a dr! See someone about it and then try the test again...you'll likely have a better result next time!

 

[Top Gun]

Well, you came close to the passing mark, so I'm sure you could pass it if you just put in a little more studying next time and manage to get your anxiety under control. Actually, I have a friend who was in a similar situation. He too failed Step 3 by a few points, but that was due to inadequate studying on his part. So he studied harder the next time and passed. Now he's working as a hospitalist for $300,000 a year. So just do what you have to do to control your anxiety, maybe study a little more next time, and you should be fine the next time you take Step 3.

Now, I do know of one guy who failed Step 3 twice, but he was a weird sort to begin with, and also very lazy and unmotivated. He constantly made excuses for his poor performance, like his messy divorce, which was during his second year of residency. He even graduated from residency ahead of me, but to this day, has yet to pass Step 3. In fact, I don't think he even attempted until after he graduated residency, which was in 2010. I'm amazed my program even allowed him to graduate.

 

[Lostin_space]

Well, you came close to the passing mark, so I'm sure you could pass it if you just put in a little more studying next time and manage to get your anxiety under control. Actually, I have a friend who was in a similar situation. He too failed Step 3 by a few points, but that was due to inadequate studying on his part. So he studied harder the next time and passed. Now he's working as a hospitalist for $300,000 a year. So just do what you have to do to control your anxiety, maybe study a little more next time, and you should be fine the next time you take Step 3.

Now, I do know of one guy who failed Step 3 twice, but he was a weird sort to begin with, and also very lazy and unmotivated. He constantly made excuses for his poor performance, like his messy divorce, which was during his second year of residency. He even graduated from residency ahead of me, but to this day, has yet to pass Step 3. In fact, I don't think he even attempted until after he graduated residency, which was in 2010. I'm amazed my program even allowed him to graduate.

I know you mean well, but talking about someone who failed step 3 twice does not help me feel better you know. I studied a ton for the first step 3 which makes it difficult for me to understand how I could have failed. I think there is something more at play here, given some computer glitches during the exam. I got almost no credit for the cases too even though most of them finished early, which makes 0 sense. I have reported the issue and I was told they will investigate. We shall see.