does anybody have any sense of what USMLE expects on step 3 in terms of thoroughness particularly in regards to preventive medicine? obviously for a health maintenance visit in the clinic it is important, but what about in general?
I was doing a third-party practice test which scored me lower because, in the ED context while working up acute cholecystitis, I failed to obtain a Pap smear and administer a TDap vaccine.
I assume you are referring to the Computer Case Simulation (CCS) portion of Step 3. I can provide some clarification, but bear in mind that no one knows for certain how the exam is graded. Please review the following link:
A and B Recommendations | United States Preventive Services Taskforce. These are all the expected preventative measures you are expected to know and order for your patient on CCS. That said, I want to make a few points.
1.) The goal is not to be exhaustive on preventative care. You may not have enough time or forget to order all the preventative items so focus on the most critical ones. If a patient comes in with pneumonia, make sure you give them the pneumonia vaccine, influenza vaccine, +/- smoking cessation before worrying about whether they need a Td or colonoscopy.
2.) These orders should not be the focus during the acuity portion of your case unless your patient comes into clinical for a wellness check-up/physical. Suppose your 65 yo male 25 PY smoker patient comes in in florid heart failure.
DO NOT waste time ordering low sodium diet etc. during the first 8min (10 min case) or 18min (20 min case). Examine the patient and order Pulse Oximetry, Oxygen, CXR, Diuretics, ABG, CMP, CBC, Troponin +/- Ferritin, TSH,
BNP, ECHO (these two aren't needed in real life) and when there is JVD, pitting edema, bilateral infiltrates give lasix, start ACE/ARB, BB later. The patient will then feel better if it's not a complicated case. Then the case will end but it will give you two minutes to input preventative measures. At this point you can order weight loss, heart failure/medication counseling, low salt diet, influenza/Tdap/PCV-13/Varicella vaccine, and abdominal ultrasound for AAA screening, and colonoscopy (review the USPTF recs).
3.) If you would like practice, I recommend you purchase this.
USMLE Step 3 CCS Case Interactive Software Simulator - All devices are 120 cases on CCScases.com and they will give you feedback on what is expected. Know one knows exactly how much weight each thing gets weighed but on CCScases treatment gets weighed 40%, workup is like 30% and preventative stuff is like 5% so keep in mind it shouldn't be the major focus of the case. The downsides to this software are 1) the diagnosis are easier and the clinical course is less complicated than the real thing 2) the order sets are not exactly the same as the real thing (the real thing makes more sense). That said, it really helped me practice CCS and I highly recommend it to everyone.
