Step 3 CCS - Just how much of it do I need to get right? Slightly Freaking out here...

monkeymedic

2+ Year Member
Mar 20, 2016
28
4
I've been doing the UW CCS cases and I'm a bit disheartened. Test is on Friday.

When I go through the grading "rubric" I hit 100% of emergency orders and 90% of physical exam (sometimes I have some neutral, but never any "suboptimal/harmful" in these categories.

In the Diagnostic Tests section, sometimes I hit nearly everything in the optimal column, sometimes I get just over half of it. +/- things in the neutral column, and I've only ever had one in the "suboptimal/harmful" column.

In therapy, I'm getting most of the meds (60-80%) and about half of the counseling. Obviously I need to improve counseling.

Finally, In location and Timing, I'm pretty much at 100% For both.

My question: Am I doing OK here? The being sometimes near 50% in diagnostics and overall 60-70% of therapy really worries me. Can I pass with this? If I study my butt off can I get this in the next 36 hours or so?

I really worry because Day 1 was very difficult and I feel like I need to crush Day 2 to have any hope of passing. I failed Step 1 and barely passed (within 15 points) Step 2 CK.

Help me freak out less please? (Or alternately, tell me I need to freak out more and move my exam date!)
 

Unty

New Member
10+ Year Member
Feb 4, 2005
461
170
Status
I've been doing the UW CCS cases and I'm a bit disheartened. Test is on Friday.

When I go through the grading "rubric" I hit 100% of emergency orders and 90% of physical exam (sometimes I have some neutral, but never any "suboptimal/harmful" in these categories.

In the Diagnostic Tests section, sometimes I hit nearly everything in the optimal column, sometimes I get just over half of it. +/- things in the neutral column, and I've only ever had one in the "suboptimal/harmful" column.

In therapy, I'm getting most of the meds (60-80%) and about half of the counseling. Obviously I need to improve counseling.

Finally, In location and Timing, I'm pretty much at 100% For both.

My question: Am I doing OK here? The being sometimes near 50% in diagnostics and overall 60-70% of therapy really worries me. Can I pass with this? If I study my butt off can I get this in the next 36 hours or so?

I really worry because Day 1 was very difficult and I feel like I need to crush Day 2 to have any hope of passing. I failed Step 1 and barely passed (within 15 points) Step 2 CK.

Help me freak out less please? (Or alternately, tell me I need to freak out more and move my exam date!)
Hard to say how you will do on the real thing in regards to ccs. You have to know what orders to place based on symptoms. What orders to place after getting results back from initial tests. Remember to monitor how the patient is doing and monitor if your treatment is working. Monitor for side effects of treatment. You really need to know uworld by heart at the very least.

If this your first time taking this test I would say go for it. Are you in residency? If you take it and fail, at least you know what you are facing in terms of this beast and can improve accordingly.
 

DisorderedDoc417

2+ Year Member
Dec 15, 2016
428
292
Status
Resident [Any Field]
Hard to say how you will do on the real thing in regards to ccs. You have to know what orders to place based on symptoms. What orders to place after getting results back from initial tests. Remember to monitor how the patient is doing and monitor if your treatment is working. Monitor for side effects of treatment. You really need to know uworld by heart at the very least.

If this your first time taking this test I would say go for it. Are you in residency? If you take it and fail, at least you know what you are facing in terms of this beast and can improve accordingly.
Can't speak about my personal experience as I have not passed the exam yet (just finished the beast yesterday). However, I can surely say that there are many folks in the 97% who pass who do not, at the very least , have uworld memorized. Obviously, I think this would serve you well, and I think it would be a great way to boost your score. But, there is no way that the requirement for 196 on step 3 is that you need "every case memorized".

I would also say go for it. Most of the cases will be more straight forward. However, I will note that on the actual exam, the lag and confirmation screens rattled me on a few cases, not to mention that they abruptly end sometimes when you give the correct treatment, and you won't hit every single order or counseling point as a result of this. Additionally you will get new cases you haven't seen before. People mess up cases, last year someone in my program KILLED a patient on the test and cried until they got the resultant score in the 220s.

Again, I can't say that I've passed, but this has been the anecdotal experience of every resident in my program within the 3 years ahead of me (n=21). All of them psych residents... some of which only viewed a handful of cases to "get the general idea" and still passed.
 
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DisorderedDoc417

2+ Year Member
Dec 15, 2016
428
292
Status
Resident [Any Field]
Can't speak about my personal experience as I have not passed the exam yet (just finished the beast yesterday). However, I can surely say that there are many folks in the 97% who pass who do not, at the very least , have uworld memorized. Obviously, I think this would serve you well, and I think it would be a great way to boost your score. But, there is no way that the requirement for 196 on step 3 is that you need "every case memorized".

I would also say go for it. Most of the cases will be more straight forward. However, I will note that on the actual exam, the lag and confirmation screens rattled me on a few cases, not to mention that they abruptly end sometimes when you give the correct treatment, and you won't hit every single order or counseling point as a result of this. Additionally you will get new cases you haven't seen before. People mess up cases, last year someone in my program KILLED a patient on the test and cried until they got the resultant score in the 220s.

Again, I can't say that I've passed, but this has been the anecdotal experience of every resident in my program within the 3 years ahead of me (n=21). All of them psych residents... some of which only viewed a handful of cases to "get the general idea" and still passed.

I might add that there is literally not a soul on this forum that actually knows how this test is graded. Sure there are suggestions on how to perform well (hint: preparation is always going to be the answer), but I can't believe the number of people who say if you mess up a case or two you can't pass. It isn't true, and it doesn't mean you need to nail all the MCQ's either. The NBME just wants to make sure you have a fairly logical method to your madness.
 

Unty

New Member
10+ Year Member
Feb 4, 2005
461
170
Status
What I meant is to go through the uworld cases and practice them as much as you can. There's no human who will be able to memorize every order. At least make sure you know the optimal orders for the cases since you have a time crunch.

Good luck to you
 
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DisorderedDoc417

2+ Year Member
Dec 15, 2016
428
292
Status
Resident [Any Field]
I've been doing the UW CCS cases and I'm a bit disheartened. Test is on Friday.

When I go through the grading "rubric" I hit 100% of emergency orders and 90% of physical exam (sometimes I have some neutral, but never any "suboptimal/harmful" in these categories.

In the Diagnostic Tests section, sometimes I hit nearly everything in the optimal column, sometimes I get just over half of it. +/- things in the neutral column, and I've only ever had one in the "suboptimal/harmful" column.

In therapy, I'm getting most of the meds (60-80%) and about half of the counseling. Obviously I need to improve counseling.

Finally, In location and Timing, I'm pretty much at 100% For both.

My question: Am I doing OK here? The being sometimes near 50% in diagnostics and overall 60-70% of therapy really worries me. Can I pass with this? If I study my butt off can I get this in the next 36 hours or so?

I really worry because Day 1 was very difficult and I feel like I need to crush Day 2 to have any hope of passing. I failed Step 1 and barely passed (within 15 points) Step 2 CK.

Help me freak out less please? (Or alternately, tell me I need to freak out more and move my exam date!)
Freak out less. You sound like you've done really well with so little time!
 
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monkeymedic

2+ Year Member
Mar 20, 2016
28
4
Hard to say how you will do on the real thing in regards to ccs. You have to know what orders to place based on symptoms. What orders to place after getting results back from initial tests. Remember to monitor how the patient is doing and monitor if your treatment is working. Monitor for side effects of treatment. You really need to know uworld by heart at the very least.

If this your first time taking this test I would say go for it. Are you in residency? If you take it and fail, at least you know what you are facing in terms of this beast and can improve accordingly.
Yes, I am a PGY-2 at an unopposed FM program. I honestly think I got a little complacent in prepping for the CCS. All the upper years told us the CCS would be easy - Office is office, ED is what we do as House Officers and in our ED months, inpatient management is what we do on service. So I took their advice and now regret not prepping for it more, especially since Day 1 went so poorly IMO.

I'm the first one in my year to take it so no one else to talk to about this...

I might add that there is literally not a soul on this forum that actually knows how this test is graded. Sure there are suggestions on how to perform well (hint: preparation is always going to be the answer), but I can't believe the number of people who say if you mess up a case or two you can't pass. It isn't true, and it doesn't mean you need to nail all the MCQ's either. The NBME just wants to make sure you have a fairly logical method to your madness.
Yeah, I have NO IDEA how it's graded. I just know I need to KILL day 2 based on how awfully I felt after Day 1. I'm hoping that I can make up for it on the MCQs for ACM and the CCS.

What I meant is to go through the uworld cases and practice them as much as you can. There's no human who will be able to memorize every order. At least make sure you know the optimal orders for the cases since you have a time crunch.

Good luck to you
Thank You! I'm focusing my time on the counseling which seem to be easy points that I keep dropping. Of course I have no idea how much it's weighted and I would guess emergent orders are weighted more than counseling at the end of the case...?

Freak out less. You sound like you've done really well with so little time!
Thanks! I regret focusing so much energy on FIP/Day 1 when I think I completely tanked it. Now I REALLY need day 2, including the CCS, to go well and barely prepped!
 
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