I scanned this board during my preparation, so here are my 2 cents...
I am a surgery intern who just finished taking Step 3 for the second time. I first took it in early February of 2012 about a week after the ABSITE, the surgery in-training exam. I reviewed Kaplan's review book the week prior and didn't work any questions. I had always heard "two months for step 1, two weeks for step 2, and a #2 pencil for step 3," and having done average on the first two, thought it wouldn't be a big deal for this one.
For that test, I finished most every MCQ block as time was expiring and marked every question I wasn't >95% sure of...and marked more than half the questions on the test (I didn't count exactly, but I know it was DEFINITELY more than half the questions). And since I was finishing with only moments to spare, I did not have time to review any questions. The second day was maybe a little better, but still was struggling to get through the MCQ blocks in time. The CSS was 9 cases and 8 ended early, so I felt pretty good about that, though I hadn't put in all the routine nursing orders, etc, so probably lost some points on that.
Anyway, got a 183/73 (passing is 190) with most of the XXXXX on the performance profile falling within the borderline area, but several falling below (nervous system, renal/urinary/male reproductive, and history/physical/diagnostic studies.
Well for the last 3 months I have been preparing more than previously. I re-read Kaplan's review book, made a large stack of flash cards (yes, made them myself), and quizzed myself repeatedly to where I'm pretty sure I had more than 70% of that book memorized. I also worked the Kaplan qbook (average of 59.6%) and approximately 1,100 of the UWorld questions (average 58%)
I retook the test yesterday and today. For each MCQ section, I finished all but one with at least 11-12 minutes to spare. I again marked all the ones I was unsure of, which were almost exactly half the questions, plus or minus a few. Those I didn't mark I was >95% sure on, and of those I did mark, 1/3 I was ~75% sure, 1/3 I had down to two possibilities, and the others I was just guessing.
There are now 12 CCS cases, 8 of which ended early. Of those, one was a 10cm AAA and one was a pediatric subdural hematoma, both of which I got the diagnosis and the appropriate intervention but took me several hours of simulated time before figuring it out and making the diagnosis.
Of the 4 that I took full time on, the first was a woman with diabetes who came in with significant hyperglycemia and a STEMI. I initially treated her for non-ketotic hyperosmolar hyperglycemia due to abd pain but no chest pain, but found the STEMI when she got worse instead of better. The second was a young boy with sickle cell, chest pain and pneumonia, and was stumped. I ended up trying to intubate him because his respiration rate was about 40 for several hours, but it was refused. The third was a woman that I diagnosed with HIV, CD4 count of 50, and non-hodgkins lymphoma, however the only anti-retroviral I could remember was zidovudine, and I wasn't sure what to do after making the diagnosis. The final one was an older male with back pain due to osteopenia and a spinal compression fracture without neurological symptoms and normal PTH/calcium/calcitonin and no evidence of multiple myeloma, and again, had no idea what to do from that point.
So 6 decent performances on the CCS, 3 delays in diagnosis, and 3 that I got the diagnosis but was lost on management.
Anyways, I feel like I did much better this time around on the MCQ. I got through them faster and there were several questions in each block that I'm very confident I got correct, but that I'm also sure I would have had to guess on had I gotten those same questions the first time around. But I don't think the CCS was as straightforward as it was previously, though I made sure to put in every minute nursing order I could think of and the "RATED SEX" orders at the end of every case, and scheduled every patient for a colonoscopy, pap smear, PSA check, etc as appropriate.
Anyways, hoping this effort was good enough to raise my score 7 points.


