The ending of CCS cases

[BillyRubinstein]

So when it comes to the "you have 5 minutes remaining" screen, are you penalized if you forget to cancel things such as IV access, oxygen, pulse ox...etc??

I feel there are times I'm on the verge of discharging a patient, when this screen pops up, and you obviously can't schedule an OP appointment at this time. Are you also penalized for things such as this?

I feel as if I'm doing well on these cases with UWorld for the most part, missing things here and there, but really have no clue what impact this will have on the score. I suppose you are all in the same boat. I just find it really wierd not being able to quantitatively guage my performance on the CCS, as one could on the MCQ's.

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[BOOKSLOVER]

My friends say, no negative point for wrong or miss, but this part evaluate with ppl not computer, so as close as posible to real managment, will help.

 

[goodies]

So when it comes to the "you have 5 minutes remaining" screen, are you penalized if you forget to cancel things such as IV access, oxygen, pulse ox...etc??

I feel there are times I'm on the verge of discharging a patient, when this screen pops up, and you obviously can't schedule an OP appointment at this time. Are you also penalized for things such as this?

I feel as if I'm doing well on these cases with UWorld for the most part, missing things here and there, but really have no clue what impact this will have on the score. I suppose you are all in the same boat. I just find it really wierd not being able to quantitatively guage my performance on the CCS, as one could on the MCQ's.

How do you end a case? Does the case only end when you answer correctly? On UW, I don't understand how to navigate the system. I put orders in and click through everything, but there is no where for me to force the case to end. Is it because I'm missing a vital step in the work up???

 

[Arctic Char]

How do you end a case? Does the case only end when you answer correctly? On UW, I don't understand how to navigate the system. I put orders in and click through everything, but there is no where for me to force the case to end. Is it because I'm missing a vital step in the work up???

ditto . . . i'm f***ing lost. and how do you enter in "taper steroids in 2 weeks"? just schedule an OP appt for that time? if i forget, am i doomed?

and when it asks "move time forward, or stop" . . . what the hell does that mean? stop NOW, as in "i want to do more things"

i hate this stupid crap. i'm a pathology resident, and this could be farther from relevent for me

 

[andwhat]

So when it comes to the "you have 5 minutes remaining" screen, are you penalized if you forget to cancel things such as IV access, oxygen, pulse ox...etc??

I feel there are times I'm on the verge of discharging a patient, when this screen pops up, and you obviously can't schedule an OP appointment at this time. Are you also penalized for things such as this?

I feel as if I'm doing well on these cases with UWorld for the most part, missing things here and there, but really have no clue what impact this will have on the score. I suppose you are all in the same boat. I just find it really wierd not being able to quantitatively guage my performance on the CCS, as one could on the MCQ's.

you may not commonly discharge patients that have IVs and require pulse ox, in the examination. Obviously this is different than real life. These patients may be admitted on the examination. I dont think that there is penalization for not D/Cing the IVs prior to the case ending, but perhaps for sending them home with IVs. There is almost no way of predicting when the 5 minute popup screen will show up.

 

[Tastebuds]

On CCS USMLE world, sometimes the case automatically changes locations for you whenever you order certain things. For example, on case 5, IBS, after I ordered normal labs, the pt was placed at home. Then I couldn't order hyocyamine to treat the patient because the patient was already at home. Is this how the real test is designed? Did I do something wrong on the case?

 

[Hassler]

BUMP..

If the patient is still in the ICU and not ready for discharge when the 5 min screen pops up, do you order all the counseling stuff? This seems to happen quite frequently even if all the management is correct

(In fact, I tried experimenting with a hypertensive emergency case on UWorld by following the exact steps as provided by the "Explanation", because I want to see whether it is possible to finish all the tasks recommended by the "Explanation" before the 5 min screen pops up. I transferred the guy to ICU on nitroprusside IV, pt stabilized with improved BP, so I transferred him to ward and d/c the IV and start the PO meds. Next thing I know, BP back up to SBP 230's again, so I had to restart the IV BP med and transfer back to ICU. Then, boom, 5 min screen pops up, and I'm like....wth. In this case, would you do all the counseling?)

 

[Hassler]

Any ideas, anyone?

If 5 min screen shows up and pt still in icu, would you still do all the necessary counseling? What about PO meds when the pt in theory still require iv meds? My confusion is the uncertainty of how this is scored. I don't want to lose "easy" points by not counseling, but I also don't want to lose points by counseling in an inappropriate setting.

Step 3 in a couple days. Appreciate any advice.

 

[Clemson Doc]

I completed the real exam yesterday, and still don't understand what prompts the "You have 5 minutes remaining" box to flash up. At that time, you can only change orders and must then enter a diagnosis. This happened on almost all of my cases in about 10 minutes, even though it says you have 25 minutes per case. I assume this means that I was managing things appropriately, as the patient was responding well. Based on the USMLE World CCS cases, this felt incomplete because I did not get to arrange for follow-up appointments.

The only case when I didn't have this screen pop up was a patient who was not responding to my treatments. I kept trying things, and nothing happened. The case ran until my time was over, with no resolution to the patient's symptoms.

Anyone have the same experience?

 

[InternationlDoc]

Hey clemson,

Dont have answers to your question but man CCS - doozy. I breezed through all the step III MCQs but CCS - what the hell was that? ALL my cases ended at 5 minute mark. and on 2 cases my patients NEEDED surgery laproscopy or ERCP and the case ended when they were in pain/fever. I had surgery in que with Abx

WHAT??? confused. Don't wanna fail this thing. MCQs weren;t too bad. Oh and I wrote family medicine consult - FOLLOW UP as 5 minute orders; how else is the patient going to follow up? so messed up. I dont think patients return once d/c from ER on real CCS cases.

Another question: Had patient with PE and on final 5 minute orders I was going into the whole thrombophilia work up (yes homocysteine, factor V) and ran out of time! could not even enter diagnosis...WTF? am I screwed? so scared now. yuck.

 

[Hassler]

Hey clemson,

Dont have answers to your question but man CCS - doozy. I breezed through all the step III MCQs but CCS - what the hell was that? ALL my cases ended at 5 minute mark. and on 2 cases my patients NEEDED surgery laproscopy or ERCP and the case ended when they were in pain/fever. I had surgery in que with Abx

WHAT??? confused. Don't wanna fail this thing. MCQs weren;t too bad. Oh and I wrote family medicine consult - FOLLOW UP as 5 minute orders; how else is the patient going to follow up? so messed up. I dont think patients return once d/c from ER on real CCS cases.

Another question: Had patient with PE and on final 5 minute orders I was going into the whole thrombophilia work up (yes homocysteine, factor V) and ran out of time! could not even enter diagnosis...WTF? am I screwed? so scared now. yuck.

I think you should be fine. If you ordered the right surgery/procedure for the patient, the case might just end and you won't be able to see the results or note patient improvement.

I agree that the way the case ends is pretty confusing. There were also a couple times where patient is NPO waiting for surgery, then case ends. I can't order the right outpatient diet for the patient because then it will ask me if I want to d/c the NPO order and obviously I don't at that moment.

Also FYI, final diagnosis is not graded (that's what it says in the instructions)

 

[Knicks]

Yet another thread stating that UW CCS is significantly lacking.

What can I / we use to efficiently prepare for the real CCS on Step 3?

(I'm bumping several of these threads because I'm planning to start a Q-bank soon and want a good way/software to prepare for the CCS).

 

[OveractiveBrain]

Yet another thread stating that UW CCS is significantly lacking.

What can I / we use to efficiently prepare for the real CCS on Step 3?

(I'm bumping several of these threads because I'm planning to start a Q-bank soon and want a good way/software to prepare for the CCS).

Literally everyone in this thread misses the crucial failure: their own.

CCS cases end when you have done the right thing. You recognize Appendicits? You do Ex-Lap. Case ends. You recognize Epiglottis and admit to unit with racemic epinephrine? Case ends.

If your case has taken longer than 10 minutes you have either failed to recognize the diagnosis or you have yet to do the appropriate therapy for that diagnosis. Followup, steroid tapers, discharge instructions... if you are evern considering these things, you have messed up... bad.

I finished every one of my REAL CCS cases in 5 minutes each. And, since I didnt fail, it means that I dominated those cases. I had one Uworld case where I missed the diagnosis. Totally wrong. I kept having her follow up in hopes more clues would pop up. They didnt. I went 3 months in the future, only to realize I had missed the diagnosis and never conisdered the appropriate therapy.

IF YOU ARE WORRYING ABOUT DISCHARGE, FOLLOWUP, OR TIDYING UP LOOSE ENDS ON YOUR CASE, YOU HAVE FAILED THE CASE

IF YOUR CASE ENDS IN 5 MINS YOU HAVE EITHER BEAT THE CASE OR YOUR PATIENT IS DEAD.... it is generally easy to tell which happened.

 

[hidoc]

On CCS cases, when you order a consult or want to view lab results, do you always advance the clock? what about when you dc a pt home but had ordered routine labs? It shows me those labs as resulted day 1, 2 or whatever, but then do i physically change the location to office to bring the person back? and the most irritating thing about it... what if you want to schedule q4 week follow-up for an OB prego pt... how do you enter that in?

thanks to anyone who can lend some expertise on this facet of the simulation

 

[TRanger]

On CCS cases, when you order a consult or want to view lab results, do you always advance the clock? what about when you dc a pt home but had ordered routine labs? It shows me those labs as resulted day 1, 2 or whatever, but then do i physically change the location to office to bring the person back? and the most irritating thing about it... what if you want to schedule q4 week follow-up for an OB prego pt... how do you enter that in?

thanks to anyone who can lend some expertise on this facet of the simulation

You do always advance the clock when you want to view lab results or order a consult.

You should set a followup appointment to have the person come back after most visits unless something serious is shown in the labs have them come back when you decided to have them follow up with you.

Again when you are finished with a patient just schedule them an appointment - which is an option when you change their setting to home. In the case of the pregnant patient set their appointment in 4 weeks from the current day and you'll be all set.

Will just admit though that most of the cases end very quickly and most of the time they'll never even come back to the followups. If they do come back to the followups that's probably a sign you did something wrong hence why it continued after you sent them home.

 

[gasblaster]

You do always advance the clock when you want to view lab results or order a consult.

You should set a followup appointment to have the person come back after most visits unless something serious is shown in the labs have them come back when you decided to have them follow up with you.

Again when you are finished with a patient just schedule them an appointment - which is an option when you change their setting to home. In the case of the pregnant patient set their appointment in 4 weeks from the current day and you'll be all set.

Will just admit though that most of the cases end very quickly and most of the time they'll never even come back to the followups. If they do come back to the followups that's probably a sign you did something wrong hence why it continued after you sent them home.

Nvm. Realized there's a clock management section on UW.

 

[hidoc]

thanks for the replies! Man, I hate CCS still🙂