Archer CCS Strategies discussion - iara2

[ArchivalUser]

thanks Iara

[ArchivalUser]

The two min screen is for placing important orders that are highly scored. It is mostly meant for monitoring and setting up follow up appointments.
Archer CCS summarizes two min screen strategy in to a couple of simple things : 1. Monitoring Orders 2. Case-specific screening orders 3. Case-specific important counseling orders.

1) If you started an intervention during the active screen, you will need to monitor that intervention most of the times. On 2-min screen, there is a calendar option specifically to set up monitoring orders. Monitoring can be two types a) monitoring for efficacy or b) monitoring for toxicity.

Efficacy monitoring examples a) You started a Statin in hyperlipidemia case. You want to place an order for Lipid panel in 1 month. You order Lipid panel and go to calendar and choose date 30 days away. Remember you can do this only on 2-min screen. You can not do this on active screen since you have no way to set up orders to take place at a "later" date. b) You treated a patient with an acute MI during active case and his EF was 30%. You want to set up a repeat ECHOcardiogram in 3months to see if EF has recovered. You set this up using later option on 2-min screen.
Apparently, all these are very highly scored. It makes sense since this is exactly what Step 3 is testing - not just diagnosis and treatment but also, monitoring.

Toxicity Monitoring examples: a) You started a Statin in hyperlipidemia case. You want to place an order for Liver function tests in 3 month. You order LFTS and go to calendar and choose date 90 days away.
b) You started INH in a Latent TB case who is also alcoholic. You probably already obtained baseline LFTs on the active screen. When you reach 2min case-end screen, you must not forget placing an order for LIVER FUNCTION TESTS in 1month.
c) You started Methotrexate in RA case. Since adverse effect is hepatitis, obtain LFTs in 3 months by choosing "later" option on 2-min screen. As per 2008 ACR recommendations, LFT monitoring at an interval of every 8 to 12 weeks is appropriate after three months of therapy and monitoring every 12 weeks can be performed beyond six months of therapy.
Methotrexate is a well known cause of acute clinically apparent liver injury which can be severe and is sometimes fatal - I know a rheumatologist that got sued because of not placing such monitoring order in real life practice. Now this is exactly what Step 3 is testing for. You can not miss certain monitoring orders which if missed can be potentially life threatening - you will get negative scoring for missing this on Step 3 CCS.

[ArchivalUser]

glad you are back..the 2-min screen suggestions are very helpful

[ArchivalUser]

thank you..very very useful thread!

[ArchivalUser]

found a link for some of solved highyield cases https://usmlestep3blog.com/usmle-step-3-...case-list/

[ArchivalUser]

anyone has archer?

[ArchivalUser]

Sequencing : Any one knows the importance of sequencing in CCS? where doe sequencing help you score more?

Sequencing is not built in to UW software and so, consultants refuse consults and several other confusing arras. Sequencing is very cleverly built in to real exam NBME CCS software. If not rightly sequenced, we will miss the score.

Examples: Sequencing consults after adequate work up like call a surgeon only after staging work up completed in colon cancer for surgery to happen.
Get a follow- up CXR in pneumothorax after chest tube only after simulated time passes report time on software so that sequencing communicates with software you did exact follow up CXR - this is scored

[ArchivalUser]

question 2?

[ArchivalUser]

any new cases?

[ArchivalUser]

Archer...is this really all it is?
#810393
duckson - 07/07/15 15:42

Do I have the correct videos? The website design is so awful. The videos I have are power point presentations (from March 2015 and some others from previous years) where he goes through cases with volunteers.

I thought this would be helpful but now I see that the cases he goes through aren't actually programmed on the screen, so you just have to listen and imagine the case. There doesn't seem to be any emphasis on clock management or how you're supposed to advance the case incrementally. All the volunteers mumble and I feel like he gives away all the answers immediately. I feel like I would just be better off reading cases than listening to this


Is there something I am missing? Are there better videos I should be watching? I'm worried I should be spending my time doing uworld cases instead of watching these tediously long videos.
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* Re:Archer...is this really all it is?
#3227877
drcee - 07/07/15 17:16

I had felt the same...
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* Re:Archer...is this really all it is?
#3227878
drcee - 07/07/15 17:16

and wanted to know if I had something wrong or if I'd gotten the wrong vids..
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* Re:Archer...is this really all it is?
#3227880
duckson - 07/07/15 17:30

yeah I feel a bit ripped off, and the site design is so poor. Apparently you have a time limit on the videos too but there doesn't seem to be any indication of how much time you actually have left. The video quality is awful too, which I guess doesn't really matter since none of what is on screen actually correlates with what he is saying. ugh
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* Re:Archer...is this really all it is?
#3227889
step2csbuddy - 07/07/15 18:20

Really, are they that bad? I was thinking of buying these videos myself in the future. Are you sure you got the 88$ PPV CCS lectures?

- step2csbuddy
CS tutor; your guide to a pass