05-07-2007, 06:46 PM
I looked closer at my (thank the dear lord) passing step 3 report and all my cases were in the superior performance so the advice here is probably ok.
1) when doing the cases, be aware that they are not like the MCQ because they are not about the minutiae, instead they are about doing the RIGHT tests in the RIGHT order. You won't be tested on the pathophysiology of lesch nyhan or glanzmann thrombocytopenia but you will be screwed if you don't know that in an unconsicous patient next to an empty bottle of pills you must
a) naloxone, thiamine, glucose, oxygen, charcoal, pulse ox, fingerstick, etc. or something to that effect...(ie there might be more clues in the vignette)
2) take your time in the cases
on one of the times that i failed step 3 i used the usmle world cases and people had told me that they would close out the cases early because they had memorized the cases. very stupid, stupid advice. i think that there is no way to memorize cases, instead you should have some idea of the management of the different presentations of
diverticulitis, asthma, pneumonia, hemmoroids, GERD, MI, unstable angina, stable angina, cellulitis, child abuse, elder abuse, etc.
3)here is my rationale, if you have only memorized one presentation then that is the only presentation that you can manage but during the actual exam, things come up, headaches don't go away despite good management and some patients still go down despite good management. at one point of preparing for CCS, I thought i could actually get away with memorizing the actual USMLEWORLD cases but that doesn't really work when you really have to think on this exam. THAT is good advice. always, always think (relaxed thinking)
examples:
is the patient pregnant? do you need a pregancy test before starting some treatment.
is there a psychiatric issue (abuse)?
allergies?
if the patient did not respond do you have to do the treatment again? ie epinepherine in anaphylaxis
does the patient need admission to the hospital?
is there a less invasive test? pulse ox before CXR before CT of chest
4)THINK THINK THINK always THINK step 3 is not a test of memorization (although some things need memorization but that will not guarantee that you will pass the test believe me i know)
5)use the step 3 USMLE software (but read some study notes more). you can learn shortcuts
examples:
a) type the first letters cbc, bmp, pt etc. learn this so that it becomes automatic and you aren't stressing on the test.
cou for counsel. etc.
b) think about when to move the patient from ICU, home etc.
c) decide whether you want to move the clock forward - some dorkmaster told me to always pick "til next available result" stupid stupid advice. is this what you do in the hospital? no in the hospital you order your tests and then you move the clock to the next morning. if something comes up then you act on it.
6)the 5 minute screen of DEATH "your case will end in 5 minutes of REAL TIME" if this pops up you have either run out of time (you actually have plenty of time to manage the case and counsel the patient) or you were in such a hurry and NOT THINKING and screwed up the case. dumb. do not do this. it also will probablly make you a really bad doctor. think. relax but think.
7)i found it helpful to think about those bad doctors on staff at your local hospital. the ones that don't know what they are doing because they order tests and tests but have no idea what they are looking for. no thinking at all. you do not want to be ordering a CT of the head because you can. you should know what you are expecting to see on a test BEFORE you order it. this is really hard yes but you have to really think.
8)if a case goes down the tubes. let it go. a new case is a new case and you wouldn't want the doctor evaluating you for subarachnoid hemmorage still thinking about their poor management of a leg rash in the patient they saw before you.
9) alternative way of thinking about the tests.
CBC - think about how you can use this test. make up scenarios. how is it useful in the management of bleeding cases, infection cases, rheumatological cases
abdominal XRAY - how much information can you get with this exam
do the same with CXR, CT scan, PT, PTT, ultrasound doppler, etc.
10) ON THIS TEST only a handfull of scenarios require immediate intervention
RECOGNIZE THEM, KNOW THEM, good doctors DO
tension pneumo, cardiac tamponade, concomittant tylenol overdose, anaphylaxis
11) by the time you get to CCS, you are EXHAUSTED. you are already at a baseline of not thinking straight. all the more you need to relax. pace yourself. drink coffee, eat candy whatever. CCs is good to practice at the end of your study day because you will be tired when you are really doing CCS.
12) people who are nervous do worse on this exam and that can make the difference in passing. you never head about the person who passed step 3 and was nervous nervous nervous. good doctors arent nervous either or at least they learn to manage it. if studying and studying makes you less nervous then so be it but realize that this test is mostly about thinking and careful reading.
1) when doing the cases, be aware that they are not like the MCQ because they are not about the minutiae, instead they are about doing the RIGHT tests in the RIGHT order. You won't be tested on the pathophysiology of lesch nyhan or glanzmann thrombocytopenia but you will be screwed if you don't know that in an unconsicous patient next to an empty bottle of pills you must
a) naloxone, thiamine, glucose, oxygen, charcoal, pulse ox, fingerstick, etc. or something to that effect...(ie there might be more clues in the vignette)
2) take your time in the cases
on one of the times that i failed step 3 i used the usmle world cases and people had told me that they would close out the cases early because they had memorized the cases. very stupid, stupid advice. i think that there is no way to memorize cases, instead you should have some idea of the management of the different presentations of
diverticulitis, asthma, pneumonia, hemmoroids, GERD, MI, unstable angina, stable angina, cellulitis, child abuse, elder abuse, etc.
3)here is my rationale, if you have only memorized one presentation then that is the only presentation that you can manage but during the actual exam, things come up, headaches don't go away despite good management and some patients still go down despite good management. at one point of preparing for CCS, I thought i could actually get away with memorizing the actual USMLEWORLD cases but that doesn't really work when you really have to think on this exam. THAT is good advice. always, always think (relaxed thinking)
examples:
is the patient pregnant? do you need a pregancy test before starting some treatment.
is there a psychiatric issue (abuse)?
allergies?
if the patient did not respond do you have to do the treatment again? ie epinepherine in anaphylaxis
does the patient need admission to the hospital?
is there a less invasive test? pulse ox before CXR before CT of chest
4)THINK THINK THINK always THINK step 3 is not a test of memorization (although some things need memorization but that will not guarantee that you will pass the test believe me i know)
5)use the step 3 USMLE software (but read some study notes more). you can learn shortcuts
examples:
a) type the first letters cbc, bmp, pt etc. learn this so that it becomes automatic and you aren't stressing on the test.
cou for counsel. etc.
b) think about when to move the patient from ICU, home etc.
c) decide whether you want to move the clock forward - some dorkmaster told me to always pick "til next available result" stupid stupid advice. is this what you do in the hospital? no in the hospital you order your tests and then you move the clock to the next morning. if something comes up then you act on it.
6)the 5 minute screen of DEATH "your case will end in 5 minutes of REAL TIME" if this pops up you have either run out of time (you actually have plenty of time to manage the case and counsel the patient) or you were in such a hurry and NOT THINKING and screwed up the case. dumb. do not do this. it also will probablly make you a really bad doctor. think. relax but think.
7)i found it helpful to think about those bad doctors on staff at your local hospital. the ones that don't know what they are doing because they order tests and tests but have no idea what they are looking for. no thinking at all. you do not want to be ordering a CT of the head because you can. you should know what you are expecting to see on a test BEFORE you order it. this is really hard yes but you have to really think.
8)if a case goes down the tubes. let it go. a new case is a new case and you wouldn't want the doctor evaluating you for subarachnoid hemmorage still thinking about their poor management of a leg rash in the patient they saw before you.
9) alternative way of thinking about the tests.
CBC - think about how you can use this test. make up scenarios. how is it useful in the management of bleeding cases, infection cases, rheumatological cases
abdominal XRAY - how much information can you get with this exam
do the same with CXR, CT scan, PT, PTT, ultrasound doppler, etc.
10) ON THIS TEST only a handfull of scenarios require immediate intervention
RECOGNIZE THEM, KNOW THEM, good doctors DO
tension pneumo, cardiac tamponade, concomittant tylenol overdose, anaphylaxis
11) by the time you get to CCS, you are EXHAUSTED. you are already at a baseline of not thinking straight. all the more you need to relax. pace yourself. drink coffee, eat candy whatever. CCs is good to practice at the end of your study day because you will be tired when you are really doing CCS.
12) people who are nervous do worse on this exam and that can make the difference in passing. you never head about the person who passed step 3 and was nervous nervous nervous. good doctors arent nervous either or at least they learn to manage it. if studying and studying makes you less nervous then so be it but realize that this test is mostly about thinking and careful reading.