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Kuldeep Raj – USMLE Step 2 CS – High Performance – Star in 2 Sections

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Hello everyone! Hope you are doing well.
I’m a ECFMG certified doctor who recently graduated.

USMLE Step 1 Score 250.
USMLE Step 2 Score 251.
USMLE Step 2 CS – Pass (First Attempt)

Will be applying for this year’s match. I have couple of months free in which i think i can teach any step of USMLE.

Have cleared CS with high performance (2 STARS). I can give you first hand experience of whole exam, tips and tricks (as if you will be ready to give in 15 days). So if anybody is looking for a CS tutor, can inbox me. Thanks in advance and Goodluck.
CLICK TO CONTACT KULDEEP

May 22, 2020

Kuldeep Raj – USMLE Step 2CK – 251 – MUST READ !!


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I’m an ECFMG certified doctor who recently graduated. I will be applying for residency this year.
USMLE Step 1 Score – 250.
USMLE Step 2 Score – 251.
USMLE Step 2 CS – Pass (First Attempt)
I’m willing to tutor for Step2CK. Through my journey, I learned that many of the people who are preparing for this exam don’t have proper guidance/plan that how to study smartly. They take years to prepare for this exam and end up getting exhausted. Some also don’t have good basics too. So here I’m to help you out through this strenuous journey.

What my course includes:-

I offer all my students individual attention necessary to come across as a professional doctor rather than a student. You will be given one-on-one sessions that will help you identify your weaknesses and will allow you to work on them.
I will drill you on your differential diagnosis skills, which is very important for CK.
I will help you with EVERY high yield concepts, where you don’t have to memorize much.

I will be providing you exam taking strategies, exam approach, and also how to nail this exam in less time.

I will answer all your queries with latest guidelines, as currently I’m half way done with Step 3 too.

Keep in mind that studying for a longer time would not help you to get high scores but studying smartly definitely will.
So don’t worry, I will be working with you on every step of your way very precisely to ensure that you master all the necessary concepts of this exam. If you are interested, you can inbox me. Thank you!!
 
May 22, 2020

Saira Fazal USMLE Step 3 Experience

 

 

Wohoo ? passed step 3 with 220, good bye USMLE!
 
So here are the details of my experience…..
Materials used:
  1. First Aid Step1: For cardiology, pharmacology, micro and immunology.
  2. UWorld CK Notes: Would highly recommend especially if its been a while since step 1 and 2 to refresh basic concepts.
  3. UWorld Qbank and CCS: I started with qbank and CCS together, did 2 rounds of both, made flash cards and notes.
  4. Archer Videos: Just watched the introductory video to familiarize myself with the software and operations.
  5. Practice Exams: UWSA1,2 and NBME 4: UWSA were not at all predictive for me, I found the exam much similar in pattern to NBME. Took UWSA1 a month before exam – got 194….was disappointed, delayed exam and studied for another month only to get 201 on UWSA 2. By that time i was tired of studying and just went for the exam.
Exam Experience:
Day 1: Basic Concepts so essentially lots of step 1 and 2 concepts. I seriously felt like i was guessing through half the exam. The questions were not at all like uworld but it turns out my performance was ok.
Day 2: Took after a gap of 1 week, practiced interactive cases on CCS and fred software, read through the practice ones. Day 2 was much better, I had practiced the whole CCS in uworld twice before so it was not menacing. All the cases went well and finished early.
A few people sent me direct messages… apologies couldn’t reply back directly. Here are the answers
  • My qbank expired so not available for sale
  • Overall experience as i walked out of day one was feeling frustrated and overwhelmed with the exam. Day 2 was better, CCS went well so i was hopeful.
My 2 cents:
  • Do CCS well, i found uworld to be enough, didnot sign up for anything else.
  • If time allows refresh cencepts from first aid step 1
  • Do the questions and CCS cases from the fred software. Those were a good approximation of my exam.
If anyone needs further info please comment here and i will try my best to answer here.
Good Luck!
October 14, 2019

Samy Ishak Step 3 Experience

 

 

This is my experience:

Score 241

1st of all if you want to do really well in this exam most important 2 things to ace are :
1- biostatistics
2- CCS
I did ck very long time ago but step 1 only 4 months ago
Duration of study…..2 months
Sources of study :
1- UW ( main source ) ….2 times
2- biostatistics of UW …..4 times
3- charts and tables of ck
4- from step 1 …. classification of micro, MOA of pharmacology and nerve lesions from anatomy
5- for CCS …..UW and ccscases.com and 1st 2 videos of Archer

Assessment tests :
UWSA1 …..230
UWSA 2 …..240

Experience of the exam :
Day 1:
The most important issue is time management as unfortunately a lot of questions are super long ….I messed up 2 drug ads completely because of the time
A- 15-20 questions from step 1 ( 5 MOA, 2 or 3 classification of micro, 2 from biochemistry and 3-5 anatomy)
2- biostatistics…. major part of day 1 ….well covered in UW 3…..about 6-10 q in each block with total (40-60 questions) including 4 drug ads
3- rest of questions are ck style mainly diagnosis and management…very easy but very long scenarios

Day 2 :
1- no step 1 qs
2- no biostatistics
3- no problems in time management…. questions are much shorter and straight forward
4- tons of questions on prevention and prognosis….which unfortunately alot of them will depend on guessing
5- CCS cases ……13 cases …..all of them with no exception from UW and ccscases.com

CCS is very important to pass the exam and extremely easy to get high performance in it if you practice well
ccscases.com was much helpful for me because of the feedback which markedly helped me to improve my performance

I did my exam in 2 consecutive days with no gap in between and this is wrong as in day 2 I was extremely exhausted and did very bad in the last 2 blocks because of the mental exhaustion
U need at least 1 day break between day 1 and 2

October 14, 2019

Jackie Wilson – USMLE Step 3 Experience

 

 

 

Just passed step 3 with a 254.
Study time 3 mo before residency
Resources:
Used uworld for McQ x2, plus incorrects an additional time
Did uworld ccs cases x 3
Read crush CSS x2
Did the primum cases for ccs x1
Read Kaplan step 3 books
Read Kaplan step 2 IM
Read MTb for everything but IM
Did uworld step 1 and 2 biostats questions
Read fa biostats
Did the archer intro lecture series for ccs
Reviewed uworld step 3 and 2 charts

Exam experience:
First day the questions were fair I felt but I made a lot of stupid mistakes that haunted me for a few days
The questions weren’t too long on my exam and were mostly uworld concepts
Biostats was ok, the drug ads and abstracts in every block made time management hard the first day. Finished each block with like 1 min left if that

Then I had 8 days in between
I read crush twice and did uworld ccs twice
Made a template so I wouldn’t forget key things
Reviewed step 3 charts
(I felt this was too much time, and I wanted to get the test over with by day 4 and it was hard to keep studying so if I were to do it again I’d have a shorter gap between test days)

Day 2 the questions were super easy , was finishing blocks with 10-15 mins to spare
Mostly uworld topics
The ccs- most of the cases are covered by uworld and most of the remaining covered by crush, the rest… (1-2) both sources give you a good foundation to manage them
The ccs I messed up a lot with sequencing and messed up 2 cases completely I felt and missed little things here and there for every case but still did well on that part

After the first day I seriously thought I failed and was considering not going in for day 2. So no matter how bad you feel just keep going on.
Hope this helps!

 
 
 
October 14, 2019

Nico Ortiz Flores USMLE step 3 Experience

 

 

Here’s my short experience for a pretty average 224: I’m a PGY2 with limited study time, did only UW 2.5 months like one hour a day or so, did one round with barely taking notes, repeated my mistakes x1. Did all the text CCS cases x2 and half of the interactive cases before the test. UWSA 1 said I’d score 210 haha, it’s true what they say about it undershooting the real score. Didn’t take UWSA 2.
If I’d change anything of my prep would be to review more step 1 pharm, got tons of really basic pharm questions that I forgot because I’m in pediatrics. If you’re already in residency, the CCS cases are very straightforward and you’d just need to know the software. If you’re not in residency, I advice to do them all at least once. Bottom line, UW all the way. The end!

October 13, 2019

Anchal Shivalik USMLE Step3 Experience

 

 

guys!!!
233!!!

EDITED :
So , first of all, I have made 2 posts already about my exam experience. Please just search them. If you still have questions beyond it, i would happily answer but please don’t ask the things I already answered.

Second, the trick that Ekta Shah mentioned for Step 3 score works. I got the Expired permit thing and I passed and someone told me they had the yellow link to reapply under it and I didn’t.

Third, I am really sorry but i cannot answer that if you are ready to give exam. I was ready before my exam, scared i would fail after exam and here I am now, so I don’t think I can answer that. If you are scoring +/- 10 within your goal range on UWSAs, I hope it should be good but again, I cannot answer that with surity.

My Step scores :
220,231, first pass.

UWSA 1 3 weeks before exam : 207
NBME 4 , 2 weeks before exam : 350
UWSA 2, 1 week before exam : 222

What i studied : MCQ : UW and CK tables. And did my own CK notes for my weak subjects. Kaplan for ethics which I didn’t think help much but read if you have ample time.

Biostats : UW step 2,3. UW Biostats. Step 1 Fa biostats. Kaplan Biostats (is a good book for this)

CCS : crush ccs, UW, CCscacses.com (was a good practice tool) Edit 2 : I forgot to mention but i also did archer , i think it’s available on the group, that one only. They are good to give you an orientation

step 1 things I read : Just a basic read of micro and pharm. Not too indepth. The ques I remember were also not very indepth

In the end :
Thank you to everyone in this group! All the people who helped answer all the queries, all the doubts, all the support, all the exam experiences. Thank you so so much.
Questions are welcome but if they are repetitive or something i have already answered in pre posts or here, I’ll probably ignore it. Thanks again everyone

October 13, 2019

Spoorthi Jagadish USMLE Step 3 Experience

 

 

Hello,
Here is my step 3 experience! Score 240.
I had taken step 2 ck in July 2018.
I took my step 3 on Jan 30 and Feb 1st.
I started preparing seriously since early November. But it was a little tough to get into the groove of studying in the middle of interviews and stuff.

Sources- I did only uworld. My scores were in the range of 55-75 in the first round. I did the incorrect questions too until I got them right (painful process). Second revision, I was able to complete less than 50% of the questions.
I spent a lot of time revising all the tables and flashcards.

For CCS, I just stuck to Uworld again. Went through the cases twice. There are also some documents in this group which I found useful- like 100 rules etc.
I made it a point to pause and reflect- does this patient need some orders like o2, ekg before exam. If unstable in office, immediately move to ER. Always take consent, counsel etc..

Exam day- started the wrong way. I had to drive down 75 miles to the exam center and it was the week of Polar vortex in the Midwest and temp was close to -50f, maybe I was foolish, but I drove down at 5.30am and managed to reach without any mishaps!
Day 1- biostat questions were several, but quite easy. I had solved uworld biostat review and revised step 1 first aid too. You need to know all formulae very well. Drug ads were pretty ok(I am normally terrible at these). I kept drug ads for the end of the block. Completed all blocks with time to spare.
There were few questions from basic micro and pharm. I took 2 breaks in total. Came out feeling kinda numb.

Day2- again drove down early in the morning. The mcqs were much easier than day 1. Ccs part- cases were pretty easy to diagnose, although I totally missed diagnosis in One of the cases. But overall went well. I took just one break in ccs( which was a wrong thing to do perhaps) because I was in the flow. Came out feeling just relieved!!

Thanks to this group. Some of the files, tips really helped.
Overall I think this was the easiest of all USMLE exams and 3 months is sufficient prep time!

 
 
 
October 13, 2019

Saminathan Anbalangan – USMLE Step 3 Experience

 

Hi, everyone. I got my results last week and secured 223. I’m an IMG from India and thought I could share my Step 3 prep experience so that people can benefit from a proper direction.

Sources I used:
For MCQ: UW (UsmleWorld) Step 3, my old UW step 2CK notes, First Aid Step 3, MTB (somewhat), Kaplan and FA step 1 pharmacology
For BioStats: UW questions from all steps, FA Step 1, Kaplan Step 1 Psychiatry book
For CCS: UW cases; CCScases.com (new software with feedback); USMLE practice software FRED

Link for the resources including archers: https://drive.google.com/open…

So my actual preparation started in October 2016 but was interrupted so many times for various reasons. I finally took the exam in Aug 2017 but my full-fledged studying was only for around 3 months. At the start, I did UW Qbank once and scored an average of 54%. I took NBME 4 and scored 400. The next day I took UWSA and got 194 and I was shit scared to take the exam. I postponed the exam, revised entire UW questions once again with special attention to wrong questions while taking notes and final the % was 78. I also read FA Step 3 once and revised my Step 2 CK notes because I took it more than a year ago. Then I redid my UWSA (since I didn’t read the explanations before) and scored 227 which boosted my confidence. Before my intense preparation, I looked through MTB and some of MKSAP (IM board exam Qs) and still UW seemed the best source to rely on for comprehensive reading. I personally felt FA was better than MTB as it had more organized facts. My thought about MKSAP is that it’s too much to study and its content level is very high for Step 3 exam. Ultimately it’s only UW for the 2nd day of step 3. I also read Biostats from all sources possible and Pharmac from Step 1 books like FA and Kaplan. This really helped me big time on Day 1 and to achieve higher end profile in MCQs.

Meanwhile, I was also preparing for CCS doing at least 1 case every day. I started with Archer CCS videos and it was IMMENSELY useful and can’t stress much it helped me. It gives you clear-cut directions that you can follow in general and for specific cases. After that, I practiced cases using UW software and the Readouts in the UW website. I was able to finish it twice. Close to my exam, I came across this new software called CCScases.com, which is a one-time 75$ pay, lifetime access software WITH FEEDBACK. It is very nice software to practice cases because you get feedback as to what you missed and what could have been done. It also gives a score! So, I purchased it and finished like half of the 100 cases it had. I’m glad I did it. I also used a mnemonics table (got it from a forum) for what all I’ve to do in all cases so that I don’t miss any of it. It helped me keep on track. Link for the mnemonics: https://drive.google.com/…/0Bw2yuwUW7nEfRjhRVDZEYzJlN…/view…

Exam experience:
Day 1: 6 blocks 38-40 Qs
It was FULL OF BIOSTATS! literally. Min 5 Qs at least. I had like 7 qs in almost all blocks. I recommend to all that you master biostats by repeatedly studying all concepts and formulas. Most Qs were simple calculations like NNT, ARR, PPV. Many concepts like the type of bias (identifying it and how to eliminate the bias), type of statistical studies, p values, type 1 and 2 errors and so forth were also tested. I had minimum 1 Drug ad in each block: interpreting the ad, interpreting p values and HR and coming to conclusions.etc. The rest of the exam was mixed from all subjects, mainly basic science. Pharmacology Qs were mechanism of action of drugs and the type of receptors they act on. Psychiatry Qs were about the pathophysiology of psychiatric diseases. Overall the entire day was about how you apply basic science concepts to patient care.

Break time for Day 1: 45 min was more than enough. I split it into 5min, 10min(went out for refreshing), 5min,20min(lunch break), 5min.

Day 2: 6 blocks 30Qs and 13 CCS cases
MCQ- Shorter and simpler questions. Exactly like UW step 3 Qbank. NO BIOSTATS. More than 50% Qs were about prognosis and risk factors which were doable. Rest was next / best step in management, dermat pictures n diagnosis, heart sound questions, ekg and radiology interpretations. Many were about most common disorders but asked in depth. Quite a number of questions from obgyn and ped also. I felt UW is enough for this day.

CCS – I had 7 20 min and 6 10 min cases. It was similar to UW and CCScases.com. I effed up one case but I guess everyone gets such cases. Rest were doable and pretty easy. Before each case, we have an extra minute to get ready. You can use that time to quickly refresh your mind / write down mnemonics. The exam software is SLOWWWW! It’s better to practice cases with FRED practice software from the USMLE website to get a hang of what it will be in the real exam. To avoid that lag I found a TRICK. After ordering multiple tests in cases like DKA, the system actually slows down and it takes time to get results. So once you place all orders in the Order screen, switch over to the H&P screen and then start advancing the simulated time to obtain the results. That way, you get results faster without the system lagging.

Break time for day 2: 45 min break wasn’t enough. I didn’t have enough break time between MCQs and first 4 CCS cases and I was exhausted when I reached there. Then I started finishing cases quickly and that extra time was added to break time to help me move forward. In the end, it was okay. So I strongly suggest you people split the 45min break time between the MCQ blocks and the 1st 3-4 CCS cases. Maybe 5,5,10,5,5 between 6 mcq blocks and then 10 min to start CCS and then 5min for next case.

My interpretation of the exam is that the level of easiness/toughness is based on the solid foundation in basic sciences and also the clinical experience you’ve had so far. Taking it soon after Step 2 CK really will help the exam. Trust me, that will be so beneficial. And for those who are applying to match, take the exam before applying as it can boost your chances of getting more interviews. It shows that you’re determined and you’re a great candidate. Moreover, it is so difficult to study during residency and you’re losing the residency experience also. Hence do take the step 3 ASAP after CK.

Suggestions:
-Do UW step 3 twice if possible and take notes
-Read FA or MTB Step 3 books if you have time
-Must Read Biostats from all sources possible (especially FA and Kaplan step 1 books and UW Step 2 Qbank)
-Must Read Pharmacology from at least FA Step 1 book or Kaplan Pharmac step 1 book
-Read through UW Step 2 CK notes (yours or someone else’s)
-Must Watch Archer videos and practice cases in UW at least once and if possible with CCScases.com also
-Don’t forget to read the 41 cases in text format on the UW website
-Practice CCS in the USMLE website practice software FRED at least twice
-Take Step 3 ASAP after your CK exam

Good luck everyone and thanks for those who contributed in the group ? Let me know if any of you have questions and I’m happy to help.

Link to My step 1 experience (252):
https://m.facebook.com/groups/666736830029592…

Link to My step 2 CK experience (251):
https://m.facebook.com/groups/213581002005720?view=permalink&id=1177130108984133

October 13, 2019

Christi Sunira USMLE Step 3 Experience

 

CONQUERING THE STEP 3 USMLE

In a Nut shell:

Time for preparation: 4 months

Materials used:

MCQs: UWORLD Step 3, First aid Step 1 for Bugs and drugs- MOA (mech of action), Biostats review from UW.

CCS: Uworld (51 +41 = 92 cases) and cases on official usmle.org (6 cases) = 98 CASES plus Crush Step 3 CCS for the not so familiar cases.

SCORES:

UWorld SIM 1 score: 221

U world Sim 2 score: 225

Actual score: 242

STRATEGY:

MCQs: The Known devil

Do a complete review of the 1500 ish UW questions. It generally covers most of everything that is going to be asked on the exam. Some suggested to read the MTB 3, which can help you with the base, I suppose. Some management given in it were in contrast to UW, so I decided to stick with one source ie UW. I covered all the Qs once and then repeated the incorrect ones only.

Though you may think that there are only 1500 qs, each question has its own weight. The explanations for every choice should be read. And the questions were also difficult to answer for example:  there were clues in the Q stem which could fit any of the given answer choices, so we need to know our subject in depth to arrive at the right answer. For me CVS and Endocrine were the hardest, so I dedicated more time to master those. On an average I was scoring from 65- 70 % on my blocks. But Of course, I did them in tutor mode, so I really can’t judge my performance there.

I am a great fan of the “Recall method “of studying, so I made questions for myself as I was studying the blocks, I did not take notes. Instead I made flashcards of the concepts that were difficult to remember. And when I reviewed the questions, I could just flip on the flash cards for the answers. But, it’s up to you if you want to take notes, as some feel more comfortable reading notes in their own writing.

Due importance should be given to Biostatistics and Ethics- again my weaker points. So I decided to buy the UW biostat review, which helped me to review the concepts and it also had some questions which helped for additional practice. Also, the Step 3 UW itself has around 120 biostat questions, which again cover many of the questions in the exam. So, make sure you give due time to those plus study the formulas, revise them and work out a few problems.

CCS: The Unknown devil

Just as the title goes, much of the fear pertaining to the CCS was there because I did not get much information about it. How do I prepare for it? What sources do I use? I went on many forums to read on what the others were saying. But in the end, I figured that there was only “Do the UW cases, you’ll be good”. Yet even when I finished the UW cases, (of which many were pretty straight forward) – I did not feel confident about it, because I did not know whether I was taking the right steps in the right sequence or not. Because even if you know the management pretty well, sequencing your steps is important. Like placing emergency orders before examining a pt who is in acute distress.

So, I came up with some practical approaches to the CCS cases, these strategies can help you in your preparation for the CCS and soon you can build on it as you do more cases.

Let me outline a few differences between the UWORLD and the Official ie exam CCS software

  • You can select MULTIPLE OPTIONS in the order sheet in the official CCS software unlike in UW CCS. In UW CSS, to select multiple options press on “ctrl” button on the keyboard as you select the options with the mouse. That’s how I practiced on UW.
  • Some Orders in the UW CSS may give you more options in the order sheet than when you place the same orders in the official CCS software. So, try to open both the UWCCS and the NBME delivery software in your computer, and make sure that the same options are reflecting in both.

For ex: When I type the order “IV” in UW CCS- it brings up [ IV access and various IV fluids] so I can select them both with one command ie IV. But in the official CCS “IV” only brings up “IV ACCESS” so if I want to order fluids, I have to order it separately.

  • The options of “Routine “or Stat” that come after selecting an order, have been removed from the Exam software. (A BIG TIME SAVER) It is still present in UW CCS though.
  • At the 2 min screen- I was able to enter many counselling points on UW CCS than I had time at the real exam. Because in the exam CCS, there is some lag once you place the order so it’s important to prioritize which counselling points are more imp than others and then click them first.
  • The diagnosis box at the end of the case have been removed from the exam software. Still present in UW CCS.

 

In addition to the steps, I have also given the commands I used where I could come with multiple orders on the screen.

For example, in an emergency case you need to order an IV Access and you want to check the fingerstick glucose. Two separate commands would be “IV” and then “GLU”.  But I figured that if you type “ACC” it brings up both “ACCESS IV “and “ACCUCHECK GLUCOSE” thus I can select two tests with 1 command.

 

 

 

 

So, lets start:  The following are points that are a conglomerate of the information I gained from reading various forums and coming up with a plan that suited me best. This is merely a guide and not a hard and a fast rule, since no one is sure of how the CCS is graded. So, read through these to get an idea of the approach to the cases:

 

  • STEP 1: Read the case history as its presented to you. Be as fast as you can, since in 10 min cases you have to save time by going through the case fast.

 

  • STEP 2: As you read, make some mental notes on whether the patient has

? Allergies to drugs- esp. penicillin, sulfa drugs.

? on any medications- these will be on the ‘order sheet’ screen, so you don’t have to write it down.

? smoker/ drugs/ alcohol – so that you can counsel at the 2-minute screen

(I read that some actually write these down on the erasable sheet in exam, but I never had the time for it. But you can, if you feel that you might forget. These points are pertinent coz, suppose you have to give amoxicillin to a patient, but u missed/forget about the penicillin allergy, that could really hurt the score, so yeah just saying)

 

 

  • Step 3- After the history, you must have realized whether the patient is in acute distress or not. So here come 3 possibilities:
  1. Routine patient in office- Do Physical Examination after case history ends.
  2. Acute distress patient in ER- Do emergency orders after case history ends.
  3. Acute distress patient in Office- This presents a dilemma: Do I put in emergency orders or do I do the Gen app/cvs/rs exam or do I shift the patient to the ER as next step?

I couldn’t get a clear answer anywhere- so this is what I did:

In patients with Acute distress- I gave Morphine and Vitals check- then did Gen app+ CVS+RS exam – then shifted to ER.

Once in the ER, I ordered the rest of MAVOC (given below) with Fluids and then did the examination and went on to place orders.

Note: one important thing to note is that: You have to examine the patient ie at least do a CVS/RS exam before shifting to the ER. Do not directly shift to ER after the history ends, even if the patient is presented to be in acute distress in history-U need to see the patient ie Examine CVS/RS before shifting to ER.

 

 

  • Step 4: EMERGENCY ORDERS:

Orders to be placed BEFORE examining the patient: ONLY for patients in acute distress. For routine patients, go to Step 5.

I used this mneumonic

MAVOC + Fluids (only when needed)

 

M- (TYPE “MOR”) Morphine  IV (can be given in all pain patients EXCEPT those in HYPOTENSION as morphine leads to peripheral vasodilatation- give Fentanyl/ Ketorolac in that case).

 

  • (TYPE “ACC”) Select- “Access IV” and “Accucheck Glucose”

V- (TYPE “VIT”) Select Vitals every 1 hour

O- (TYPE “OXY”)- Select “PULSE OXIMETER & OXYGEN, NASAL”

C- (TYPE “CARD”) – Select “Cardiac Monitor”

C- C SPINE COLLAR- Only for TRAUMA patients- should be placed BEFORE examining the patient.

  • Step 5:  EXAMINATION:

 

ROUTINE patients: FULL examination (yes COMPLETE examination incl PR/PV- so select ALL the boxes in the physical exam )

 

ACUTE DISTRESS patients: Do RELEVANT examination only = GEN APPEARANCE +CVS+ RS+ SYSTEM in question ( ie abdominal distress= examine Gen app + CVS + RS +abdomen + rectal)

 

  • Step 6: As you start the examination, the orders that you placed as emergency orders will give you updates.

Click “Continue” if the vitals are good.

Click “Stop “if you want to go and place orders before proceeding with the examination.

 

For example, after I have clicked the boxes in the physical examination and as it is opening, I get an update saying that SpO2= 90%. If I have already ordered Nasal O2 in my MAVOC orders, I will press “Continue”

If I had ordered only “oximeter” in my MAVOC orders, now I have to stop the examination- go to Order sheet and put in Nasal O2. And then come back and check the boxes for the physical examination again. (Though you might think that this could cost you a few extra precious seconds, proceeding with the physical examination without giving Nasal O2 can negatively impact your scores).

 

  • Step 7: Orders

Now the examination is completed- Go to the Order sheet and start placing your orders.

 

As its often said, when you are under pressure it is possible to forget something, when under normal circumstances you would have remembered. Say, we all know to order Ecg in chest pain. Yet in CCS there is a possibility that you will order CXR and Cardiac enzymes and forgot about the ECG.

 

 

So I came up with this mneumonic, that helped my mind to run over all the important tests that I am supposed to order. I don’t order these tests for all the patients, if chest pain then tests in relation to that and so on.

 

CCC

UAE H

LUSCENT

 

  • C- CBC
  • C- CMP ( BMP + LFT)
  • C- CXR and CT scans ( If Lung case- think Sputum)

 

  • U- USG ABD/PELVIS/KUB
  • ABG (For all pts with resp distress)
  • E- ECG (think of other test like- Cardiac enzymes, d-dimer, CT PA, Echo)
  • H- HCG (urine preg test) (all females 15- 50 yrs.) it’s a crude rule, but just to rem it.

 

  • L- LFT, PT/INR, PTT, Bleeding time

 

  • U- Urine routine, Culture.

 

  • S- stool- FOBT, culture, ova/parasite, leukocytes, Fat stain

 

  • Culture- Blood (all fever cases)

 

  • E- ESR

 

  • N- Neuro checks (all altered sensorium pts)

 

  • T- TSH

I know that the above is not exhaustive, it doesn’t cover the tests for acute pancreatitis or say anemia or tests for auto immune diseases. But we will not forget those specific tests for specific diseases, right?

It’s the urine preg test in reproductive age women, or the blood culture in fever cases that we are most likely to forget. So, it’s those kinds of tests that I have incl in the above. You can add to this, or create your own as you see fit.

  • STEP 8: Now the orders have been placed, the next step is

In Acute distress pts: remember we have not completed the full physical exam- so now is the time to finish that.  Its important that you remember to complete the physical exam in all pts. Once you complete the physical exam, the clock moves and the results of the updates will be presented to you.

In Routine pts: You can move the clock to get to the test result that is most relevant to the case or send the pt home with a f/up appt (usually in 1 week) and then review the test results.

  • Each time you send a patient home with a new medication- you have to “counsel” regarding the medication side effects, adherence and “No alcohol” orders- . Don’t wait until the 2-minute screen to counsel regarding the side effects and no alcohol, becoz the pt is taking the drug now, the 2 min screen can pop up after 2 weeks of simulated time. So if you are starting a new medication now, don’t forget to enter these counselling points before sending the patient home.

 

  • All the treatment and management points have been discussed well in UWCCS, and you will become more proficient by doing the cases.

 

A Few thoughts:

  • In many forums there are students who say that we should not intubate any patient in the CCS. But this is wrong, I had cases on my exam where I had to intubate-ventilate and the patient’s vitals immediately improved. UW CCS doesn’t have any case where Intubation is needed- but in the actual exam you may need to intubate a deteriorating patient. The orders to give here are “INTUBATE” AND “VENTILATE” don’t just stop with the intubate order.
  • You don’t have to provide any Ventilator settings. The case usually ends with an update saying that the patient has improved (if Intubation was the appropriate treatment.)
  • Once you have given the appropriate treatment or the patient becomes better, you will get an update that the pt is improving and then- the 2minute screen will pop up.
  • At the 2 mins page- type “counsel” and select all the counselling points that are pertinent to that patient. But mostly you will have time for 4 or 5 only. So, pick the important ones first say for ex: for a STD pt- partner counselling, contraceptive counselling here is more imp than counselling on diet/exercise.
  • Much has been said about the CCS format- how it can make or break your score, and I feel that it is right. It can certainly give a boost to your score.
  • Some other thing that was discussed in a few forums was like how it really doesn’t reflect the real-world scenario and stuff like that. Though it may be true, we don’t have the option of not studying for it. So yeah, there is only one way to face it: We have to prepare for it and conquer it! It can be done.

ALL THE BEST FRIENDS!

October 13, 2019
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