Hi there. Here’s whatever is worth of my USMLE Step 3 experiences. CCS cases in particular. Sure hope they’re of some help!
If you are crossing time zones, try to get to your venue a couple of days earlier so as to adjust. USMLE is long, tough and requires a lot of concentration.
The first day is tough. That’s my feeling. Seven 1 hr. sets of MCQs. Either way, it’s 1 min. 15 secs. for a question and by Jove, you’ll need it. The questions are long.
If I were you, I’d read the answers first. Makes it easier when you scan the question. For instance, the real choices may be about the required ethical decision. But the question will be full of technical fluff.
Concentrate on Office/Satellite settings. That’s about the size of the exam. Those with experience in family practice will just love Step 3.
Second day – three shorter sets of questions. CCS follows. And CCS is what this posting is really about.
CCS is actually fun! Immensely enjoyable. Nine cases on the whole, easily diagnosable. How u manage them is the crux of the matter.
You must do the five samples given by USMLE. Also do the practice scenarios and think through the case. This is before doing the real exam. A MUST.
At the beginning you’re given a very short introduction. Something like “a 45 aged white man comes with a complaint of severe chest pain. Then you’ll be given the history of the complaint and additionally PMH, Allergies, DH, ROS and FH etc. You have no alternative except to read through all the material.
Before you move on, these are what you should do:
- Try to come to a narrow differential diagnosis – even before the physical exam
- Note down any allergies (in case you administer the wrong Rx accidentally).
- Note down risk factors like obesity, hypertension, smoking etc. You could get extra points if you counsel the patient on these at the end of the case.
- If pertinent and necessary, you can sign off with a order for some sensible screening tests such as pap smear or mammography etc.
Right. Now that you’ve gone through the complete history and come to a conclusion on the differential diagnosis, your next important query would be:
Is the patient stable? That is, is there anything to be done immediately? If the answer is yes, no point in doing a physical. It would be inappropriate. Imagine you’re on the spot. You’ve a patient with severe chest pain. Would you waste your time doing a through physical? No! You’d straight away go in for oxygen, iv access (for pain relief or otherwise), pulsox, EKG and portable CXR and ABCs. If there is any indication, don’t forget to get tests such as ABG, serum glucose, PEFR and urine analysis done. These are just routine that you might just forget them.
Another essential point; what if this took place in an ‘office’? Application of oxygen and perchance an IV line might be possible, but you’ll soon have to do a move location to an ER for further management.
If the condition of the patient is severe and the situation warrants it there will be justification in carrying out all these emergency actions before the actual physical. Once a semblance of normalcy is established move on to the PE and click on the systems that you wish to examine. A cardio/respiratory/abdominal exam is essential and shouldn’t be missed. Also any other appropriate ones.
Once you go through the PE findings, your differential should be narrowed down even more further. With the coming in of the EKG, the CXR and the blood results, you should have a preliminary diagnosis.
This is when you start on a specific line of management.
If you had ordered a number of tests and are waiting for the results, you can try to obtain those results earlier. In case your method of management is correct, feedbacks like “the patient is more comfortable” or “is less breathless” will come in. In case you are wrong, the feedback would more possibly be “your patient’s breathless is increasing”, etc.
Keep firmly in mind the venue. If your patient is unstable, that is he/she is having acute heart failure, DKA, MI or Pneumothorax, move him/her to the Intensive Care Unit (ICU) immediately. In the US of A, pneumothoraces and DKAs are usually taken care for in the ICU. If necessary, a central line, or an arterial line or a PA catheter might be given. If immobile, keep heparin in mind.
If the patient is in your consulting rooms, with some minor complaint, there is no necessity for a rush. You can take your time to examine your patient. You can then order any tests that are relevant. And if you need those results to confirm your diagnosis, get your patients to undergo them without any delay.
The CCS will show you when the results of the tests that u ordered will be made available. In a consulting room, blood tests will take about a day. You can send the patient home with a pain killer, if necessary, and ask them to come back with the test results.
Specifically in a consulting room situation, you may have to see the patient a couple of times over a week or two or more to see if he/she is getting better. So, if for instance, it is a patient with Iron deficiency, don’t just prescribe ferrous sulphate and some counseling and forget about them. But do counsel them if required. For instance for drug compliance or cessation of smoking.
Location change is also important in the reverse. If your patient in the ICU is much better, shift him/her to the general ward.
Over-treating will not get u extra points. You just might end up losing some. Like, for example, if you do an unwarranted expensive or invasive procedure.
In a CCS setting you are the patient’s primary physician. Usually you’ll not be allowed to perform an specialized procedure like evacuating a subdural hematoma. If such a procedure is deemed necessary, you’ll have to refer the case to the specialist concerned.
Clicking “consult” in the orders page will list out the choice of specialists.
If you do not have sufficient grounds for a referral, the specialist will not put in his appearance. For example, for a cough, you’ll most probably get a refusal from the Pulmonary Specialist. But if you did an imaging on the chest that turned up a discrete lesion, not only will the pulmonologist but also the oncologist will evince interest. The point is, have solid evidence, like imaging. Once the problem is identified then the operation on the patient can be carried out.
Right! Here it goes!
Had my exams for two days January 16th and 17th. My results came out last week.
Prep. Time – 2 weeks.
Books – None. No time for books.
Other than books material used – UW CCS cases and UW Multiple Choice Questions. No time to complete the UW questions. Answered about 800 or 900 questions; all in timed mode. Got an average score of 58%.
Went through the UW cases once. Tried the five practice cases so many times that I’ve lost count. Learnt how to use the Primum software and tried out a few UW cases on it.
NBME – Tried it out for the sake of trying it out. Got a decent score of 420.
Right! Now for the real thing. Very hectic day one. Very long questions. Lots of them in Geriatrics. Patients on multiple drug and with some 60 or 7 diagnoses. Usually these questions would test issues of drug interaction or ethics.
Some of the questions were straightforward some were ambiguous. I’d say that on an average, I’d be sure of some 60% of the questions for each block and sort of sure for about 10 to 20%. No inkling of the rest.
Lots of pictures of skin – some easy, some indistinguishable. Dermatology questions were tough as the history of the patients were vague.
There were only a few X-Rays and just a sole EKG.
Questions seem to be in the UW pattern though whether they were similar or not is quite difficult to say.
The second day moved like lightning. But a block of questions out of the 36 was singularly hard. Can’t say if I was fagged out or otherwise. Couldn’t really concentrate in the final block. Just wanted to finish the whole thing and walk out. Felt smothered.
CCS cases – Just snapped through it. Eight minutes per case, no more. Fact is, the last one lasted only 4 min. All the patients recovered. First case was a failure. Couldn’t figure it out. Even took 20 min. Just didn’t recover.
Final Score was 86%. Couldn’t be better satisfied.
Studying successfully for Step 2 of the USMLE
As you get ready to study for USMLE Step 2, have no doubt in your mind that it is going to be tough and that you will be under immense pressure. The pressure may not be to the extent that u faced when preparing for Step 1, but there will be some. Some study procedures that might help you score the marks that you expect are given for your benefit.
First Procedure : First of all you have to have a plan of study. Ensure that there is sufficient time to study so that you do not finding yourself cramming at the last minute before the exam. You must have heard of some kind of scheduling that is required. You may also have heard that though it requires 2 months of study for Step 1, 2 weeks would be sufficient for Step 2. Take it to heart but do not stick to this plan as you will require more than two weeks for preparing for Step 2. Two weeks just will not do.
Second Procedure : The First Aid book is an absolute necessity for Step 2, if you want to get off on a flying start and be successful in getting through its examination. If you are used to the First Aid series for Step 1then this will be the format that you will also get for Step 2. You can get the most of the book by reading it a more than a couple of times. Schedule yourself a plan of study and try to extract all the information that you can get in the first read itself. Utilize the same kind of methodology of studying in the subsequent readings as you are bound to leave out some information in each read.
Third Procedure : Make it a point to consult a number of sources when preparing for an exam or for anything else for that matter. Every time u read another fresh material, you will find that there is something new that u did not get in the previous source. Once u have gone through the First Aid for Step 2, you can move on to the next Crush Step 2 material. As u read new material from different sources u will find that the presentation is also different so that you will not get bored with repetitions. The Crush Step 2 will be a fresh format.
Fourth Procedure : Step 2 Secrets will definitely complement your study for the USMLE Step 2 exam. You will not be learning anything new, just that you will be reviewing what you had already studied and finding out the stuff that you had missed out. Step 2 Secrets is excellent resource material since it permits you to test yourself. It is also perfect for a fast recap prior to the exam, that is if you really get the top 100 secrets correctly.
Fifth Procedure : You have only two choices when it comes down to databases – the Kaplan Q-Bank or the USMLE World. Which are you going to choose? Even though the choice is yours, many people who have passed out successfully swear on the USMLE World. The reasons are that a. It is only a one month $60 subscription and b. The questions are more deep. If you want to guarantee yourself a success and have the means to do so, then purchase both. If you do not mind the expense, then also purchase both the databases.
Even either one of the databases might just overwhelm you. To make it easier for you set it up in sections of 46 questions each to be done in the timed mode. By doing so you are setting up a mock exam session and so there will be no surprises on the real exam day. Don’t try to go into the tutor mode and cut down the 46 question format just to relieve yourself. You have to get used to the atmosphere of the exam that you’re going to sit for. But whichever database you use, make sure that you use it completely and thoroughly.
Ensure that you review all the material, both the ones that you got right and the ones that you got wrong; with more concentration on the wrong ones. This is the only way by which you can identify the reasons why you gave the specific answers to the questions.
As you go through the First Aid for Step 2 book, make marginal notes. You’ll find that these notes are really helpful when you do the review just prior to the real exam. Use all your resources.
If you conscientiously followed the five procedures spelt out and reach the end of your study, there is little doubt that you will get through the Step 2 exam and come out with flying colors
I am very happy. I just received my IMG score. I wanted to give my advice, the advice that I wished I had received before I began studying for the United States Medical Licensing Examination (USMLE). But this is the rough outline of the way I would prepare for the exam.
1. You will require three to six months preparation time depending on your current level of your studies. If you know your pharmacology, pathology and microbiology, then three months should be sufficient. If not then you’d need nearer to six months. You would need lesser time if you are going to medical school in the United States.
2. Start by going through the A rated books on FA (physiology, BRS pathology etc.) Ensure that you understand everything; when I say “understand”, I really mean “understand”. This examination really tests your understanding. Just learning the facts is not sufficient.
3. As you study and understand each subject –
- Annotate your First Aid book so that you can understand every fact in it clearly. On its own, first aid is not interesting and unless you read it over and over again during the last two to four weeks you cannot prepare for the exam efficiently. You should be so familiar with the subject that you should be able to review it completely in just one day.
- The record of all the topics given at the beginning of each of the chapters is of great use it is advisable to cover all of them at the very first time that you read it.
- Make a note of those subjects that seem to be theoretically difficult. This will be helpful when you revise so that you can go straight to the topic. It is important as revising for this exam is tiresome and boring. When you revise, do the difficult subjects first so that at the end of the day you can concentrate on the easier subject. It is difficult to read about epilepsy management, anti-cancer drugs and renal pathology when you are tired.
- See that you are strong in those areas in first aid that are important – microbiology, endocrinology, autonomic pharmacology etc.
4. Once you have finished reading all the subjects, I would attempt all the Board Simulator questions and or the medrevu.com questions, subject by subject. This will reinforce your knowledge. As far as I am concerned, these questions are good for teaching purposes by not good from the point of view of the exams as they are too choosy. You should do it only because the analysis of your answers is automatic.
5. If you have finished the medrevu.com questions then you should check out those areas in which you are weak. No point in doing a repeat on those subjects that you are well versed in. Focus on the subjects that you are weak in. Use the results of your medrevu.com analysis of your answers and the notes that I told you to make previously. This is more essential, especially if you happen to be weak in those subjects that will give you a better score. Don’t waste your precious time on subjects in which you will probably get only one question, the one question that you’ll probably get wrong. Some four months would have gone past by the time you get to this point. From this point onwards use “kaplan qbank” and shift your focus to all areas. That should leave you some two more months to prepare. Read a couple of subjects more for the next three days or so, for example, behavioral science and microbiology and then repeat the qbank questions. Do this again and again until you have completed all the subjects and all the questions in qbank. This should take another month. Leave the last month for a complete review, concentrating on the weak areas. You should be able to review FA in a day with the exception of pathology, perhaps.
Some General Points For Study : Learn the subjects from a clinical angle. You have to be strong in pathology because one of USMLE’s favorite question id to ask you to describe a disease and then quiz you about its immunology, pharmacology, microbiology etc. If you haven’t studied your pathology, you’re bound to get stuck. No point in looking up the previous questions that have been asked or the question that others have been asked. They are all different. FA is a better guide. And don’t go about comparing your scores with those of others; your standard of preparation will be different from theirs. Focus on your scores and they will gradually rise to the place where you want them to be. Do your practice questions a couple of weeks before the actual examination so that you will have time to rectify your mistakes.
Make an attempt to score some 70% and above in realistic examination standard questions. Kaplan simulated USMLE exam CDs would be the best for practice. Though there is no guarantee to success, scoring 70% in the Random Tests should do the trick. To my opinion, anatomy is the least important simply because there is so much to study. Keep in mind that each individuals exam is different and everyone gets a bombshell to blast them out of the exams. Frankly, mine was in molecular biology. So many questions! If there is any subject that you intend to gloss over, make it anatomy. From what I can make out, that is the subject that is not likely to come up with many questions. There is also ne necessity to look at too many slides in histopathology. You can make out most of the histopathology slides just by looking at them.
What I am now imparting to you is an improved version of the study methodology that I followed. I did not prepare as well as I have advised you to. Make alterations to this pattern of study to suit your temperament and your time schedule. But on the whole I believe this will be useful. That is Understand FA. Answer a lot of test questions. Put your focus on weak areas! Do Not Give Up!
The scores that you should aim are :
ü Qbank 69% (a month prior to the real exam)
ü USMLE CD 39 to 45%
ü Kaplan Simulator CD 73% ( a week prior to the actual exam)
ü Books to read up : BRS Pathology / Physiology / Behavioral Sciences(BRS pathology is the best), Microbiology Made Simple(the best), Lippincott’s Biochemistry, Pharmacology, Immunology and FA for all subjects.
If I think of anything else, I’ll post it. Bye for now and Good Luck.
I just got through my United States Medical Licensing Examination (USMLE) Step 1 and here are the experiences and the lessons I learnt for whatever it worth to you.
1. Covered the FA from cover to cover and jotted down lots and lots of notes from it. In those subjects that I was weak in I spent more time reviewing matter from other sources.
2. In spite of the fact that my main source of study was the FA, I read and studied several other books also. If u can get it and go through it, Lippincott’s Biochemistry is worth its weight in gold. I could complete it in about 5 to 6 weeks and it was worth every second. If you really studied that book, there’s nothing that they can ask you about biochemistry that you cannot answer. Additionally, it gives you mechanisms. This makes the learning a lot more easier. At least it did for me. The heavier Robbins will do you a whole lot of good as a reference book for pathology. It is quite impractical to go through the book.
3. Physiology was one subject that I went through in depth. As I was weak in Renal and Pulmonary physiology, I started from the basics and then applied what I had learnt to the disease process. ICU books are extremely helpful in that they lay thread bare the basics of physiology in relation to disease.
4. Answered some twenty plus practice questions daily for the first three weeks of my study. During the last 2½ weeks I was doing 200+ questions daily, randomly. I also reviewed in detail each and every question, whether I had got it right or wrong. This reinforced the material that I had already studied. The source of my questions was the Kaplan QBank.
5. I did have some doubts about the Kaplan QBank. You see, the exam questions aren’t as detailed as they are in QBank. But if you study them in depth you’ll really learn the subject. I went through practically 95% of the questions and I was scoring a decent 74% overall and that too in the random timed mode; not just the review mode. Doing it in the tutor mode might have got some people some good scores, but that isn’t like the real examination.
6. Review, Review and Review again. You should reserve at least one day per week for reviewing what you had studied previously. It did it at the end of each study day, one FA section per day. This helped me go through my annotated version of the FA foe more than a couple of times before I went for the examination. When reviewing, don’t skip anything. If you really take a closer look, you’ll find that there is more than what you thought there was and some more. You learn something more and you also get a deeper understanding of the subject.
7. Did one of the NBME examinations just a day prior to the examination and then rested the rest of the day. I got my predicted score of 251. I gave a sigh of relief and I gained more confidence to go to the real examination.
8. Studied for a total of six plus weeks. Sat for the examination in the middle of February. The scores came up three weeks later. Scored 258/99. Patted myself on the back!
I’d highly recommend getting First Aid (FA) and reading it in the first and early second years. Take notes and annotate it so that when you come to the time for reviewing you have everything pat and ready for you. Makes life easier.
It is absolutely possible to score 99 in Step 2 Ck, and you should aim for it. If your aim is 95, your score will be around 90. So it’s always better to have a higher aim. We can assure you that you can succeed in achieving this high score.
Since you have just begun your career avoid frustration and take one step at a time. No doubt you have acquired high IQ after passing Step 1. You are assured of excellent education and life in the United States. Just think how many students in your own country can contemplate of such a possibility.
I shall explain what I did to succeed in Step 2 Ck. I had to sit down for nearly two hours to honestly answer some questions. I switched off my cellphone lest should I be disturbed. I took out my notepad and started writing the answers.
Question no.1 was what my requirement was. Obviously the answer was a score 99 in USMLE Step 2 Ck. Any aberration from this correct answer would entail deviation from your aim. The next question was about the experience that you would get when the goal is achieved. Surely you would celebrate with your pals when you have scored 99 in USMLE Step 2 Ck.
The other usual questions that require your answers are:
What are the hindrances that can cause difficulties in reaching your goal?
What is the timeframe for achieving the target?
What resources are at hand to help achieve your goal?
Who was successful in accomplishment of the goal and can be emulated by you as a role model?
Prepare the timetable and plan for achieving your goal on your notepad and write down on it your honest and detailed answers to the above questions. Whatever is your native language, go on writing for above ½ hour. At the end, read aloud what you have written. Or you can go to the seashore and read the answers aloud there. Make sure to read them first thing in the morning and last thing in the night. Being obsessed with your aim will help you to achieve it with ease. You will be comfortable with no problems in studying hard.
Take the Kaplan Q book and begin with memorization of the first fifty pages. There you will find the ideal ways to how to be organized for the exam and how to respond to various questions. The best method to study medicine as well as other subjects is to ask yourself these questions before you begin reading the book:
Why do I read this book?
For whose purpose do I read this book?
Your answers would elaborate about your patients. Main points from a single of line from the text can help in saving the patient’s life. Subsequently you will be induced to read more and gather the meanings of every line in the Kaplan textbook.
You should read medicine and then pediatrics for twelve days each during the revision, beginning with the CVS chapter in each subject. This will help you save time and energy. For the first five days the O&G is to be read, followed by Surgery for three days and Psychiatry/Behavioral Sciences for four days. You can complete a set of revisions in twenty-four days in this manner.
During this period you should access the website www.usmleworld.com and begin to answer all the questions listed therein. Don’t leave out any one question. Continue your studies with USMLE sample CD (can be obtained from ECFMG), Kaplan Q book (10-12 blocks), and Question bank (10-12 blocks). Once again don’t leave out any question.
So, all these materials are required for a 99 score in USMLE Step 2 CK:
Kaplan Q book and Q bank of usmleworld.com
USMLE sample CD
Harrison’s Text Book of Internal Medicine with hematology/dermatology slides
Photos from First Aid book
During the last ten to twelve days don’t try to first answer the questions; you should devote your time on reading the texts several times. Regular intake of Vitamin B-complex will guard against Wernicke’s encephalopathy. Then you can find answers for the USMLE CD and the Kaplan simulated. After this you can devote two to three days for each subject. You need not read some textbook other than Kaplan and resist the impulse to read other books. Surely you will get to know all the correct answers. It is better to make a note of the points in Kaplan that you can’t recall from memory, such as pediatric guidelines, leukemia, AIDS infection, etc. Don’t read new text in the last three days. Just go through what you have taken down in your notepad earlier. You may need memorization of some topics in CNS, hematology and Renal system, and a quick revision of these topics is advised. Find answers for the USMLE CD once more in the two days before the exam and also view the pictures in Harrison.
One day before the test, you can have some entertainment or fun. You can go for a movie, a body massage, or a haircut, and have some relaxation. Don’t sleep in the afternoon or you will lose sleep in the night before the test. It’s better do some exercise like walking, etc. In the morning you should read the fifty pages at the start of the Kaplan Q book where you will find how the USMLE questions should be answered. Don’t read any text on the day before the test; check your id and orange card.
The night before the test, before going to the bed, imagine yourself to be at the exam hall and answering the papers. Think that you will do well as you know the right answers. Read something that can motivate you so that get up with a positive attitude in the morning, refreshed and all ready to face your exam.
Take some bottles of energy drinks with you to provide quick energy. You can also take along a few jam sandwiches or some sweet items to provide you with sugar sufficient to supply your brain with energy. Let your breakfast contain some apples, as these are a source of stimulation, and better than coffee or tea. Also two Vitamin B-complex capsules need to be taken. If you are a coffee or tea drinker, take it along too. Once again check your id and orange card. Now you may invoke the blessings of the Almighty, your elders and your well wishers. When you’re at the exam venue, breathe deeply and relax before the commencement of the exam. Wash your face with water at the toilet so that you’re fresh.
When you.ve entered the exam hall, don’t rush to answer the questions. Insert the earplugs in your ears and write on your pad that you will be doing your very best. Now you’ve gained confidence and you can start with the tutorial of the test. You can’t skip it, but continue to press the NEXT button. When it’s over you can type your CIN number in the required field and the exam will begin.
Read very carefully and proceed with the test. Have patience and take the test as if you’re playing a game. Remember, it’s important that you should be enjoying the test.
As each of the blocks is passed over note it on your pad. When you’re through with 4 or 5 blocks, you can have a light meal. Now you have done almost 70% of your exam. As you complete each block, try to write some good points about yourself on the pad. This is one of my secrets which I actually did in my test.
Should you need any help feel free to contact me. I’m sure you all will do your best at the test and anyone can reach a 99 score just because all of us are doctors. I wish good luck to all of you.