dontgiveup!
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Hi Gang!
When I received my score examination results in the mail, like many of you, my ticker was pumping. I was so happy to see that I passed this hellatious exam. The score was not great, 194, but it satisfied the gorillas!
Here is how I studied:
Firstly, as stated in Strong Medicine - PLEASE TAKE THE TEST SERIOUSLY. It has gotten much, much harder over the past years. Also, they have recently increased the minimum passing score which used to be 175, I believe.
Secondly, we all know how to memorize data and concepts. We have done this all our lives. It is the essence of being in medical school.
However, applying these concepts in 45 seconds after reading a three paragraph vignette with multiple answers is the key. I honestly believe that step 3, like all of the usmle exams, tests how great of a "test taker" you are more than how much "medicine" you know.
Can you mark an answer and go on to the next question without having the shadow of the previous question distracting you? Can you stay focused and confident when the time clock has LEAPED into the next millineum and you still have more than 60% of the questions left to answer? All of this is key to passing.
I would suggest studying the test questions over and over and over and over, until you can spot a diagnosis in your sleep. You should be able to recognize key words in the case and have an idea of what is to be expected BEFORE you get to the multiple choice answers.
The step 3 exam tests you on commonly known diseases that you should recognize, if given common symptoms and signs. Period.
As stated on the USMLE webpage, topics in internal medicine are very important. Knowing all about the basics of medicine may be helpful in preparing for the exam: DM, CAD, UTI, impetigo, liver disease, common orthopaedic injuries, rheumatoid arthritis, osteoporosis, temporal arteritis, e.t.c.
I would recommend reviewing all of the common dermatological diseases we all saw in medical school. The Crush Step 3 text has good sections on psoriatic scars, rosacea, actinic keratosis, melanoma, pityriasis rosea (christmas tree rash), and so on...
I used Q-bank and Crush Step 3 seriously. I reviewed and reviewed the test questions until I could sense the theme of each question.
I did not review the incorrect answers in Q-book, as I only wanted to concentrate on the correct answers. I did not find memorizing the incorrect answers to each question helpful, but rather confusing. Also, it was extremely time-consuming to do so. I studied in a way where I could read a case, know what was going on and arrive at the correct answer in the time allowed.
I found that the most recent edition of crush step three had at least 30%+ of the material directly on the boards. It is a must.
For outline reading, I used Strong Medicine and First Aid. They were helpful for the CCS cases. However, the outline format of Strong Medicine was difficult for me to follow. I preferred the style of the Crush Step 3 and Q-bank texts.
I bought a test CD off EBay and practised test-taking every day. I timed myself over and over until I could finish the exam on time or with minutes to spare.
I also practised the sample USMLE CD that came with the examination ticket too many times to count for the CCS section. I became VERY familar with the computer software and developed a strategy to answer the CCS cases.
This paid off, as I truly believe I aced the CCS section. The cases ended exactly when they should have - after making the diagnosis and treating the patient completely.
CCS counts for 25% of your score. As the Crush book states, no matter how well you do on the multiple choice questions, if you are not prepared for the CCS cases, you will do poorly, perhaps not pass.
The CCS cases were my ticket to pass. I nailed the diagnosis, and gilded the lily with lots of preventive medicine and counselling!!! Please don't forget the preventative medicine. They love that!
Give that mom a talk on using a car seat for her 2 year old. Educate that 18 year old college girl about safe sex and offer her a pap smear! Tell that 60 year old COPDer to quit smoking. Believe me, it helps!
I wish all of you guys the best of luck and know you will all do well with time and perseverance. I studied for two months with lots of distractors about 10 hours a day.
I did not want a super score, I just wanted to pass so I could move on with my life. And.... yes indeed, I am happy! :0) May God Bless You!
Edited by dontgiveup! on 07/18/06 - 10:52 AM
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| Budlight
Forum Senior
Topics: 9
Posts: 92
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hi Dont Give up!
Congratulations, and thanks for sharing all of that info! i am currently following your advice,
Did you do the NBME and what did you get on it? and what did you get on the Kaplan q book questions.
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| infliximab
Forum Guru
Topics: 22
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CONGRATS
GREAT POST
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| LisaM
Forum Guru
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Dontgiveup, Congratulations and thank you for sharing the details of your preparation and exam. Helpful as it is, you may want to edit the actual CCS cases that you got in you exam from the post as I am pretty sure it is not ok to reveal actual exam questions.
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| dontgiveup!
Forum Newbie
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Hi Budlight!
I did not use the NBME text to study. I followed the advice of others who passed the exam and only concentrated on 2 good, solid review books. Strong Medicine and First Aid were outlines, for most of the information in those texts were covered in great deal in the Q-book and mentioned in Crush Step 3.
I used Crush Step 3 to define my weaknesses and then used regular, standard texts from medical school, such as the Harrison text for IM, and similar Paeds, Ob/Gyn books to focus on the key concepts that I had either missed or did not understand. I did not read from cover to cover. I only reviewed the concepts that I had missed upon test-taking.
For example, I did not remember all of the common heart murmurs, which is in a big chart in the Crush Book. So, I reviewed Harrisons and a Physical Diagnosis text to learn/better understand the different heart sounds, where to listen for them and so on.
I noticed that in all of the the MCQs from several study sources, all of the COPD and CAD patient cases provided information about the heart sounds and lung sounds more than anything else. There was no mention of a barrel-chest, no radiograph, only the key points of the physical exam.
Whether it is an S3 gallop, a decrescendo murmour in the axilla, or a split S2 proved to be very important and useful, for there are cases where specific heart sounds are pathnogmonic:
Example #1
1) Turner's syndrome - There may be no mention of the wide-spaced nipples, the webbed neck or the short stature. Only, what is the most likely cardiac murmour? Use good study guides. This was well-reviewed in both of the study texts I used.
Example #2
2) Bacterial endocarditis - You may not see a mention of Roth spots or Janeway lesions. Instead, knowing the key words in other terms, such as "cotton wool exudates" and "firm, nontender lesions on the soles", may be helpful.
Learning key words as you study is the ticket. Otherwise, you can easily look over these hints, think about something else and miss what would seem to be a common, straightforward disease.
When I first started studying, I scored between 44-48% on the Q-book tests. After a lot of reviewing of the concepts, key signs and symptoms for common diseases - including what lab findings would be expected, what EKG changes would be most likely, ABG gases e.t.c., I missed about 7-9 from each 50 question set in Q book. I was able to take the 50 question test is just about the right amount of time, sometimes with a minute or two left.
This did not come overnight, for I had to learn how to focus on the questions, how to recognise key hints/buzz words and allow myself sufficient time to do so. Towards the end of my study time, say about 2 weeks from my test date, I started taking the test for real.
For example, I would do four sets of the Q-book exams and I started using the sample USMLE test CD that I got off Ebay. After each testing session, I checked my time and focusing strategy.
From the very beginning, I tested everyday, at least one 50 block question set from Q-book daily. Then, I reviewed the set later in the evening, the next day and continued until I could easily spot the birdie--- oh, here comes another COPD exacerbation or oh, here comes another case of pulmonary embolus.
Balancing your time is one of the keys to passing. You cannot mark the correct answer, no matter how much medicine you know, if your mind is stressing about how many questions you have left and how little time you have. I would highly recommend putting a lot of time into pacing yourself.
Then, when you arrive at the exam, a good part of the stress is reduced, for you have practised and are ready for the time clock to begin ticking away.
Guys, a lot of the test is still fresh in my mind since I just recently took it. I am happy to help all of you as much as I can, for I want to see you as happy as I am to move on. If you have any more questions, just ask!
From one great doctor to another - helpful medicine!
Best!
Edited by dontgiveup! on 07/18/06 - 10:33 AM
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| dontgiveup!
Forum Newbie
Topics: 1
Posts: 6
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LisaM wrote:
Dontgiveup, Congratulations and thank you for sharing the details of your preparation and exam. Helpful as it is, you may want to edit the actual CCS cases that you got in you exam from the post as I am pretty sure it is not ok to reveal actual exam questions.
Thanks Lisa:
It's done!
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| Budlight
Forum Senior
Topics: 9
Posts: 92
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Hi Dontgiveup,
I have one more question. Is there negative marking on the CCS for ordering too many tests or the wrong tests?
will there be points taken out for mistakes?
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| dontgiveup!
Forum Newbie
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Budlight wrote:
Hi Dontgiveup,
I have one more question. Is there negative marking on the CCS for ordering too many tests or the wrong tests?
will there be points taken out for mistakes?
Hi Budlight!
The CCS cases are all about management. There are hundreds of different ways to treat an illness. If you just remember not to harm the patient and keep the cost of medical treatment as low as possible, you should do fine.
You are penalised if you order tests that are harmful or hurtful to the patient. You also lose points if you order tests that are costly or offer a high risk, given the clinical situation.
I would suggest pulling out the sample CCS CD that came with your USMLE registration ticket. Go to the CCS section and print out the feedback page of each of the cases.
The USMLE people have provided a good guide on what you should have ordered and what will cause you to score high and low. I printed out this feedback and found it very useful in understanding what they wanted. It was also useful for helping me develop a consistent stragety for the CCS sections.
Make sure you do the CCS on the USMLE sample CD often so that you are EXTREMELY familar with how to advance the clock to get results, move the patient, order tests and drugs and other things.
Lastly, make certain you know how to discontinue your orders. This may sound mickey mouse, but you may encounter a patient that needs heparin, followed by long term anti-coagulation.
So, you admit your patient to the hospital, start IV heparin and warfarin and check his PTT and INR as expected. On day #4, you notice his INR is a nice therapeutic 2.5. So, you want to continue the warfarin and stop the IV heparin and Q6h PTTs.
If you do not know how to stop the IV heparin and cancel the lab tests, the USMLE people may interpret this as you treating the patient with both heparin and coumadin when the patient's INR is therapeutic.
We all know the outcome of supertherapeutic INRs.... See what I mean? You would definitely lose points for something like that.
Practise, practise, practise the sample CCS cases on the CD man, and you should do fine. Make sure you can do the CCS cases well.
A signal of how well you are doing on the sample CCS cases is evidenced by how and when the case closes. If you follow the feedback tips that came with the sample CCS cases and enter the tests and orders that the USMLE people have indicated are good management, you will see that the CCS case will end as soon as you have done so.
Once you have satisifed the basics of patient care - stabilising the patient and treating the patient's problem, the case will usually end. I found this consistently every time I practised those sample CCS cases.
I played around with it and entered the tests in different names, drugs in different names, e.t.c. No matter how many times I tired, as soon as that sample patient with abdominal pain was given an stool exam for Giardia antigen and metronidazole, the case ended. I even gave the patient an anti-diarhorrea medicine, acetaminophen, oral hydration and lots of other stuff before that.
Still, irregardless, the case only ended after he was given the first two pearls - Stool exam for Giardia antigen and good ole metronidazole. However, on the real exam, things may certainly be different. Each person's test may be different, including the CCS sections.
Don't forget the preventative medicine!! Order some counselling for that guy. In this case, metronidazole has a serious side effect in some people that is similar to drinking alcohol when on anti-abuse medicine.
Make sure to order: "counselling on side-effect of medication"....
Good Luck, Man!
Dontgiveup!
Edited by dontgiveup! on 07/20/06 - 12:38 PM
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| Budlight
Forum Senior
Topics: 9
Posts: 92
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Thanks a lot Dont give up. I would have ordered more tests than necessary but now i will be careful about the aftereffects of testing.
Thank you for helping me.
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| dontgiveup!
Forum Newbie
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Budlight wrote:
Thanks a lot Dont give up. I would have ordered more tests than necessary but now i will be careful about the aftereffects of testing.
Thank you for helping me.
Best of Luck to you Budlight and Everyone Else on the Running Path!
I'm outta here and movin' on to better things.
Good Luck and Dontgiveup!
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| kj72patel
Forum Newbie
Topics: 0
Posts: 2
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hey do you wanna help me?
i took this exam before did not make it. 71
i am doing kaplan q book, q bank, uw, step 2, step 3 notes
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| dontgiveup!
Forum Newbie
Topics: 1
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kj72patel wrote:
hey do you wanna help me?
i took this exam before did not make it. 71
i am doing kaplan q book, q bank, uw, step 2, step 3 notes
Hi K72patel:
That sounds good man, but make certain you do practise questions over and over and over and over until you can answer the question in the allotted amount of time. I cannot over emphasize this, since most of the stuff we are tested on are common medical problems.
The USMLE people HAVE TO GIVE YOU well known signs and symptoms of the disease since you cannot see the patient. So, being able to identify these "key words" and "buzz words" is clue.
Also, don't forget the usefulness of the Crush Step III text. It had so much of the USMLE material on the exam that is was not funny... Make sure you know that text cold, as it is extremely high yield.
Once again, do practise test questions from any source you want. Practising test questions is one of the keys to success. Good Luck man. I know you will do fine.
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| karusmle
Forum Guru
Topics: 292
Posts: 986
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dontgiveup,
where can i get this crush step 3 ?i m in US now, how long will it take approximately if i order it online??
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| iamjee
Forum Senior
Topics: 7
Posts: 75
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Passed. Not entirely satisfied with my score. But a few important points I felt were worthwhile mentioning.
First things first- complete your blocks. I could not complete 2 blocks- left around 6 questions unattempted in compos mentis.Thats criminal.This is especially possible on day 2 when you are fatigued and want to get on with CCS and finish the exam.Especially because I had an afternoon block on day 1 and morning block on day 2.Thats the worst possible combo.Dont get caught up on questions you could possibly have no clue about.Focus on getting to the end of the block.
Weak links: Ambulatory med- have no real source for reading on this. But in retropspect felt that Swanson might have helped (for this topic only- otherwise not a great book if you are short of time); ethics- everyone's graveyard. Read up UW website, other sources that you may have, guess, pray,pick your lucky number....thats about all you can do I guess; behavioural and emotional( thats mentioned as a category I was judged on the backside of the score sheet); ER- what you do next questions might be a bit tricky when every answer seems possibly true- use ABC rules in that order.
Dont take it easy right upto the end of the exam.Get a good night's sleep before day 2.
CCS is really the scoring section. Its fun if you have practised the FSMB CD enough.There might be an ocassional glitch done such as patient not being moved from ER for a week by you or investigations not yielding results expected.But if you manage to reach case end before 20 mins then you have accomplished the objectives of the case. So if you see that screen before 20 mins its heartening.This might only mean initial stabilisation or symptomatic therapy in some cases.But thats waht they want.I did not do the UW CCS-so cant really correlate.
As far as correlation between UW scores and the real test goes, dont let yourself get into a false sense of security if you are yet to take the exam.Dont add 20 to your UW scores and bve content with that. Questions are similar in pattern but content is almost non overlapping.This said, still UW is the best prep for the Step 3.There might be such correlations maybe, but testing circumstance is far more tiring on the actual exam and fatigue factor does count when you are doing blocks rat-a-tat without taking time and reflecting on elapsed block.
Do keep yourself informed -if you have time of course-the hottest topics on JAMA or AIM. I was asked about HPV vaccine and BRCA testing, treatment of hyperthermia( last yrs heatwave), new changes to the CPR chest comp to vent ratio, recombinant factor seven, best protocol for PMTCT in HIV positive pregnancy among others.
Keep a cool head, enjoy the exam as much as you have tensed yourself preparing for it.Remember stress has a bell shaped curve with performance.All the best.
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| drk1980
Forum Guru
Topics: 147
Posts: 1,038
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thanks! very useful advice in this thread....
iamjee, during your prep which material did you use for CCS?
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| iamjee
Forum Senior
Topics: 7
Posts: 75
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DRK hi....(funny I had a teacher by we call by those initials.) I used UW and Kaplan step 2 notes.A little bit of Swanson. Skimmed through FA.Scored around 63-70% on UW.
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| iamjee
Forum Senior
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Oops I misread your Q.....CCS- the CD. UW was a bit of a disappointment as I thought I would get a similar software to practise.But its the best of what you have I guess.Should be able to finish CCS in 3-4 days even if you sit and ponder about each scenario and possible goof ups.
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| veterana
Forum Junior
Topics: 9
Posts: 31
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Thanks for sharing your experience! Are there brand names for drugs in the exam? How much doses we need to study?
Thanks for your help!
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