How to prepare for the CCS

Title	How to prepare for the CCS
Message Text	I had many basic questions about step 3 when I started out, especially the CCS part. I have put together some of those questions and answered them from my experience. 1. When is the CCS tested? Step 3 is a two day exam and CCS is tested on the second day. The first day, there are 7 blocks of MCQs with 48 questions each and second day 4 blocks of 36 questions each. After the MCQs, there are 9 CCS cases. 2. What are the questions like in Step 3? What materials are required for preparation? What duration is ideal? The questions on step 3 are similar to CK with the focus being more on management than on diagnosis. I think the materials used for CK alone are sufficient for Step 3 and if CK has been taken within 6 months to a year and the score aimed for is similar, then about 2 months of preparation with 6 hours per day must be enough. I used Kaplan materials and UW. I thought of buying Washington manual, Strong Medicine etc, but then decided against it as those are totally new text books for me and it would take considerable time to just go through them. 3. What is the CCS like? How to prepare for it? What are some tips and suggestions? How much time must be spent in preparing for this? How much does this count towards the Step 3 score? The CCS (Computer- based Case simulations) expects us to manage a typical case that we would encounter in the ER, office or wards. I used only UW cases and the USMLE CD. There are some practice softwares available that others have used and found useful. I had some breaks in my step 3 preparation. By the time I was ready to practice CCS, my UW subscrition had ran out and I only had the print out of the 60 cases to work with. If I had to do it over again, with the same material, this is what I would do: I would allot the last 15 days of Step 3 prep for CCS. First, it is good to be familiar with the CCS format and this is best done by solving the CCS cases from the USMLE CD. The first time, I did pretty badly and was extremely nervous as well. Then I read through the CCS cases from UW, taking 10 cases per day. It took me about two to 3 hours per day to to this. In 6 days, I had an idea of what kind of cases were on the exam and what kind of management was expected. Now I was ready to practice the same cases. I decided to open one of the non-emergent cases in the USMLE CD, and type out instructions like I would for the practice case scenario in UW. I was a little overwhelmed and found myself unable to think while trying to navigate through the software. Then a friend suggested that I try working out the cases on paper. This really helped me. I wrote the instructions on paper and found that I missed about 25% of the stuff suggested by UW. Again, I took 10 cases per day. After the first 30 cases, I was comfortable with my thinking process in approaching the cases, and I only had to master familiarity with the software. I worked the other 30 cases with the software. This time, I was quite comfortable and explored the different options in the software and was able to navigate quite easily. For each case, I wrote down whatever I missed on paper and revised this list before exams. I did feel that UW went a little overboard with investigations, but decided to learn it as such because I guess the fear of litigation and freely available resources compel us to do the same in the real world scenario here. The USMLE CD is very friendly for practice. It made me smile when I requested a pregnancy test on a man, and it noted that it can only be done on a female. At the end of my preparatin, I had practised all 60 cases in UW with the USMLE CD. I learnt what short cuts I was going to use and what were not so useful. For example, while "cbc" and "cxr" were great, when I typed "oxy" tons of options popped up. I found it easier to type "oxygen". I realized that some options are not available like "sliding scale insulin". After a while, I did not see the need to type out everything, but just what was new like "haptoglobin" "d-dimer" etc. I found the "virus" option useful too, as it helped me remember what I needed to request! Though the software has few thousand options, we only need to develop a limited vocabulary to work with. For example, we could counsel the patient to stop smoking by typing "stop smoking" or just type "counsel" and then find "Stop smoking". At first, I found it a little annoying that I was not able to counsel for more than one thing at a time, and what I had counselled for did not appear on the final screen. I guess small things like this can cause major anxiety if they have not been tried on the software first and a comfortable alternative way to work around it is found. Eventually, I decided to just type "counsel" and when the counsel options came up, selected one at a time and waited. I realized that it was useful to develop different strategies while working towards CCS. PACING AND APPROACH: TAKING NOTES FROM HISTORY: TO COMFORT, CONSULT AND COUNSEL: I have read that the CCS contributes to only about 20% of the final score on Step 3. That's all I can think of now. All the best!
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Ownership	LisaM
Tags	ccs
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Submission Date	Sep 24, 2006

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