Step 3 write-up from a not prepared PGY-2 + the exam secret that saved me on CCS!
After I posted my Step 3 score/experience, my inbox got flooded.
I’m guessing mainly because people could tell from my original post that I was not one of those “finished all of UWorld twice + every NBME + 100 CCS cases” people. I’ll be honest..I did not prep much. Residency, life, kids, exhaustion, excuses, whatever you want to call it. This was not some beautiful dedicated study arc. My goal was basically pass and never think about this exam again.
Anyways, instead of replying to everyone one by one, I made this post. Here’s my breakdown:
US-IMG
Step 1: Pass
Step 2: 246
Step 3: 224
Day 1: Weird. Just weird.
Lots of biostats, ethics, drug MOAs, random associations you haven’t thought about in forever, and“why are they asking about THIS?”
Didn’t feel amazing. Didn’t feel terrible. Just mentally cooked.
Day 2: Felt more clinically intuitive. But CCS is what everyone keeps asking about, so here’s the truth. CCSCases.com is honestly a very good mimic. The interface, order system, flow, close enough that if you practiced there, you won’t be lost.
That matters way more than people think.
The 10-minute cases are way more difficult than the 20-minute ones. No breathing room.
CCS advice that will save you 1-2 minutes on the 10m cases (this saved me)
Before Day 2 cases start, during tutorial create a list of all the orders you will need in your cases. There are many posts with generic/template order lists. Learn them and jot them down on the scratchpad first during tutorial (or during a break) to prevent the off-chance that you may blank out on orders during the actual cases.
Then during the first CCS case, quickly type the giant generic order set (even the orders you won't need for that case). Type keywords (as if you're googling) so that multiple orders appear in the same menu (for example: try to type "culture" instead of "urine" so you can click urine and blood culture if needed, or vaccine instead of Tdap or varicella, etc) Practice doing this on CCS cases and then curate your list in the way you will rememeber it.
Then CTRL+C the entire list. Yes, copy/paste works.
For every future case: CTRL+V that "masterlist" of orders and then delete what you don’t need and add case-specific orders. This trick saved me about 2 minutes on the 10m cases, which makes a huge difference.
Obviously, never leave an invasive order on this list by accident.
Broad harmless labs? Fine.
But don’t put intubation, biopsy, surgery, invasive procedures on this masterlist.
Some other random tips are:
Get every PE for every patient. Advance your orders one day at a time. Quickly. Any pertinent negative/positives? Stop and assess if patient location needs to change!
This deserves another line: Again do not forget to decide on a location as soon as your first location-determining order result comes back.
You will probably accumulate break time after each 20 minute case (I think you'll have 5-8 minutes left which rollover into break). So feel free to use up your actual break time during the MCQ blocks, if needed.
You will be a little disoriented for the first few cases. Just know that everyone will have this same adjustment period which probably affects everyone's scores in a way. Don't let the first few case mistakes or confusion about the software get to you. By the end of the exam, I was basically just "pasting" my orders from what I had "copied", changing 2-3 things, and the case would end relatively quick with a diagnosed and workup all complete.
I believe that more intense studying would have increased my score, but not by a large chunk. Most of my answers were coming from knowledge accumulated over time and more nuance clinical thinking. This means a good night's sleep may affect your score much more than an extra week or two of studying.
Lastly, do not be AFRAID of being stressed. I walked into the exam too calm and then realized I was working WAY too slow. I adjusted and timing became manageable, thanks to the "stress." So if you're feeling a bit jittery or nervous the day of, PERFECT, you'll need that for the initial boost.
Good luck!!
P.S. The new block format is much better than prior. For example, instead of realizing you need to pee 10 questions into a block, but needing to hold it in for 30 more questions, you can basically take a break after finishing just 10 more questions!