Thursday, October 22, 2020

USMLE Step 3 experience (247 score)

Overview
Ø  Score: 247
Ø  Preparation time: 1.5 months
Ø  Main Resources: Step 3 UW + UW CCS Cases + CCScases.com
Ø  Supplemental Resources: Step 1 First Aid + Crush CCS pdf + USMLE Primum software + Random overview of few Step 2 CK notes

Assessments

Ø  NBME 5: 540 (4 weeks before day 1)
Ø  UWSA 1: 229 (2 weeks before day 1)
Ø  UWSA 2: 247 (1 week before day 1)
Ø  FRED FIP: 81%, 79%
Ø  FRED ACM: 77%, 77%
Ø  UW 1st pass: 78%

Prep division:

1.       Started with Step 3 UW:
1600 questions in all.
I studied it system-wise, in timed mode.
Advisable to do in the timed mode as sometimes in the real deal, the questions can be long.
System wise because UW is a learning tool, and consolidating every system together helped me a lot.

2.       While solving UW questions, I kept referring to Step 2 CK notes. 
Initially, I used to solve 40 questions a day, then went to 60/day

3.       CCS Cases (after UW 1st pass)

🔴Go to usmle.org
Watch the video
Watch the animation

🔴Download the premium software
Practice the 6 cases

🔴Read crush ccs step 3 pdf about how to actually handle the 6 cases and the 6 subcategories in which we are scored.

🔴Read 5 practice cases from UW, so that you understand how things are to be done

🔴Practice 5 interactive cases from UW to get an idea
All this can be done in 1-2 days!

🔴Then, once you feel a tad bit confident, practice cases on ccscases.com
They give you feedback with % (which is missing from UW). (Aim for >80%)
So, you know what you're doing wrong.
You can practice the same case multiple times to get a hang of it.

🔴After doing 50/101 cases from ccscases.com, do 20 interactive cases from UW.
The way UW distributes scores is slightly different and it is good to know both software.
Aim for 15-20 cases a day.
So in one week, you'll be super confident.

🔴And then I'm hoping you can

1. Practice remaining cases from UW and ccs cases for more exposure,

2. Redo cases from ccs cases

3. Read UW practice cases

4. Read crush ccs pdf
Between day 1 and day 2 for more confidence.

4.       1-2 weeks before the exam
·         Do the marked questions from UW as your 2nd pass
·         Solve random questions from Amboss for more practice. Choose to include step 1 and Step 2 CK style questions as well, especially for immunology, microbiology, a few topics from pharmacology, and few topics from biochemistry.
·         Read Step 1 First Aid (Just the basic topics, not in detail)
·         Do UW biostatistics review (It’s fun. Shouldn’t take more than a few hours)

5.       CCS Sheet for orders
I did not use this in the test, as I liked to go with my intuition as to which tests to order. However, during practice, I had made a list of tests that I kept in mind later on!

·         Emergency Orders
-Cardiac Monitor
-ECG
-Type ‘oxygen’ and select both ‘pulse oximetry’ and ‘oxygen therapy’
-BP monitor
-Type ‘iva’ and ‘NSS’ (for IV access and NS)
-cervical collar if trauma

·         Physical Exam

·         Other important orders
-x-ray/ CXR/ x-ray abdomen for acute condition
-Pericardiocentesis or needle thoracostomy etc (all emergency treatments)
-FAST if trauma

·         Basic tests
-CBC
-BMP
-LFT (CMP = BMP + LFT)
-Urine analysis
-ESR/CRP
-TSH
-Lipid panel
-Accucheck (for glucose)

·         Cultures: blood/ urine/ wound/ tampon/ csf/ sputum etc

·         If you do synovial fluid aspiration, also place separate orders for synovial fluid gram stain, culture, gonococcal antigen, crystals, cell count, etc

·         If you suspect STD, don’t forget to rule out other STDs (HIV, Hepatitis panel, VDRL, Chlamydia, Gonorrhea)

·         In a woman of reproductive age, don’t forget: Beta HCG

·         In a pregnant woman, don’t forget: NST and fetal cardiac doppler

·         Pre-op Orders
-NPO
-Ptt/pt
-Cephazoline
-“type and cross match”
-ECG

·         When you transfer a patient to the ward
A: Ambulatory
B: Bed rest
C: Stress ulcer prophylaxis (PPI)
D: Diet (diabetic, low salt, NPO)
D: DVT prophylaxis (LMWH, compression stockings)
E: Elevate head end of the bed
F: Foley and “urine output”
G: Gastric tube if needed

Written by Amrin Kharawala

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