A Clinical Shelf Exam Survival Guide

 

The countdown is officially on! With 5 of the 6 shelf exams under my belt, only one more shelf exam and 2 board exams stand between me and my 4th year of medical school. I decided to share what resources I used and tips for acing these shelf exams during my 3rd year.

My medical school requires we pass 6 NBME  clinical shelf exams during the course of our 3rd year; psychiatry, internal medicine, pediatrics, OBGYN, family medicine, and surgery. Other institutions require students to pass the neurology shelf, but that is not a requirement at my school.

NBME exams are scored differently depending on the medical school. My school requires that you score at least 2 standard deviations above the national mean score. Unlike other schools, my school doesn’t offer honors depending on how high you score, they are only concerned with a passing grade for the shelf. So if you are hoping to score above the 90th percentile on a shelf exam, take my advice as a “bare minimum” amount of studying to pass the exam and then supplement with other resources.

OVERVIEW

What is a Shelf Exam? Shelf Exams are standardized tests given to medical students across the United States at the end of clerkship to assess their competency in a single specialty.

What is the format of a shelf exam? Much like USMLE Step 1 and UWorld, the vignettes tend to be long, typically about a 1/2 page in length. Unlike USMLE Step 1, shelf exams may have matching style questions and multi-part questions.

How long do I have to complete a shelf exam? Most exams are 110 questions and you are given 2 hours and 45 minutes to complete the exam. An exception is the Family Medicine shelf which has a shorter version with 90 questions in 2 hours and 15 minutes.

How is the test administered? As these are national exams, the tests are only administered at authorized sites such as a Prometric Test Center or at your medical school.

GENERAL ADVICE

Regardless of which shelf you are preparing for, UWorld is the gold standard. Purchase a year long subscription to UWorld Step 2 CK question bank at the start of your 3rd year. Do the corresponding questions during each clerkship and you will have a good basic understanding of each specialty prior to taking the shelf exam.

Emma Holiday‘s clerkship review video’s by The University of Texas are a god send. These are 2 hour long videos that cover the most high yield topics for Internal Medicine, Psychiatry, Pediatrics, and Surgery. I would review the power point at the start of each clerkship and then I would watch the review video the week of my shelf exam. While this is a great resource, keep in mind that this is not a comprehensive resource. She will focus on the most high yield topics, but you have to do the work to understand the underlying pathology and physiology.

NBME Self Assessment Exams are available to purchase for $20 each. These retired shelf exams are a great way to practice with the format of the test and to become familiar with the style of questions. One benefit of purchasing a self-assessment is that they sometimes repeat questions on the current version of the shelf. Each specialty has 4 retired exams to choose from. My only complaint with the self assessment exams is that even though they are advertised as having “expanded feedback”, the feedback consists of a list of questions you got wrong. It does not provide you with the correct answer or an explanation of the question. Because of this, I don’t believe the self assessment exams are a good study resource, but rather a good practice for what to expect on test day.

Online Med Ed is a favorite resource of mine for many reasons. For one, it is absolutely free to use many of the features.  Online Med Ed is a databank of videos for each specialty. Simply create an account and you have access to all of their videos which range between 10-40 minutes and focus on specific topics per specialty. If you really love Online Med Ed, you can pay for a subscription which allows you to view notes and audio files for the video, but the free account is a sufficient resource for shelf exams.  While Online Med Ed may not be comprehensive enough to prepare for Step 2 board exams, it is an excellent overview for shelf exams. Also, did I mention it is FREE??

 

Although I didn’t use either, series such as Case Files and Pre Tests are excellent supplemental books for each clerkship. Case Files books are available to be purchased for each specialty. Each book has real life cases and board style review questions that teach the most pertinent findings per specialty. If its any consolation, many of my classmates swear by the Case Files series. The Pre Test series is also available for each specialty and features USMLE style questions with in depth explanations of the answers. Although not as popular as Case Files (at least among my classmates) I have never heard anything negative about the Pre Test series and it seems to be a sufficient clerkship prep book.

 

Psychiatry Shelf 

First Aid for the Psychiatry Clerkship is spot on for this rotation. This book was easy to read and highlighted all the critical information needed to do well on the test. While the newest edition (4th) is not necessary, it has been updated to reflect the changes in DSM V.

The exam itself was very straightforward. My #1 recommendation is to focus on adverse affects of psych pharmacology. Memorize the big side effects for each drug class. Yes, I know there are a lot of them, but honestly medication questions accounted for a large majority of the exam. Be sure to be comfortable differentiating between toxic syndromes (NMS vs serotinin syndrome, etc). Also be comfortable with the defense mechanisms and differences between malingering vs. factious disorder vs. somatization vs conversion disorder.

If you are aiming for >90th percentile, take time to study medical disorders that can result in psychological disturbances (Think hepatic encephalopathy, Huntington’s Disease, DKA, meningitis, etc.). While it wasn’t heavily tested, I want to say that I had between 3-4 questions that pertained to neurologic conditions instead of psych disturbances.

 

 

Internal Medicine Shelf

Studying for the IM shelf felt like I was preparing for boards all over again. It seemed like there was so much to learn for such a small exam.

My main resource for this exam was Step Up to Medicine. The book was very wordy and long-winded but it does provide a thorough overview of the most high yield topics in internal medicine. I annotated my copy of SUM while watching the Online Med Ed video series. While I was unable to finish reading the entirety of SUM during my IM clerkship, I felt well prepared for my shelf exam.

I carried Pocket Medicine with me while in the hospital and would study each case i saw on the wards. This book is a quick study reference and its small size makes it a perfect book to tote around in your white coat.

OBGYN Shelf

I cannot express enough how great Blueprints for OBGYN was for this shelf exam! I have never read any of the other books in the Blueprint series, but after hearing that OBGYN was one of the more difficult exams I wanted a thorough resource to use to prepare for the test. I was fortunate that my OBGYN rotation was not very busy and I had plenty of time to read the book. I imagine if you were on a busier OBGYN service Blueprints would be way too time consuming to finish in 4 weeks. If you find yourself strapped for time while preparing for the shelf, either read the summary page at the end of each chapter or pick an alternate resource like Case Files.

To supplement the UWorld OBGYN questions, many students used UWise. To access this question bank, create an account on APGO using your institution email address (.edu). Before creating an account with UWise, check if your school has purchased UWise subscriptions because otherwise it can get pretty spendy if you are buying it for yourself ($175 for 3 months of access).

Focus on gynecology for the shelf. It seemed a large amount of my questions focused on urogynecology so make sure you understand the difference in diagnosis and treatment of the various types of incontinence. Also Be aware of diagnosis and treatment of the most common STIs.

Pediatrics Shelf

I believe my Pediatrics Shelf was by far the most difficult exam I have taken all year. I felt the exam covered a broad variety of conditions and it was hard to pinpoint what I could’ve focused on to do better on the exam. With that being said, I took this rotation over Christmas and New Years so my study habits weren’t the most robust during this time.

Truthfully, the only resources I used to prepare for this exam was UWorld and Online Med Ed. Additionally I watched the Emma Holiday pediatric’s video which covered many high yield topics but fell short on pediatric nephrology.

I would recommend focusing on TORCH infections, congenital heart defects, and preventative medicine. Do not waste your time memorizing vaccination schedules or developmental milestones for this exam. While there will be some questions on these topics, unless you have a stellar memory, don’t waste your time learning these tables as they are relatively low yield. The “Well Child” video from Online Med Ed gives a great overview of developmental milestones which should be sufficient for the shelf exam.

 

Family Medicine Shelf 

This shelf exam was a hodge podge of topics, but I felt the test was relatively straightforward. I had my Family Medicine shelf after my Internal Medicine clerkship and I think that helped a lot. If at all possible, try to take this shelf exam later in your 3rd year after being exposed to a wide variety of medicine.

There are no UWorld questions specific for Family Medicine.I would recommend using your .edu email address to create an account with AAFP. Under the medical student tab there are 200 10 question quizzes that test on a broad range of Family Medicine topics. Each question has a detailed explanation. While the AAFP questions have good content, the style of questions are much shorter vignettes than that of the shelf. For any DO students out there, Combank does offer a “Family Medicine” set of questions in the Level 2 question bank.

I would recommend focusing on preventative medicine. Reviewing the AAFP guidelines are sufficient for this exam. I also recommend reading the Step Up to Medicine ambulatory medicine chapter and the preventative medicine chapter in Step 2 Secrets.

 

Surgery Shelf

As I am only taking this shelf in 3 weeks (wish me luck!) I can’t say with 100% certainty that these resources are sufficient for the shelf exam as I have not taken it yet.

I have heard that this test is heavy on Internal Medicine, so if you can choose when to take your exam try to schedule surgery and IM close together. The surgery shelf mainly tests if surgery is indicated but it does not focus on procedures or techniques.

To study, I have watched the Online Med Ed videos and I have completed both the Combank and UWorld surgery question sets. I have read the relevant chapters in Step 2 Secretes (General Surgery, Vascular Surgery, Orthopedic Surgery, etc.). I plan on reading through Pestana twice prior to taking my exam.

Surgical Recall is a good reference to read prior to the start of your surgical clerkship. It has the answers to many of the questions your surgeon might pimp you on, but it is not the best resource to use to prepare for the shelf exam.

Other resources that are useful to prepare for the exam are NMS Surgery Casebook and De Virgilio. I have heard excellent things about De Virgilio’s book, and I think it is a great resource if you are planning on pursuing a surgical specialty. With that being said, the biggest mistake a medical student could make is being bogged down with too many resources. Stick to Pestana and UWorld, and if you have time only then should you supplement your knowledge with an additional textbook.

 

Thanks for reading! I’d love to hear what good resources are out there and what worked for you when preparing for your shelf exams!


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