A Complete Guide On How To Study For Shelf Exams

Are you gearing up for your upcoming shelf exams and wondering, how long are shelf exams? Worry not! Whether you're a medical student or a professional needing a refresher, acing these exams is crucial. Our blog will not only answer your questions about shelf exams but also provide you with the necessary strategies and tips to enhance your study tactics. Find all the details about shelf exams and implement effective strategies to study and ace your shelf exams.

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Table of Contents

• What Is Self Exams

• What Is Tested On The Shelf Exams?

• How Difficult Are Shelf Exams?

• How To Study For Shelf Exams

• Are Shelf Exams Mandatory?

• How Do Students Decide The Order Of Rotations?

• Why Take The Shelf Exams?

• Resources For Improving Your Self Exam Score

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What Is Self Exams

The concept of shelf exams resonates with medical school students across the nation. These exams provide a common ground for schools to assess students’ medical knowledge and compare their performance with peers nationwide. The National Board of Medical Examiners (NBME) offers a range of Shelf exams covering various topics from basic sciences to advanced clinical areas like Internal Medicine and Emergency Medicine. These exams consist of questions derived from expired USMLE Step 1 and Step 2 CK exams, offering a comprehensive evaluation of medical students’ knowledge.

What to Expect in Shelf Exams: A Deep Dive

As the name suggests, shelf exams cover a wide array of medical topics. Students are presented with 110 multiple-choice questions based on diverse hypothetical clinical scenarios. These exams delve into areas such as heart failure, diabetes, cancer, liver disease, movement disorders, multiple sclerosis, and various other medical conditions. Given the broad scope of topics and the need to apply knowledge to clinical situations, Shelf exams are often perceived as challenging and require extensive preparation.

The Importance of Shelf Exam Scores

While not all medical schools consider Shelf exam scores while grading clerkships, these scores can be crucial in determining a student's acceptance at a residency program. A strong performance in Shelf exams reflects positively on a student's application through their Dean's Letter, showcasing their composite rotation performance. As a result, excelling in Shelf exams becomes a critical aspect of a medical student's journey towards a successful residency placement.

Shelf exams are integral to medical education, serving as a benchmark for students to gauge their medical knowledge against national standards. By understanding Shelf exams' structure, content, and significance, medical students can optimize their preparation strategies and enhance their chances of excelling in these standardized assessments.

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What Is Tested On The Shelf Exams?

In contrast to the questions on the United States Medical Licensing Exam (USMLE) Step 1, shelf exams focus much more on the care of patients, including how to diagnose and treat diseases. You should expect to be tested on identifying the next steps in management, utilizing appropriate and cost-effective diagnostic tests, and selecting the correct pharmacotherapy.

In general, the questions reflect the USMLE Step 2 CK. Many have likened Step 2 CK to a sampling of questions from all the shelf exams consolidated into one test.

Topics on a Shelf Exam

Intuitively, the content of each exam will relate to the field of medicine or surgery you just did a rotation in. For more specific details, the NBME publishes a content outline online that provides a breakdown of the different items tested on each exam. For example, the internal medicine shelf exam outline can be found here.

It’s important to understand that material can overlap across multiple shelf exams. An important example is the surgical shelf exam, which tends to focus less on procedures or techniques and more on the medical management of surgical patients (e.g., diagnosing postoperative fever or recognizing peritonitis).

Other examples include concepts at the intersection of neurology and psychiatry or internal medicine and pediatrics. This means that, while earlier shelf exams may be inherently more challenging, shelf exams become easier as you see recurring concepts across specialties.

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How Difficult Are Shelf Exams?

Shelf exams are not easy. The exams cover all seven medical school rotations, which means you must know a lot of information to pass them. As you can guess, these exams require you to memorize a lot of information. Then, you have to use this information to solve hypothetical problems. One way to assess how hard these exams are is to look at your scores on the USMLE Step 1 exam.

How To Study For Shelf Exams

1. Establish a Schedule Early On and Stick to It

Establishing a schedule early in your clerkship year is essential for success on the shelf exams. Even though you will be spending most of your time in a clinical setting, maintaining effective study habits is crucial. 

This is not only helpful for your shelf exams but also for USMLE Step 2, as it covers much of the clinical knowledge you will acquire during your core rotations. It is understandable that you will be tired after long hours in the wards. It is tempting to just come home, change out of your scrubs, eat, and watch Netflix. Avoid falling into this pattern, as it will leave you unprepared during the week of your rotation.

2. Get a calendar and count up how many days you have until the shelf exam

At the beginning of each rotation, identify the resources you want to use for studying. Calculate the number of pages to read and the number of questions by the days available for studying. This structured schedule and daily goal will help you space out the material to cover and the practice questions you must complete and review. Being fully prepared when it's time to take your shelf exam at the end of each rotation is key.

3. Take at least one NBME for each rotation

It is recommended to take an NBME practice test 1-2 weeks before taking the shelf exam. This will put you in test-taking mode, provide more material to review, and help you identify topic-area weaknesses.

4. Make studying a daily habit

Creating a schedule and adhering to it will help you avoid last-minute cramming and unnecessary stress and anxiety. Study every day for a set amount of time and chip away at your goal as much as possible, even if you can't hit your plan on a particular day. One solid hour of studying is better than none. Cultivate a daily study habit and establish a routine throughout your clerkship year.

5. Take Good Notes

Ensuring you have high-quality study materials is key to your success. Passive note-taking can lead to passively reviewing subject material, which doesn't help cement knowledge. Active learning and taking useful notes are essential for effective studying. The Cornell note-taking method can be helpful, involving dividing your notebook into three columns for key information, cues/questions, and summaries.

6. Use Study Guides and Resources

Utilize online study guides that focus specifically on the shelf exam. Many med students have utilized these resources, and you can benefit from them too.

7. Break Concepts Down

Divide and conquer the vast amount of information you need to learn. Break concepts down by subject and discipline to manage the memorization chaos. Organize your notes by separating them into categories like cardiovascular, digestive, and respiratory. 

Categorizing and organizing your notes will help you better recall the information and reduce the overwhelming feeling of memorization.That more than half the questions on your internal medicine shelf exam are likely to cover cardiovascular, respiratory, digestive, and endocrine systems, so prioritize studying these areas.

Are Shelf Exams Mandatory?

Not all medical programs make students take the Shelf exams, but most do. These tests are an important way to see if students get what they need to know in clinical rotations. Some schools make students pass these exams to graduate, and some programs take the scores into account in figuring out if a student passed the clerkships.

Shelf exam scores are not needed to apply for residency programs, and the programs won’t see the results. But, the scores could affect the student’s overall grade for the clerkship. If a student gets a fail, the exam will have to be taken again, and the term ‘Conditional Pass’ or ‘Conditional High Pass’ will show on the student’s transcript. A fail could affect the MSPE at the end of the rotation. A program could use the final clerkship grade to make a decision on whether to let a student in or not.

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How Do Students Decide The Order Of Rotations?

Each shelf exam is one to one with the rotation itself, so scheduling is super specific to the medical school. Depending on your school, you may be able to decide the order of rotations, or you may not. Some schools allow students to pick their rotation order, some schools try to accommodate requests but aren’t always able to, and other schools randomly assign rotation order.

Shelf Exam Timing During Core Rotations

Core rotations typically last 6-12 weeks. Unlike Step 1 and Step 2, where you can choose the day, you can’t necessarily choose the date of your shelf exam, as if you’re on the rotation, you will be expected to complete the exam at the end of it.

Shelf Exam Timing During Core Rotations

This poses a challenge to students who do not plan ahead or adequately prepare, as you can’t delay your test. That said, some schools operate on a pass/fail system, so your exact grade may not matter so much. Some schools implement a non-grading system to encourage students to focus on the hands-on elements of the rotation itself, rather than being distracted by a strict and strenuous study schedule.

Why Take The Shelf Exams?

Clerkship Grades

Your shelf exam score is used to calculate your grade for each clerkship. Depending on how your medical school determines final grades for each clerkship, how well you do on the shelf exam can significantly impact your final grade. 

For example, if your medical school does something like 60% clinical performance and 40% shelf exam score, then how well you do on the exam can have a notable impact on your final grade. Your shelf exam performance is the most objective control you have over your final clerkship grade since there are many subjective variables to how attendings and residents evaluate your clinical performance on each rotation.

Step 2 CK Preparation

The more diligently you study for shelf exams, the better off you’ll be when you sit down to prepare for Step 2 CK. The material covered during clinical rotations and shelf exam prep is the same material you must master for Step 2 CK. The studying you do for your shelf exams will pay off big time when you start to prep for Step 2 CK. 

Shelf exam prep and Step 2 CK prep are so interconnected that we recommend you use UWorld’s Step 2 CK question bank throughout your clerkship year to prepare for each shelf exam.

Resources For Improving Your Self Exam Score

1. Internal Medicine: “Step-Up to Medicine” and OnlineMedEd

Step-Up to Medicine is an excellent resource for internal medicine, offering high-yield information that is crucial for the exam. 

OnlineMedEd, a widely used resource among medical students, also provides video lectures and notes specifically geared towards preparing for the internal medicine shelf exam.

2. Surgery: “Dr. Pestana’s Surgery Notes” and “Surgical Recall”

For the surgery shelf exam, Dr. Pestana’s Surgery Notes is a must-read resource. It concisely outlines key surgical conditions and their management.

Surgical Recall offers a question and answer format to help solidify important surgical concepts.

3. Pediatrics: “Blueprints Pediatrics” and “Case Files Pediatrics”

Blueprints Pediatrics is a comprehensive review book that covers major topics in pediatrics in a logical and organized manner. 

Case Files Pediatrics, on the other hand, provides clinical cases with explanations to help reinforce key concepts in pediatrics.

4. Family Medicine: “Case Files Family Medicine” and "Blueprints FM"

Case Files Family Medicine is a popular resource that presents clinical cases in a question and answer format, testing your knowledge and application of family medicine concepts. 

Blueprints FM provides an overview of the key topics in family medicine, making it an essential resource for exam preparation.

5. Obstetrics and Gynecology: “Blueprints Obstetrics and Gynecology” and APGO uWISE Program

Blueprints Obstetrics and Gynecology is a well-structured review book that contains key information for the OB/GYN shelf exam. 

The APGO uWISE program offers online modules to help reinforce your knowledge of obstetrics and gynecology.

6. Psychiatry: “First Aid for the Psychiatry Clerkship” and “Case Files Psychiatry”

First Aid for the Psychiatry Clerkship is a popular resource that covers key psychiatric topics in a concise and easy-to-understand format. 

Case Files Psychiatry provides clinical cases that help reinforce your understanding of psychiatric disorders and their management.

7. Neurology: “Blueprints Neurology”

Blueprints Neurology is a comprehensive review book that covers essential topics in neurology, making it an invaluable resource for the neurology shelf exam. The book provides a structured approach to studying neurology, helping you retain and apply key concepts effectively.

That shelf exams are still standardized exams, so good test-taking skills will maximize your performance. Make sure to incorporate techniques such as reviewing questions before reading vignettes, the process of elimination, and practice questions to enhance your test-taking skills.

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