Shelf Exams

How To Prepare, Study, & Pass Your Any NBME Shelf Exam

Conquer your shelf exam with confidence using the strategies outlined in this guide. From study tips to test-taking strategies, we've got you!

Jul 2, 2024

books for preparation of Shelf Exam
books for preparation of Shelf Exam
books for preparation of Shelf Exam

Are you wondering, how long are shelf exams? As medical students, facing the challenge of shelf exams can be overwhelming. The pressure to perform well can be intense, and feeling bothered is natural. Understanding how to prepare for shelf exams can help you succeed, and this article provides valuable insights to help you tackle the challenge.

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Table of Contents

What Exactly Are Medical School Shelf Exams?

classroom for testing - Shelf Exam

NBME medicine shelf exams are 165-minute exams at the end of each core rotation, also known as clinical clerkship. These exams evaluate your medical knowledge and your ability to apply that knowledge practically. You will be taking the same shelf exam as every other medical student in the country, regardless of the specific medical school you’re studying at—though the weight of the shelf exams is extremely specific to each school, which we’ll touch on later.

Required rotations include:

  • Internal medicine

  • Family medicine

  • Surgery

  • Neurology

  • Pediatrics

  • OB/GYN

  • Psychiatry

Elective rotations, such as dermatology, do not have shelf exams, as there is no nationalized, standardized rotation that every medical student is required to take.

Simulating USMLE Steps

Shelf exams are licensed by the National Board of Medical Examiners (NBME), the organization that designs the USMLE step exams. Each shelf exam follows the same format as the:

  • USMLE Step 1

  • Step 2 CK

  • Step 3 exams

The exams are called shelf exams because they consist of shelved (expired) USMLE Step 1 and Step 2 CK questions from old exams. You will typically be asked 110 multiple-choice questions about hypothetical medical and surgical scenarios and situations.

When Do Shelf Exams Take Place?

a private room with calender - Shelf Exam

Shelf exams often happen in the third year of medical school, typically between USMLE Step 1 and USMLE Step 2, during the clinical rotations portion of your medical education. How your shelf exams are spaced out depends on your rotation schedule, which may or may not be up to you, depending on your school’s process. 

The tests usually occur on the last day of your clerkship, but the exact timing depends on the medical school. Unlike Step 1 and Step 2, shelf exams are standardized for you. Everyone takes them on the same day through the same proctoring. Whoever is on your rotation will also take the exam with you. You also don’t have to worry about finding a date and going to a test center; this depends on your school’s resources. The setting will vary, but shelf exams are often virtual now, so you’ll likely take them at home with a virtual proctor.

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Do Shelf Exams Matter For Residency?

doctor with mobile phone - Shelf Exam

While the shelf exam is not required by all medical school programs, and it's not a requirement of obtaining a US medical license, shelf exams remain a popular way to test medical students on the knowledge acquired during their clinical rotations. Depending on your medical school program, the results of your shelf exam may or may not determine whether you pass your clinical clerkships. 

Impact on Residency Applications

Shelf exam results are also not required for your residency application, and the programs you're applying for will not see your exam results. 

  • Your exam results may be considered when grading your overall clinical clerkship results. In the case of failure of a shelf exam, you will be required to retake the exam, and a grade of conditional pass or conditional high pass will appear on your transcript. 

  • If you fail one of your shelf exams, it could affect your MSPE at the end of your rotation. The final grade of your clinical clerkship is something residency programs will see and may determine your acceptance. 

So, if your medical school program uses shelf exams, it's best to get a high grade on them so your final clinical clerkship grade is as high as possible. If you score well on your shelf exams, it can complement your OSCE or NAC OSCE when readying your residency applications.

Where Do The Assessment Questions On The Shelf Exam Come From?

doctor researching about Shelf Exam

The NBME® website curates an extensive list of sample content and questions for each Shelf exam. When preparing for your Shelf exams, you must familiarize yourself with the free practice questions and the tutorial interface. This can help you tailor your learning opportunities and experiences on each rotation to ensure you get the most out of your clinical experience. 

Mirroring the USMLE®: NBME® Shelf Exam Format and Question Style

The assessment questions on NBME® Shelf exams are developed by experts and intended to mimic those found on the USMLE® Step 1 and 2 exams. Examinees are generally presented with multiple-choice questions and expected to select a single best answer. The assessments are conducted under timed, proctored conditions using NBME® software that closely mirrors the software used for the USMLE® Step 1 and 2 exams. 

Shelf Exams as Preparation for USMLE® Steps

The USMLE® Shelf exams bridge your clinical rotations and the USMLE® Step 1 and 2 exams. By familiarizing yourself with the assessment questions on the NBME® website, you can enhance your chances of excelling in these crucial exams. 

Maximize Your Resources

When preparing for your Shelf exams, make the most of the available resources, including the sample content and questions on the NBME® website. By diving into these practice questions, you can better prepare yourself for the challenges you may encounter during your Shelf exams. 

Learning Opportunities

Each practice question offers you a valuable opportunity to learn and grow in your understanding of the medical concepts crucial to your exam success. Regularly engaging with these questions can boost your confidence and competence in various medical concepts, helping you perform better in your Shelf exams. 

Sample Content Mimics Real-world Scenarios

The sample content and questions on the NBME® website are designed to challenge your knowledge and skills, providing a comprehensive learning experience that prepares you for the various scenarios you may encounter during your clinical rotations. By actively engaging with these questions, you can fine-tune your clinical reasoning and decision-making skills, setting a solid foundation for your success in the USMLE® Step 1 and 2 exams. 

Sample Content Mimics Real-world Scenarios

Reviewing the sample content and questions on the NBME® website can help you navigate the complexities of the Shelf exam assessments, giving you an edge over your peers. By delving into these questions, you can identify your strengths and weaknesses, allowing you to focus on improving your understanding of the medical concepts crucial to your exam success. 

Practice Makes Perfect

As you embark on your journey to excel in the Shelf exams, remember that practice questions are key to success. The more you engage with these questions, the better equipped you will be to tackle the challenges presented in the exams and perform to the best of your abilities.

Practice questions are a vital tool in your preparation for the Shelf exams. By actively engaging with the sample content and questions on the NBME® website, you can enhance your understanding of the medical concepts essential to success in these exams. So, what are you waiting for? Dive into these questions today, and take the first steps towards acing your Shelf exams!

Are Shelf Exams Harder Than Step 1 Or Step 2?

woman wondering difficulty of Shelf Exam

Shelf exams are generally designed to be of comparable difficulty to those on USMLE® Step 1 and Step 2. Many of the questions are retired from previous Step exams! The NBME® writes both the shelf and step exams; similar software is used to administer them. The proctoring rules and time constraints are also very similar.

Shelf exams can seem more difficult to many students than Step 1 or 2. This might be because Shelf exams are intended to help you prepare and practice for these subsequent exams, rather than because the tests are designed to be harder. Using the score reports from your shelf exams can help focus your studying on areas of weakness before you take Step 1 or Step 2. The Step exams may seem easier if you can improve in these areas!

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How To Prepare For A Shelf Exam? 6 Best Tips

students preparing for Shelf Exam

1. Establish a Schedule Early On and Stick to It

Establishing a schedule early on is vital to preparing for your Shelf exams. While MS3 means you’ll spend most of your time in a clinical setting, keeping effective and consistent study habits is still essential to success. Creating a schedule before your rotation begins will give you the foundational knowledge to succeed and impress your superiors. Continue studying a little each day, and try to relate what you’re studying to the real-life practice you’re gaining in the hospital.

2. Set aside a few days before the shelf exam for dedicated studying

Leave the 2-3 days immediately before the shelf exam for dedicated studying. Use this time to review the material and practice questions you’ve covered over the past few weeks. Such a study regimen allows you to consolidate all the information you’ve learned and identify any areas needing further revision.

3. Take at least one NBME for each rotation

Taking an NBME practice test 1-2 weeks before you take the shelf exam is crucial. This will help to put you in test-taking mode, give you more material to review, and identify your topic-area weaknesses. Practicing test-taking strategies with an NBME will also help to alleviate test anxiety and build confidence.

4. Make studying a daily habit

Creating a schedule and sticking to a plan will help you avoid last-minute cramming and alleviate unnecessary stress and anxiety. Be diligent — make it a goal to study daily for a set amount of time. Even if you don’t have time to hit your plan on a particular day, you should still sit down to study and chip away at your goal as much as possible. Even one solid hour of studying is better than no studying at all.

5. Don’t Over Resource

There are many resources available to help you prepare for your shelf exams. Using too many resources can lead to diminishing returns and make your studying more complicated. Committing to a few reliable resources and sticking to them to avoid confusion and ensure focused preparation is essential.

6. Be Diligent During the Clerkship Year, but Also Be Flexible

While being diligent and consistent in your study habits during your clerkship year is important, it is also essential to be flexible. Some days you may be unable to meet your study goals due to personal obligations or other factors. In such instances, it is crucial to rework your study schedule and make up for the missed work over the next few days. Sticking to your study schedule while being flexible in adapting to unforeseen circumstances will help you stay on track with your preparation for shelf exams.

Study Guides For Shelf Exams

Various online study guides exist to help medical students with their shelf exams. Some guides are broken down by subject matter, surgery, pediatrics, neurology, etc., and some are comprehensive. Some services have free resources or trials; others are paid, such as AMBOSS or UWorld.

Students can also seek help from professional study services, which help them create a study guide and strategize answer strategies for questions and subject matter on the exam. 

Comprehensive Online Resources

Some of the most highly recommended online guides include resources like UWorld and OnlineMedEd, which provide in-depth help on studying and mastering the shelf exams in every subject. Study guides like these are broken down so students can prepare for each part of the shelf exam in pieces and include advice on mastering each section of this comprehensive exam. Using a study guide as the only study resource is not recommended. 

Personalized Learning

Taking your own notes and utilizing your experiences will be more beneficial to your studying practices than reviewing as many study guides as possible or one comprehensive study guide alone. Otio helps summarize lengthy slides into useful personal notes you can study.

There are also many recommended books like Pocket Medicine which comes in handy where there are no access to electronics.

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