Studying for Shelf exams can be overwhelming, especially when you're unsure how long they last. Do you wonder, how long are Shelf Exams? Understanding the duration and structure of these exams is crucial, as it can help you prepare efficiently and manage your time effectively. In this blog, we provide insights on Shelf Exam Length, offering essential information to help you succeed and feel confident during your assessment.
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Table of Contents
What Are Medical School Shelf Exams?
Shelf exams are a standardized way to assess and compare students' medical knowledge with other students nationwide. The NBME® offers many of these exams, from basic science topics to advanced Internal Medicine and Emergency Medicine clinical exams. These exams are called shelf exams because they consist of “shelved” USMLE step 1 and step 2 CK questions from old exams.
The Coverage of Shelf Exams
Expect to be asked questions about heart failure, diabetes, cancer, liver disease, and so on. The shelf exam for neurology will be more narrow in focus, including questions about movement disorders, multiple sclerosis, and other neurological disease processes.
The Structure of the Shelf Exams
You will be asked 110 multiple-choice questions about hypothetical medical and surgical scenarios and situations. Shelf exams cover a broad range of medical topics and are widely considered difficult due to the massive amount of knowledge students must memorize and understand.
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What Is Tested On 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 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.
What topics are 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.
The Surgical Shelf Exam as an Example
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).
Neurology & Psychiatry, Internal Medicine & Pediatrics
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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When Do Shelf Exams Take Place?
Shelf exams usually 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. Your shelf exams are spaced out based 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. Scheduling is straightforward.
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; however, this does depend 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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What Is The Shelf Exam Length?
Family Medicine Shelf Exams
Family medicine shelf exams have a slightly different structure compared to other specialties:
Family Medicine Modular - Core Only
Length: 90 questions
Duration: 2 hours and 15 minutes
Family Medicine Modular - Core + Chronic Care
Length: 100 questions
Duration: 2 hours and 30 minutes
Shelf Exam Length Breakdown: General Shelf Exams
General Shelf Exams
Length: 110 questions
Duration: 2 hours and 45 minutes
Time per question: Approximately 1.5 minutes
How Many Shelf Exams Are There?
There are 7 core clinical rotations:
Internal medicine
Family medicine
General surgery
Neurology
Pediatrics
OB/GYN
Psychiatry
You will face a shelf exam at the end of each of these rotations, so expect to have at least 7 shelf exams. While not typical, some schools may require additional core rotations, such as emergency medicine, radiology, or anesthesiology. Depending on your school, it’s possible you will face shelf exams for these rotations as well.
How Do Students Decide The Order Of Rotations?
Each shelf exam is one-to-one with the rotation, so scheduling is 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.
Fixed Duration and Rotation Schedule
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.
Different Approaches to Shelf Exam Scores
This challenges 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.
5 Tips for Preparing For The Shelf Exams
1. Establish a Schedule Early On and Stick to It
During my core rotations, it is crucial to establish a schedule early on and stick to it. Although spending most of my time in a clinical setting during MS3, keeping effective and consistent study habits is still essential to my success. This is true for my shelf exams and USMLE Step 2, which covers much of the clinical knowledge I will acquire during my core rotations.
It is understandable and expected that I will be exhausted after spending long hours in the wards. When I finally make it home after a long day, I will be tempted to just change out of my scrubs, eat food, and watch Netflix. But I need to avoid falling into this pattern. It will leave me scrambling during the last week of my rotation.
2. Get a calendar and count up how many days you have until the shelf exam
At the start of each rotation, I need to identify the resources I want to use to study. Then, I should divide the number of pages to read and the number of questions by the days available for studying. This method gives me a structured schedule and a daily goal. It spaces out the material to cover and the practice questions I must complete and review. When the time comes for me to take my shelf exam at the end of each rotation, I will be fully prepared.
3. Take at least one NBME for each rotation
I recommend taking an NBME practice test 1-2 weeks before the shelf exam. This will help put me in test-taking mode, give me more material to review, and identify my topic-area weaknesses.
4. Make studying a daily habit
Creating a schedule and sticking to a plan will help me avoid last-minute cramming and alleviate unnecessary stress and anxiety. Being diligent is important — making it a goal to study every day for a set amount of time. Even if I don’t have time to hit my plan on a particular day, I should still sit down to study and chip away at my goal as much as possible. Even one solid hour of studying is better than no studying at all. Cultivating a daily study habit and solidifying a routine throughout my clerkship year is essential.
5. Don’t Over Resource
There are many resources at my fingertips, so many that it can be confusing to know where to begin or which ones are the most effective. Plus, the best study tools can vary from rotation to rotation. But when it comes to study resources, more isn’t better. I need to commit to something and stick to it. Using too many resources leads to diminishing returns and will only complicate my studying.
For primary resources, I recommend the latest AnKing Anki Deck with its shelf-specific tags or Step-Up to Medicine, depending on whether I prefer flashcards or books. If I prefer videos, the Boards & Beyond videos + White Coat Companion study aid or OnlineMedEd are also great resources. For on-the-go studiers and auditory learners, the Divine Intervention Podcasts specific to my shelf exam are a great comprehensive rapid review option to listen to in transit, while cooking, or exercising.
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