Just started my 8 week IM rotation last week. People have said that this is the hardest shelf exam. Anyone have any hints or tips on how to succeed on the medicine shelf besides the standard "study MKSAP2"?

blah. i'm taking it this afternoon. haven't studied a whole lot for it as the last 11 weeks of IM have sucked the life out of me. know what to do with a positive PPD. becoming familiar with the diagnostic and treatment algorithms in pocket medicine should serve you well too.

Just started my 8 week IM rotation last week. People have said that this is the hardest shelf exam. Anyone have any hints or tips on how to succeed on the medicine shelf besides the standard "study MKSAP2"?
I thought there was already an IM thread. Here is my input anyway, blueprints, MKSAP-2, pre tests, Qbook (400 IM questions). Kaplan qbook was on point with a very similar format to the shelf in terms of length of passages and content tested. Can't tell how I did yet, since I just took it last week. But again wished I'd study more instead going out so much since brake up with my gf. +pity+

I didn't think any one particular study resource "mirrored" the exam, but I would have to say MKSAP-2 was the best resource, I went through it twice. Pretest was easier than the real thing, but still worth doing. I also read First Aid for Medicine, which covered a lot of the tested material. I'm not sure what the national average is on the exam, but I think I did pretty well, it boosted my IM grade from excellent to honors. Hope this helps and good luck!

I thought there was already an IM thread. Here is my input anyway, blueprints, MKSAP-2, pre tests, Qbook (400 IM questions). Kaplan qbook was on point with a very similar format to the shelf in terms of length of passages and content tested. Can't tell how I did yet, since I just took it last week. But again wished I'd study more instead going out so much since brake up with my gf. +pity+
Okay got my results back 82 raw score=88 percentile, good enough to get a letter of distinction= to honors at my school. Again Qbook was the best.

The last 10 questions seemed more difficult. Consider doing them first, when your brain is fresh.

It's been a while since I took it, but here's how I "studied":

1. picked up complicated patients with multiple problems affecting multiple systems
1a. read about them in NMS Medicine and UpToDate
2. Did MKSAP. Although I ran out of time to study at the end, and for the last half of the book I skipped the questions and just read the answers and highlighted the important stuff.
3. Gave presentations on stuff that's basic and useful, but not commonly presented by med students. I would pull the topic from Case Files Internal Medicine, and then look up a good review article and a study to incorporate into the presentation.

The IM rotation at my school is really solid, but my particular team was staying so much later every day than all the others that I would have bombed the shelf if I hadn't come in knowing a good chunk of the material already. I have no idea how the other students on my team did, but they all finished in time (as did >2/3 of my rotation group), so I hope that bodes well.

As for the test itself, I didn't use any gimmicks. I just read each question in order, read the choices and picked the one I thought was best.

Don't be surprised if you see one or two questions that clearly belong on some other shelf exam (i.e. neuro, psych, surgery, peds). Common sense will usually lead you the correct answer on these.

top 5%, studied only FA for Medicine and IM Qbank. The day before exam read B & W's.

Does anyone know an online reference where you can do some practice questions for free? I know there are some for Step 1 and such, but what about shelfs? I prefer not to pay Kaplan's overpriced bank for just a shelf.

Thanks Guys!

Also, anyone have any neurology or dermatology on your medicine shelf exam. These two subjects are not well covered when following patients.

Thanks Guys!

Also, anyone have any neurology or dermatology on your medicine shelf exam. These two subjects are not well covered when following patients.

no neurology or derm for me on the medicine shelf. oddly enough i had a few derm on the surgery shelf but that's another thread :)

I'd agree with the qbook and MKSAP, i took it in september and had a raw score of 91....not quite sure what percentile that is

Kluver Bucy, what review books do you recommend?

Kluver Bucy, what review books do you recommend?

Pox, the exam was tough. Hopefully I passed. The upper level students at my school recommended First Aid for Medicine, PreTest Medicine, and MKSAP2. Those are the 3 sources I used. I wish I started memorizing First Aid earlier. :(
For the pharmacology questions, I wish I read through first aid for Step 1 pharm section.

Pox, the exam was tough. Hopefully I passed. The upper level students at my school recommended First Aid for Medicine, PreTest Medicine, and MKSAP2. Those are the 3 sources I used. I wish I started memorizing First Aid earlier. :(
For the pharmacology questions, I wish I read through first aid for Step 1 pharm section.

Thanks. I think I'm going to take your advice and re-read the Step 1 pharm section from First Aid (annotated of course!) prior to my Medicine exam and/or Step 2. Hopefully you did better than you think. I've heard MKSAP2 is solid. :thumbup:

The best advice I can give having taken the test a year ago is:
1 - read up on issues IN DEPTH that each one of your patient has as you go along on your clerkship. As you get closer to the exam, you'll have less time to read up on each disease in detail, so it'll be good if you already have this to draw upon while reviewing later.

2- as for review books and materials that I used I would rank them in this order:
#1 - MKSAP - try to go thru twice if you have time
#2 - First Aid for Medicine
#3 - Pre-Test

Thanks. I think I'm going to take your advice and re-read the Step 1 pharm section from First Aid (annotated of course!) prior to my Medicine exam and/or Step 2. Hopefully you did better than you think. I've heard MKSAP2 is solid. :thumbup:
just an FYI, but I think the only pharm question I had was making sure to add an ACE inhibitor to the regimen the patient already had for either diabetes or heart issues, can't remember which one. don't waste too much time on pharm.

there is another recent thread with really good advice in it. I'd pass on First Aid for Step-Up.

top 5%, studied only FA for Medicine and IM Qbank. The day before exam read B & W's.


That's great, but I gotta say, this is not the norm. This method may not work for everyone, but for people who learn well from FA-style and who have proven that's all they need to do well, go for it. FA was too skimpy for me.

One thing about this board, when you ask people who did well what they studied, you will get a lot of different responses, and they are all extremely subjective, and depend entirely on that person's learning style, knowledge base, and if they are generally "good test takers".

Buyer beware. :)

sorry, sent twice...

For those of you who go through question books twice--why? I hear people say, "I'm going to go through this twice" like it's some magical formula for learning the material. And I just don't get how that helps. I can barely read most textbooks once, without having a sleep attack every few paragraphs. And for the question books, I always remember the right answer, so it doesn't help me. I just look at the question, hardly even reading it, and think, "oh yeah, that one was C." But if you change the scenario, who can say whether I'd get it right?

For those of you who go through question books twice--why? I hear people say, "I'm going to go through this twice" like it's some magical formula for learning the material. And I just don't get how that helps. I can barely read most textbooks once, without having a sleep attack every few paragraphs. And for the question books, I always remember the right answer, so it doesn't help me. I just look at the question, hardly even reading it, and think, "oh yeah, that one was C." But if you change the scenario, who can say whether I'd get it right?

It is helpful for me because when I run through the answer choices I explain to myself why the wrong answer choices are wrong. Also, with MKSAP2, I often found myself picking the wrong answer choice AGAIN! On those questions it was very important to understand what was tripping me up about the material.

My technique for the IM shelf;
- MKSAP2. Repeat at least twice (I did x 3). The 'feel' of the self questions are very similar to MKSAP. You can put the CD on a USB zip drive and do questions on the wards when you a little down time. I use practice questions to focus my studying and then read more in Harrison’s/Up-to-Date about the topics that I’m weak on.

- A lot of my classmates used books like First Aid for medicine which present the material in bullets. I did not find FA helpful because most shelf questions are "what will you do next" type questions and FA does not present the material in that format. I prefer studying from practice questions.

Dang, the Medicine shelf was not as easy as I imagined it would be by the end of the year. I did MKSAP through 1.5x, whipped through Pretest Medicine for chapters covering topics I had no clinical exposure to...and despite studying, and reading a ton on my patients etc. during our 2-month rotation, I still felt totally unprepared. I finish most shelf exams with significant time to spare, and I pretty much used every second of the time available for the medicine shelf to agonize over stuff. Luckily, the shelf is only 25% of our rotation grade, but still, yikes....I'll be happy with anything over 80.

Dang, the Medicine shelf was not as easy as I imagined it would be by the end of the year. I did MKSAP through 1.5x, whipped through Pretest Medicine for chapters covering topics I had no clinical exposure to...and despite studying, and reading a ton on my patients etc. during our 2-month rotation, I still felt totally unprepared. I finish most shelf exams with significant time to spare, and I pretty much used every second of the time available for the medicine shelf to agonize over stuff. Luckily, the shelf is only 25% of our rotation grade, but still, yikes....I'll be happy with anything over 80.

I felt the same way! I did MKSAP, Pre-Test, and the Kaplan Q-Bank questions and still found myself uncertain on a lot of the answers. At my school, I need to score one standard deviation above the national mean to maintain Honors. However, I seriously doubt that happened! At this point, I am hoping that I passed the darned thing!

Step Up To Medicine. It's way better than First Aid, in fact probably the best book of 3rd year period. I felt that the shelf questions were literally pulled directly from that book. Step Up + MKSAP = awesome

I didn't think any one particular study resource "mirrored" the exam, but I would have to say MKSAP-2 was the best resource, I went through it twice. Pretest was easier than the real thing, but still worth doing. I also read First Aid for Medicine, which covered a lot of the tested material. I'm not sure what the national average is on the exam, but I think I did pretty well, it boosted my IM grade from excellent to honors. Hope this helps and good luck!

What is MKSAP-2?

I did 60% of MKSAP (ran out of time, these questions are hard and take forever!!!) and glanced at Case Files. After taking the shelf, I thought MKSAP was good, and I think I would have done better if I really used Case Files. I think Case Files are pretty good for all the subjects esp. Medicine and OBGyn.

Through the rotation, I watched the kaplan videos. I took the medicine shelf at the end of the year with all the other shelfs back to back so it was hard to really prepare for any of the shelfs in such limited time, but it was a huge advantage to take the shelfs at the end cuz at the end of 3rd year it all kinda comes together.

Got a 93 (curved) - Finishing MKSAP, case files and kaplan notes will easily get u a 90+ raw score i would imagine.

PS- MKSAP also helped on the family med shelf which i thought was kinda easy compared to medicine shelf.

Oddly, only 1 person in this thread has mentioned Step-up to Medicine...but in the "Books for Medicine" thread it is by far the most recommended :confused:

Oddly, only 1 person in this thread has mentioned Step-up to Medicine...but in the "Books for Medicine" thread it is by far the most recommended :confused:

i had ob/gyn and psych before medicine. used step-up to medicine, pretest, and mksap. i also looked some things up more indepth on my patients on up to date. got the highest grade on the shelf in our group of students. i thought step-up was more than sufficient while concise at the same time.

does anyone know if there's a big difference between Step Up to Medicine and Step Up to USMLE Step 2?? I bought Step Up to USMLE Step 2 because the bookstore didn't carry Step Up to Medicine. I'm wondering if I should return it and order it online. Thanks :)

Again, what is MKSAP? Let us know please. Never heard of it.

MKSAP is the medical knowledge self assessment assembled by the american college of physicians and the CDIM. It is a book of questions.

As for the Step Up to Medicine vs. Step Up to Step 2, Step Up to Medicine is approximately 600 pages of focused topics in medicine where as the Step 2 is a broad general overview of the entire third year (psych, ob, gyn, surgery).

It probably doesn't matter too much what you use as long as you stick with it andread up on stuff on a consistent basis. As far as questions, just do as many as humanly possible. I did mostly reading the first half (mostly from blueprints and CMDT) and then questions the second half. I think MKSAP is the best, but I also used IM qbank which in my opinion were harder than the real thing.

I got a 92, which was a good 10 points better than my 2nd best score. So I think it paid off.

Too bad for that bs attending eval.....

Hi,

I highly recommend Step Up for Medicine and MKSAP2 or 3 which is the new one out. I did not read FA for Medicine but I did read FA for the Int. Medicine Board Exam for residents and that book is amazing but a little too much in certain chapters. I also recommend looking at boards and wards a day or two before the exam. Additionally, you need to learn from your patients on the wards for this exam more than any other. Make sure you look over management for your classic patients, i.e. Upper/Lower GI Bleed due to ulcer, pancreatitis, TB, Pneumonia, etc. KNOW your management for chest pain and shortness of breath complaints. The test basically requires an in depth knowledge of your bread and butter medicine and a basic knowledge of the rest (diagnostic test, basic symptoms, and main treatment).

Got a 93 (curved) - Finishing MKSAP, case files and kaplan notes will easily get u a 90+ raw score i would imagine..


:rolleyes:

Dang, the Medicine shelf was not as easy as I imagined it would be by the end of the year. I did MKSAP through 1.5x, whipped through Pretest Medicine for chapters covering topics I had no clinical exposure to...and despite studying, and reading a ton on my patients etc. during our 2-month rotation, I still felt totally unprepared. I finish most shelf exams with significant time to spare, and I pretty much used every second of the time available for the medicine shelf to agonize over stuff. Luckily, the shelf is only 25% of our rotation grade, but still, yikes....I'll be happy with anything over 80.
The average for our rotation was a 76, the high was an 87, and the low was a 66.

I had..."83." Considering how rapidly I was copying answers from the book to the answer sheet at the end, I'm just glad I didn't screw up.

Hopefully that's good enough to keep me on the Letters/Honors train....

top 5%, studied only FA for Medicine and IM Qbank. The day before exam read B & W's.

What is B & W's?

Edit: Figured it out, boards and wards. Apparently there's no way to delete a message once it's posted.

so my medschool grades the shelf by percentage, not percentile. You literally have to get a 90%, to get Honors, not 90th percentile. Pretty ridiculous, IMHO... I got a 85% on the shelf, which excluded me from getting Honors, unless I got above 95% on the clinical evaluation (also nearly impossible).

Plus we only had internal medicine for three weeks (technically it's a six week clerkship but the first three weeks were spent in a Family-Medicine-style outpatient office, where I learned essentially nothing but the business end of medicine, and nothing for the shelf.)

Nevertheless, I managed to get an 85%. This is how:

1. Step Up to Medicine. I read all of it, during the two weeks before the exam. Reading all that in two weeks was hard, but definitely worth it. Pay attention to the Diagnosis and Treatment section after each disease entity. The shelf is essentially full of questions that ask, "What's the next step in management?", "Which test would confirm your diagnosis?", "What's the most appropriate treatment?" There was only one question that I recall which asked for the pathophysiology or mechanism of disease (reminiscent of Step1).

2. I did MKSAP2, once. Use the CD and do it on the computer. The questions were similar in length and complexity.

3. Read fast, time is not on your side. Don't read every word in the question. Skim. We were given only 2 hrs and 10 minutes.

4. Most importantly, I felt you really can't study for the shelf (this is coming from someone who usually studies and worries and obsesses a lot before exams). The best thing to do is be alert as possible on the wards, pay close attention to your team's patients, closely follow the attending's reasoning on why order this and that test, and try to answer the pimping questions. Look up stuff on your assigned patients and any other interesting cases assigned to other people (you can keep the latter to yourself so you won't come off like a total ass-kisser).

I noticed that most people just wrote "used MKSAP" and some specified MKSAP 2. Does anyone have any suggestions concerning using MKSAP 2 vs MKSAP 3? Thanks.

MKSAP 3 is the newest one (until MKSAP 4 comes out), so just get the newest one...which will be the one on the shelf at your friendly local medical school bookstore.

I'd agree with the qbook and MKSAP, i took it in september and had a raw score of 91....not quite sure what percentile that is

wow your amazing, considering NBME doesn't report raw scores......

When reading FA or step-up how do best absorb the material. Do you take notes, write in the margins, make flash cards, highlight, just read etc???
what works best for you?
On my prior rotations (ob, peds, family med) the material was fairly finite and manageable, but medicine seems overwhelming.

wow your amazing, considering NBME doesn't report raw scores......

I recieved a raw score on my surgery shelf. :confused:

I used Cecil's Essentials of Medicine (pretty good, liked it better than Harrisons) as my textbook for the rotation as well as plenty of UpToDate, Boards and Wards for review, and MKSAP for questions.

Just took the exam this morning. It really wasn't that terrible. It was more difficult than Peds, but easier than Surgery. I read step-up, and going through it after the test, I really don't think I could have done any different if given more time to read. There were many subjective questions and the only way you can really hit those is doing as much as you can and asking alot of questions during clinics. Anyways, heres a quick breakdown:

GI and Cardio were about 30 Qs
Renal and Pulmonary about 20 Qs
Rheum 10Qs
Hemo 10Qs
Endo 10Qs
About 15 Qs from those were based on an infection disease
A couple CNS, Dermatology, Psych, OBGYN Qs

Quite a few questions with patient presenting with SOB.

Most questions were either 'what is the diagnosis' or 'what is next step in treatment/management'

i took the medicine shelf today

this was my experience...

FUU CKKKKKKKKK MEEEEEEE!!!!


i completed....case files medicine, step up medicine, mksap, qbook and knew them backwards and forwards, didn't make a difference.

this was the question breakdown

30 q...bs
20q...more bs
20q...wtf
10q...miscellaneous bs
10q...ethical bs

MKSAP is the medical knowledge self assessment assembled by the american college of physicians and the CDIM. It is a book of questions.

As for the Step Up to Medicine vs. Step Up to Step 2, Step Up to Medicine is approximately 600 pages of focused topics in medicine where as the Step 2 is a broad general overview of the entire third year (psych, ob, gyn, surgery).

540 for Step up to Med and if your rotation is a month and a 1/2 to 2 months that's about 10 pages a day. I found it to be the single best book since BRS Path for step 1. I scored way above the mean using this book and no MKSAP on my fourth yr IM shelf. Don't expect to cram with it though. Once it gets down to the wire use the IM section in Boards and Wards for review which you can get through very quickly in the few days before the shelf.

i took the medicine shelf today

this was my experience...

FUU CKKKKKKKKK MEEEEEEE!!!!


i completed....case files medicine, step up medicine, mksap, qbook and knew them backwards and forwards, didn't make a difference.

this was the question breakdown

30 q...bs
20q...more bs
20q...wtf
10q...miscellaneous bs
10q...ethical bs

I'm sure you did well. That was my thoughts after taking it as well. Probably everyone thinks they bombed it.

I'm not sure if the exam has changed much, but I thought this was the most straight forward exam thus far. Very few ethical Q's (I can only think of one), the cardio questions were straight forward, as were the pulmonology Q's. Most of my classmates felt the same as well. We took this exam along with all the others at the end of our 3rd year, maybe that made a big difference.

As mentioned previously, "What would be the next best step in management?" was probably the most heavily represented of all question types.


Sources:
Step-UP - I read through it several times throughout the year and twice in the weeks leading up to the exam. There was very little on the exam that wasn't covered in this book.

Kaplan IM Qbank - used this waaaaay back in the beginning of the year. I remember thinking these were pretty rigorous questions. I worked them during lunch breaks with my attending and he thought most of them were nit-picky rather than conceptually difficult. I'm not sure how I'd feel about these now after having learned more throughout the year...

MKSAP 3 - the best question source for learning IM. I didn't feel that working these questions had any real impact on my performance on the board exam, however, they contributed significantly to my knowledge of IM.

PreTest Medicine - Very good source of questions, probably one of the best in the series.

UsmleWorld - probably made it through half of the IM questions. I started getting tired of missing questions due to B.$. semantics...

Crush Step 2 Q's - good set of questions, but the difficulty level is a little underwhelming... I used this rather than Secrets (by the same author) b/c most of the info in Secrets is in Step-Up.

NMS Question book - these on the otherhand were pretty overwhelming... I've made it through about half of the 1000 Q's.

Kaplan Q-book - great question book, several Q's I thought were lifted right out of several of the shelf exams. One complaint though, is that there are several errors in the IM section so keep your eyes peeled...

I honestly felt a little overprepared for this shelf exam. My goal for this exam was unreasonable...I was shooting for a 800...this is why I read Step-Up so many times and used so many question books. It seemed like the "hard Q's" were difficult b/c of trickiness/wordplay rather than not knowing the concept. Hopefully this doesn't sound arrogant, but I think it's possible to know too much going into these board exams. I believe I missed more Q's b/c I talked myself out of the right answer than I did b/c I didn't know WTF the question was aking. This was disappointing b/c I'd rather miss a Q b/c I didn't know the concept... Time wasn't as much of a factor on this exam as the others, we had the usual 2 hr 10 min.

Update:
Score came back as 94. Good luck guys, they pull questions from everywhere!!

I'm sure you did well. That was my thoughts after taking it as well. Probably everyone thinks they bombed it.

You were right. i got a 93. i still felt like crap after the exam was over, this just prove that G-d exists. thanks G-d. :thumbup:

Step Up To Medicine. It's way better than First Aid, in fact probably the best book of 3rd year period. I felt that the shelf questions were literally pulled directly from that book. Step Up + MKSAP = awesome

This is the bare minimum I am working on getting done. Is PreTest necessary on top of this? Or, perhaps more importantly, has anyone found it to help keep the brain from going numb? Thanks!

Hey guys-
I need some advice. So I'm on ambulatory right now and I've been reading Step Up Internal Medicine. The book is freakin awesome but something I noticed about myself - I'll read a chapter in the book and then the next day, I get a patient presenting with what I had just read the night before and when I'm asked to list the differential dx, I can't remember jack! If I had a multiple choice exam I could totally pick out the correct answer but when I'm asked to verbalize my knowledge, I just can't do it and it's not cause I'm nervous. It's just all fuzzy in my head. Any tips for remembering all this stuff in the book?

ugh i have the SAME problem!!!!!!

btw r u reading the ambulatory part or all parts of it? just curious b/c im on family now and reading just the ambulatory section and relevant other sections that i see with patients.

wow im slow this is the IM shelf thread i apologize for my stupidity :) of course youre reading the whole book....good luck!

well..my exam is next week.

i only have my hands on PreTest right now, and really can't fathom shelling out $45 for MKSAP ...

for those who have taken the shelf and passed:

might Pretest, in and of itself, be enough?

just got the score back from the IM shelf exam, 90% which was the highest score for the group of 30 students who finished the clerkship at my medical school. the groups average was 74.

the way i studied was the following: MKSAP 3 went through it 2 times, Medicine Pre-Test 2 times through, read medicine case-files, and read Hospital Medicine Secrets once through. I think that it also helped that I did the Medicine rotation first, directly after taking USMLE Step 1.

Good luck everyone!

i meant 90 raw, not 90%. not sure what the percentile would be with a 90 raw. :)

good luck again!

i started step up & then decided to drop the text & just do questions. I learn more by getting questions wrong then by reading a text. I did mksap, 2, 3 & 14 (computer) as well as qbook & got honors on the shelf.

Ahh, the medicine shelf. My story:

We have 12 weeks for IM+FM here (8 IM, 4 FM), with the IM shelf at the end.
My base book was Step-Up - anything I read that was more recent than Step-Up forced me to annotate (and read whatever disease it was in Step-Up I was annotating).

1) Essentials of IM for Clerkship Students: very up-to-date, but has a lot of fluff - you could burn through this in 10 days while annotating in Step-Up. It's great in the beginning - useless in the end of the rotation.

2) CaseFiles IM: not as useful as other CaseFiles just b/c it only covers so few cases when it's quite obvious that IM is a pretty large field, but I still did it, annotating Step-Up.

3) Went through Step up formally, using PreTest IM as little mini-tests for each review system to make sure that I got the main ideas (1min/q). Some sections of it suck (e.g. renal).

4) Did MKSAP (the newest one), annotating Step-Up as needed.

5) Went through Step Up a second time, doing all 8 QBook tests timed, intermittently (it feels good to watch your score go up); never >1min/q. Then the day before, the test, I was postcall, (and the weekend before, I was on call - I just have the best luck, ever) and I sat down and did every single MKSAP question again (goes by really really fast), just as a final test.

Score: 95

I'm going to get flamed b/c that's a lot of books to go through, and clearly "no one should have that much time to go through so many books", but it's definitely doable. If need be, skip CaseFiles and substitute FA for Step-Up (but I absolutely hate the lay-out of FA). I did do a couple of Lange tests - only the major organ systems - I' can only recommend the cardio and GI tests in it - the rest were not as good. I will say that questions are absolutely key on the shelf b/c you need to be a superb pattern recognizer.

Best of luck!

lol so i just got my shelf score back and i got a 93 raw. don't ask me how I did it because nothing i read for this shelf helped at all. the mksap questions I did were worthless. i read step up to medicine in like 6 days so i barely retained any of it because i had only less than 2 weeks to study. apparently, the best prep i had for this test was studying for step 1.


so to review:

best way to ace the medicine shelf is ace your step 1 exam. gg.

well..my exam is next week.

i only have my hands on PreTest right now, and really can't fathom shelling out $45 for MKSAP ...

for those who have taken the shelf and passed:

might Pretest, in and of itself, be enough?

Check your schools library for a copy, or tag team with some ward mates.

Hey guys-
I need some advice. So I'm on ambulatory right now and I've been reading Step Up Internal Medicine. The book is freakin awesome but something I noticed about myself - I'll read a chapter in the book and then the next day, I get a patient presenting with what I had just read the night before and when I'm asked to list the differential dx, I can't remember jack! If I had a multiple choice exam I could totally pick out the correct answer but when I'm asked to verbalize my knowledge, I just can't do it and it's not cause I'm nervous. It's just all fuzzy in my head. Any tips for remembering all this stuff in the book?

Have something on hand in your white coat, something on your PDA, like Epocrates or better yet FirstConsult. If anything, this can help reinforce what you are reading.

I have MKSAP 3 and I hear good things, is it worth it to do it twice or is once enough?

what about the blueprints for Step 2, there is a 200 questions Internal test in there any one have luck with that

any other questions that I could do that would really help?

thanks

lzzy

Here is what I did and how it worked out:
I went through MKSAP two times- once each half of the rotation and focused on the answers.
I read IM Case Files once- very quick and high yield
Did five of the 50 question tests in the Kaplan Step 2 Qbook- these were awesome.
I ended up with a raw score of 90 (99th percentile).

MKSAP once now, and once the day before (you'll remember the questions so it'll fly by) ...

also, qbook i think is crucial - medicine shelf is all pattern-recognition, so practice up on that - there is no time to dwell on large differentials

MKSAP once now, and once the day before (you'll remember the questions so it'll fly by) ...

also, qbook i think is crucial - medicine shelf is all pattern-recognition, so practice up on that - there is no time to dwell on large differentials

you think kaplan qbank would work instead of qbook?

I suppose it would - I kinda wanted to simulate the paper-pencil test though, just to get the hang of the real thing.

Okay got my results back 82 raw score=88 percentile, good enough to get a letter of distinction= to honors at my school. Again Qbook was the best.

man, at our school we have to be 90 percentile to get letter :(

wow your amazing, considering NBME doesn't report raw scores......

so what does NBME report? Cause our school say that grade is calculated by formula approved by our dean?? :confused:

so what does NBME report? Cause our school say that grade is calculated by formula approved by our dean?? :confused:

NBME reports number correct out of 100. As opposed to 2nd year where you got a 3 digit score based on standard deviation.

Disregard any mention of %ile...NBME does NOT report percentiles(shelf or step). You are confusing a 2 digit score conversion with a percentile...similar to your 2 digit step score. Unfortunately, this myth of a "percentile" will continue to be propagated.

NBME reports number correct out of 100. As opposed to 2nd year where you got a 3 digit score based on standard deviation.
This is incorrect. From the PDF available on the NBME site (http://www.nbme.org/programs-services/medical-schools/subject-examinations/index.html) explaining the shelf exams:

Subject Examination scores are provided on a scale that has been developed individually for each test and are statistically equated across test administrations to a common score scale. Scores are statistically adjusted for shifts in test difficulty and consequently, can be used to track school and student performance over time. For the basic science disciplines, the subject examination score is scaled to have a mean of 500 and a standard deviation of 100 for a specific group of first–time takers who took the examination as an end-of-course or end-of-year assessment. For the clinical science disciplines, the subject examination scores are scaled to have a mean of 70 and a standard deviation of 8 for a specific group of first-time takers who took the examination as an end-of-clerkship examination. It is important to note that although the subject examination scores for the clinical science examinations have the “look and feel” of percent correct scores, they are not.

Hey guys-
I need some advice. So I'm on ambulatory right now and I've been reading Step Up Internal Medicine. The book is freakin awesome but something I noticed about myself - I'll read a chapter in the book and then the next day, I get a patient presenting with what I had just read the night before and when I'm asked to list the differential dx, I can't remember jack! If I had a multiple choice exam I could totally pick out the correct answer but when I'm asked to verbalize my knowledge, I just can't do it and it's not cause I'm nervous. It's just all fuzzy in my head. Any tips for remembering all this stuff in the book?

Thank you so much for posting - on a night like tonight - I needed to hear your story... this is my life - and why I probably can't go into medicine. I study my ass off, I'm a hard worker, but when it comes down to it - when I'm on the spot - I'm borderline retarded and likely appear completely incompetent - I start sweating - I have nothing but a blank whiteboard in my head and yet my peers can remember lists upon lists of ddx and pathophys.... there I am - like the dumb monkey in the room - nodding my head in recognition, but unable to verbalize and manipulate anything I know or learn - it's sad - it makes me feel incompetent. The only thing I feel good about is that it wasn't a problem on L&D and it wasn't a problem in psych - hence helping me make a decision - I would make a crappy internist - very crappy - i just can't think globally like that - i wish i could - but anyway - I feel you - completely - I'm glad to know I"m not the only one struggling out there.

the mksap questions I did were worthless.

Agreed with this. Not sure why everyone recommends MKSAP so much... I don't think it's very good at all. The only way to feel very prepared for the IM shelf is to either 1) do LOTS of questions from MULTIPLE resources, or 2) read and be totally familiar with Step-Up to Medicine (this book has just about everything in it).

Also, the majority of the test is cardiology and pulmonary. The derm questions were the hardest of them all, IMO.

This is incorrect. From the PDF available on the NBME site (http://www.nbme.org/programs-services/medical-schools/subject-examinations/index.html) explaining the shelf exams:

:thumbup: Good to know...I stand corrected.

Does anyone know how many question u can get off the MKSAP web site? and what is the difference bet. the book and the subscribe on line

Thought I'd add my 2 cents for those who are taking the test later:
I read Step Up twice, Case files, MKSAP3, and all 1500 USMLEWorld medicine questions once (I know that's a ton, but at my school the shelf pretty much determines whether or not you get honors).

Score: 96 raw

I thought MKSAP was worthless compared to USMLEWorld. Step Up gave me the foundation, Case Files helped me integrate everything, and the questions got me those extra details that pushed me over the top. It's doable if you put in the time - none of my other shelves were within 15 points of that.

Any advice from those who could do it all over again and had six days left to study for the IM shelf? I am freaking out!!! :eek::eek::eek: I suck at these shelf exams.

Gotta just pass it. I don't need to rock it, just a 70% is all I need to stay in school.

Thanks for any advice. :)

I've been looking at this thread a lot, so I figured I should give back.

Got my scores today:

Raw 78 --> 69 %tile

Used Step Up and MKSAP 3 (prb should give a nod to Pocket Medicine from Mass Gen as well...)

I thought both didn't really do that much for me, but I did much better than I expected.

MKSAP 3 did not look like anything on the shelf, but I learned a lot from it if that counts for anything.

Step Up is just a good book, I can recommend it, though I don't think it really prepared me --> BUT it must have b/c it was my main source of info.

Just FYI, I didn't read the Ambulatory section which turned out to be a mistake. I didn't the neuro info either, but I did take the neuro shelf right b4 this one, so if you don't know the basics of neuro (stroke, parkinson's, alz, guillan barre, myasthenia gravis, etc.) read it. It may be a little overkill, but it'll be good for you.

Best thing is prb just getting good experience during your rotation. I think I got a lot of questions right b/c I remember what tests we actually used.


PS I HIGHLY recommned just getting USMLEWORLD.org questions for Step 2 and just going through the Internal med questions (there are 1,000+). I wish I would've known about this earlier...

Thought I'd add my 2 cents for those who are taking the test later:
I read Step Up twice, Case files, MKSAP3, and all 1500 USMLEWorld medicine questions once (I know that's a ton, but at my school the shelf pretty much determines whether or not you get honors).

Score: 96 raw

I thought MKSAP was worthless compared to USMLEWorld. Step Up gave me the foundation, Case Files helped me integrate everything, and the questions got me those extra details that pushed me over the top. It's doable if you put in the time - none of my other shelves were within 15 points of that.
holy crap, I didn't even use 1500 questions when I used UW for step 1. I think I might get it for the medicine shelf though.

Can someone post a 'feel' for how tough the real thing was-----for example -- QBank IM section: is it about that difficult or is it more like pre-test or what?

Also, with the standard 7-7 workday, how did you avoid being mentally burnt after each day to get the time in to study?

Can someone post a 'feel' for how tough the real thing was-----for example -- QBank IM section: is it about that difficult or is it more like pre-test or what?

Also, with the standard 7-7 workday, how did you avoid being mentally burnt after each day to get the time in to study?

That is my question as well. How are you guys reading so much material after coming home from a long day? Not to mention theres no weekends really either.

That is my question as well. How are you guys reading so much material after coming home from a long day? Not to mention theres no weekends really either.

I'm not. I've pretty much done about 1/3 of the assigned Cecil's reading for our departmental final.....

Done about 100 Q's from Kaplan QBank, the cardio sections of PreTest/StepUp/MKSAP.....so I'm kicking it into gear now...only have a month left.....

Don't feel bad....some people I know of haven't touched anything since starting......and some will probably wait until 2 weeks before the exam....

So I got 3 weeks before the shelf exam. I pretty much finished Step Up but I want to reread a couple of chapters like cardio. I haven't done any questions yet but plan to hit them hard in the next week. any other suggestions on how to best prepare for this test especially good question sources (i have MKSAP)

Just got the UW step 2 CK Qbank for the medicine questions. Did 20 questions. Got a 45%. Apparently that's the 7th percentile.

Dangit. I know a 60% on UW step 1 Qbank was pretty good, so what's a decent score on these questions?

Just got the UW step 2 CK Qbank for the medicine questions. Did 20 questions. Got a 45%. Apparently that's the 7th percentile.

Dangit. I know a 60% on UW step 1 Qbank was pretty good, so what's a decent score on these questions?

LOL. I just did a test of 23 questions and got a 47%, which is 10th percentile even though the average score was a 56%. I guess the standard deviation is about 5% points. Awesome!

UWorld is known to have F-d up calculation of percentile. I'm not too worried, I still have about a month left.

Anyone know of the predictive value of the Kaplan IM Qbank questions with regard to the shelf?

I recently came across the "Subject Examination Content Outlines and Sample Items" pdf on the NBME website: http://www.nbme.org/PDF/NBME2008SubjExams.pdf

Does anyone know if the questions for the Medicine exam in this pdf are truly representative of the medicine shelf? Based on my scores so far on the MKSAP 3 and Qbook (average ~70%), I've been very worried about my upcoming IM shelf. Then I did those NBME sample questions and only missed 1 out of 20, so now I don't know what to think! Anyone have any insight?

I recently came across the "Subject Examination Content Outlines and Sample Items" pdf on the NBME website: http://www.nbme.org/PDF/NBME2008SubjExams.pdf

Does anyone know if the questions for the Medicine exam in this pdf are truly representative of the medicine shelf?
On every shelf exam I took, I saw at least one of the sample items from the corresponding NBME subject exam pdf.

Just got the UW step 2 CK Qbank for the medicine questions. Did 20 questions. Got a 45%. Apparently that's the 7th percentile.

Dangit. I know a 60% on UW step 1 Qbank was pretty good, so what's a decent score on these questions?You need to do a lot more than 20 questions to get a good idea of your percentile. For the shelf, 50% overall is very good, 60% is outstanding. Don't worry about the percentiles, just do as many questions as you can and read the explanations. Your scores will improve.

Out of UW, MKSAP3, and Kaplan questions, which is the best?

On every shelf exam I took, I saw at least one of the sample items from the corresponding NBME subject exam pdf.

Well, at least I know I'll get one question right! :)

I've heard MKSAP3. I got the book for free - on loan - from the medicine department, so I'm using that, and I used UW for step 1, so I got it for a month as well.

For what it's worth, I was bent over and rectalized repeatedly with a corn cob by this thing today. :-D

We'll see what the actual score turns out to be...

Ugh i dont know how people manage to get >80 raw on this shelf. I was prepared to speed read and move quickly but still just barely finished with no real time to check back answers. You were pretty Fed if you didnt know your stuff or are just slow. Major respect to those that do well because this exam is a beast.

No question source out there completely emulates this exam. Going in I did all the Uslmeworld for medicine excluding the neuro section, pretest, MKSAP, and Kaplan QBook. Read case files cover to cover several times and Step Up. Best preparation seems crushing step I and remembering every tiny detail that was ever said on my medicine rotation :meanie:.

When I took it, it was nowhere near as general as I expected. There were a number of Step 1-type super picky or obscure questions. I'm not sure I had more than 1 CHF question.

Is the IM shelf more therapy or diagnosis.

Should I focus on figuring out what the patient presents with or how to treat it?

Thanks guys!

Is the IM shelf more therapy or diagnosis.

Should I focus on figuring out what the patient presents with or how to treat it?

Thanks guys!

A bit of both, but more diagnosis than therapy IMO. Much much less emphasis on recently issued society guidelines and things of that nature than you'll find in MKSAP.

A bit of both, but more diagnosis than therapy IMO. Much much less emphasis on recently issued society guidelines and things of that nature than you'll find in MKSAP.

As in "what is the next best step in the management" or "what is the diagnosis"? Also, should I be worried about the various shades of asthma and when to add what specific treatment, a la MKSAP? What about those pesky pneumonia questions (that I got killed on for MKSAP) with CAP vs Pseudomonal risk vs blah -- i.e. which abx to give?

...

So I'll ask again...anyone know of a correlative score with Kaplan IM QBank scores?

oof, that was the first time I actually ran out of time on UW. I was doing 40 questions of IM, and I hit stop with like 8 seconds left. I can see how people run out of time on the shelf.

Hey so I did the practice NBME questions and got 19/20. I totally haven't studied enough during this rotation and I'm a little scared of failing the shelf. My hopes are resting on how I did on the practice q's. I haven't even quite gotten through Step Up, nor touched any qbanks of any sort at all. I did find myself easily and quickly answering the NBME 20 practice q's though. What should I make of my situation? Shelf on Friday.

I feel that I have a relatively strong fund of knowledge, 236 Step I, and good test taking skills in general. A little worried, a little not...basically just can't wait to be done with this rotation.

Oh, man, I GET IT. BLACK WOMEN GET SARCOIDOSIS. SARCOIDOSIS AFFECTS BLACK WOMEN. WOMEN, WHO ARE BLACK, GET SARCOIDOSIS. SARCOIDOSIS AFFECTS WOMEN WHO ARE BLACK.

Ugh, seriously. How many times does UW think they need to ask me?

Just took the practice NBME questions as well. 19/20. Missed the melanoma question (thought it was basal cell). Those questions were seriously a piece of cake. I didn't get all the way through Step Up or Case Files either, but I've done 400+ UW questions and a good chunk of MKSAP3. Shelf is in the morning. Here goes nothing.

2 months is nearly not enough to study for this thing... oh well, at least i get psych next :cool:

Just took the practice NBME questions as well. 19/20. Missed the melanoma question (thought it was basal cell). Those questions were seriously a piece of cake. I didn't get all the way through Step Up or Case Files either, but I've done 400+ UW questions and a good chunk of MKSAP3. Shelf is in the morning. Here goes nothing.Yeah the questions were a walk in the park, totally misleading. I got rocked on the shelf this morn, hope I passed :( didn't pace myself well and had to randomly bubble a few at the end

Yeah the questions were a walk in the park, totally misleading. I got rocked on the shelf this morn, hope I passed :( didn't pace myself well and had to randomly bubble a few at the end
that test felt like a sprint. I didn't have enough time on any question on that test to really think all the way through it. After I read the six-paragraph stem, I had to breeze through the answers and try to pick the right one.

Yeah, don't really understand the need for question stems that are ridiculously long only to have one little detail or lab value that gives away the answer... oh well, just kind of gets tiring with NBME reaming you test after test

wow... that was one hell of a tough exam. i have no clue how people get fewer than 10 questions wrong on that! pretty mind-boggling... anyone have any idea what the national mean is?

i'm not too thrilled that this counts as 50% of our clerkship grade at my school. woof! :thumbdown

wow... that was one hell of a tough exam. i have no clue how people get fewer than 10 questions wrong on that! pretty mind-boggling... anyone have any idea what the national mean is?

i'm not too thrilled that this counts as 50% of our clerkship grade at my school. woof! :thumbdown

Our administration changed the clerkship grade weight of the shelf from 15% to 50% less than 1 week into my IM rotation...which was at the county hospital here...stopped counting weekly hours at 84 (worse yet, most was scut) with 3 days off out of 28...literally had zero time to study let alone read on my own patients, until I had a meeting with my resident mid-way through week 3 of a 4 week rotation...then he started limiting my hours to 8 to 10 per day.

Too little, too late for me. I made an educated guess on at least 75% of the shelf questions. Ouch.

Were there any items you wish you would've studied more or seemed like they were over represented on the test?

Were there any items you wish you would've studied more or seemed like they were over represented on the test?
I wouldn't have prepared any differently than I did. More time would've been nice, but it's like Step 1 - there's so much material that COULD be on there that you have to study everything as much as possible, but there's no way you'll cover it all.

Were there any items you wish you would've studied more or seemed like they were over represented on the test?

for my test, i remember a lot more rheumatology than I would have liked to see.

does anyone know what score would be good for 75th percentile?

For those of you who used UWorld Step 2 questions to review for this test, how representative was UWorld topics for topics on the shelf?

At my school neuro is a seperate rotation, but UWorld includes a lot of neuro under internal medicine. Was there any neuro on the shelf that didnt fall under what you would typically see on the medicine wards (i.e. some delirium, mental status changes, DTs, etc)?

To anyone who has taken the shelf exam:

How many questions were on your test?

Added later:

Was there a particular focus on your shelf exam? For example, would you say ambulatory medicine was more frequently tested compared to say hematology?

For those of you who used UWorld Step 2 questions to review for this test, how representative was UWorld topics for topics on the shelf?

At my school neuro is a seperate rotation, but UWorld includes a lot of neuro under internal medicine. Was there any neuro on the shelf that didnt fall under what you would typically see on the medicine wards (i.e. some delirium, mental status changes, DTs, etc)?
I took it on Friday, and no lie, it's already a huge black hole in my mind. The test went so fast that it was hard for me to do anything other than read and fill in the scantron. Stroke questions are definitely fair game.

test was a freakin blur...had bout 6 questions i had to randomly fill in without even lookin at the choices cuz i ran out of time cuz i made the mistake of getting bogged down by hard questions and not moving on...just read as fast as you can..test is actually pretty basic...mksap 3 is cash money...i wish i would have done it multiple times...also case files is legit and i wish i had read more of it....i studied for oral exams from pocket medicine and covered the 15 core topics we had to learn for those..it was very good...dont get caught up with numbers and charts...you will never need to know all the components of a Child Score for this test..reading the sections on diagnosis and treatment in pocket medicine is pretty much all you need for this test cuz you should remember the basics from step 1 and you combine that prior knowledge with all this diagnosis and treatment stuff from pocket and then read mksap to fill in the blanks...mksap was good cept for some parts in cardio as well as alkalosis/acidosis crap which was too detailed as you wont have to calculate on this test...but dont sleep on mksap and pocket med..

a lot of people think that your score is the number of questions you get right which is far from the truth...i know from personal experience regarding the number of questions i know for sure i got wrong in addition to the ones i absolutely guessed on...actually i freaked out because i filled in all C's for the final 6 choices and then realized afterwards that they were matching questions and so i missed at least 5 of em for being an idiot :( but thats what you get for basically pulling an all nighter...

... anyone have any idea what the national mean is?....

According to the report my school furnished us afterward, the national averages are:

Examination National Mean


Internal Medicine 75.2

Obstetrics / Gynecology 72.6

Pediatrics 74.6

Psychiatry 76.3

Family Medicine 72

Surgery 71.8

According to the report my school furnished us afterward, the national averages are:

Examination National Mean


Internal Medicine 75.2

Obstetrics / Gynecology 72.6

Pediatrics 74.6

Psychiatry 76.3

Family Medicine 72

Surgery 71.8

O_O I thought the mean for the shelf exams are set at 70 with a std dev of 8. I guess you must be talking about raw scores, and I'm surprised that the raw scores average are so high.

Got an 85 (91st percentile) which is good enough to honor the exam component for the clerkship :D

I read through Step Up which I liked and did MKSAP 3, 5 of the Kaplan Q book medicine tests, and some pre-test. I think Kaplan Q book is probably the best representation of the test from the question sources that I used. And the test is nothing like those free NBME questions online.

Got an 85 (91st percentile) which is good enough to honor the exam component for our shelf :D

I read through Step Up which I liked and did MKSAP 3, 5 of the Kaplan Q book medicine tests, and some pre-test. I think Kaplan Q book is probably the best representation of the test from the question sources that I used. And the test is nothing like those free NBME questions online.

99 here, obviously very happy. However, this was almost my exact experience with respect to Kaplan and NBME free q's. The NBME questions were ridiculously easy and not representative. What a gyp.

Was a hard shelf overall for sure. Definitely lots of ortho/anatomy q's and surgery q's I didn't know (someone with an ileostomy draining blah colored fluid- what electrolyte/molecule is deficient?? hello, when did I ever deal with patients s/p ileostomy?? and no, it wasn't as basic as b12 or standard malabsorption as far as I remember). And a bunch of 'which nerve is affected?'. One neuro stroke localization question. Bunch of step 1-level stuff too.

Fortunately, very little in terms of picky asthma guidelines and minute MKSAP stuff. Very little in terms of the nuances of antibiotic selection in the same MKSAP vein, other than maybe amox allergy, prophylaxis, and coverage for atypicals. I only got one 'complex' acid/base q, and that was a simple ABG and needed you to just use your common sense and calculate the AG. Yeah, no Child-Puigh score or anything like that, but I think I had a Ranson's criteria application q.

100 questions, the last 10 (maybe?) have choices A-M or something ridiculous like that. Some of those last few were 'pairs' with the same answer choices, like variants of a GI bleed and you had to tailor your management options to that particular complication in the question. You can definitely think of the answers before answering though. A lot more 'what is the diagnosis?' than I expected, where I had prepared more for 'what is the next step in the diagnostic workup?' or 'what is the next best step in the management?'

I went in being really afraid for time based on what I read here, so I worked extra fast and read really quickly, and always the last line so that I knew what I was looking for. There's a lot of stupid extraneous stuff, like "She owns two cats" (prob to include cat-scratch??). I finished with 40 minutes to spare, but marked about 7 questions I had to think long+hard about. The EKG's were easy, but very application oriented (like knowing which AV blocks are more benign than others).

EKG: Dubin's (a child molester, but fantastic book!)

Wards: Pocket Medicine (so fantastic)

Shelf: Step Up!! (SO FULL OF MISTAKES/TYPOS and wrong arrows and signs, but definitely on track for 'next step in the management')

Case Files 1x, it was ok. Skimmed NMS very lightly on my weak areas. Pretest (easy, but some wacked out q's), MKSAP 2, 3, 14, Kaplan Step 2 QBook (all 8 tests), Harrison's Qbook, Schreier Casebook, NMS questions (hard! and sometimes stupid!), UWorld IM q's (though I got sick of these since they got so repetitive and didn't finish).

Read the relevant Harrison's chapters on chest pain + diabetes + pulm.

In my opinion, as above, Kaplan was the most like the real thing, though the shelf was harder than that.

.... I think Kaplan Q book is probably the best representation of the test from the question sources that I used....

I agree wholeheartedly.

When you say Kaplan qbook, do you mean the Kaplan Step 2 CK qbook or the qbook specifically for internal medicine? I was thinking of getting that to supplement UWORLD and MKSAP

When you say Kaplan qbook, do you mean the Kaplan Step 2 CK qbook or the qbook specifically for internal medicine? I was thinking of getting that to supplement UWORLD and MKSAP

I was referring to the step 2 Q book. theres about 15 tests and 8 of them are IM.

I am ready to give up. I am getting reamed on these UWorld questions. I REALLY hope the difficulty of these questions arent similar to the real thing.

Are the question stems of the shelf exam similar in length to these?

I am ready to give up. I am getting reamed on these UWorld questions. I REALLY hope the difficulty of these questions arent similar to the real thing.

Are the question stems of the shelf exam similar in length to these?

i don't have any experience with the UW questions for medicine but yes, the shelf questions are quite long and difficult. i was pretty exhausted after 100 questions.

To the students who took the QBook IM questions, about what percent were you getting correct. I am getting about 60-70. Is that good enough to pull an 80 on the real deal.

Thanks

To the students who took the QBook IM questions, about what percent were you getting correct. I am getting about 60-70. Is that good enough to pull an 80 on the real deal.

Thanks

on the same note, is there a thread somewhere that correlates percent correct on UW with actual shelf score? I would be very interested to see where I really stand.

on the same note, is there a thread somewhere that correlates percent correct on UW with actual shelf score? I would be very interested to see where I really stand.

i used uw (did about 500 of the IM questions) and mksap (finished most of the book). i was scoring around 60% on uw and i'd say i would usually get 4-5 wrong per question set on mksap and i ended up with a 93 on the shelf. to be honest, i thought the shelf questions were more difficult than both mksap and uw, although i'd say uw comes pretty close. i've been trying to figure out how they grade the exam because i am certain that i did not get 93/100 correct, it's just impossible. anyway, it's a really difficult test and you really need to study and do questions because most of the stuff on the exam is going to be outside the realm of what you actually see on your 8 or 12 weeks of internal medicine. best of luck.

Took the exam today. It was a beast. This was the first time I ever ran out of time on a test.

The last set of questions were really really hard. Did not know what to think of them.

I don't think MKSAP helped that much. Step up was okay. I really felt it was like step 1 all over again.

I hope i passed. Let me know if you have any questions.

Were the Kaplan qbook questions similar in length to the real test?

With respect to content, I think Qbook does a good job. The questions on the real deal are longer. Some questions took up the whole page as they told you everything about the person, his mother and his brother. It was ridiculous.

Good luck

everything about the person, his mother and his brother. It was ridiculous.

and cat/pets.

Just finished the test . . . it was a beat down. I used case files, step up, uworld, kaplan and mksap; so I don't know what more I could have done. It's just one big blur . . . I barely finished in time.

Just finished the test . . . it was a beat down. I used case files, step up, uworld, kaplan and mksap; so I don't know what more I could have done. It's just one big blur . . . I barely finished in time.


welcome to the club...

Are you guys talking about this Kaplan internal medicine book by Conrad Fischer?

http://www.amazon.com/Kaplan-Medical-Internal-Medicine-Question/dp/142779572X

I used the actual Kaplan Step 2 CK question book. It has internal medicine tests. I looked at the book you mentioned, but I was worried it would be too in depth since it is for residents. Doing the kaplan tests helped a little; however, the test was still really difficult. Good luck studying.

I have to take the SHELF exams for my clinical rotations but they don't impact our grade at all so I was wondering: do you think that if one were to do all of the USMLEworld questions for IM 2 or 3 times that that would be enough to comfortably pass the IM SHELF exam?

I have to take the SHELF exams for my clinical rotations but they don't impact our grade at all so I was wondering: do you think that if one were to do all of the USMLEworld questions for IM 2 or 3 times that that would be enough to comfortably pass the IM SHELF exam?

i've heard that 1500 of the 2000 questions on UW are internal medicine so yeah, i think you could manage passing the shelf with UW.

so why exactly do you have to take the shelf if it doesn't do anything?

So I got my grade back, and I actually did pretty well - both nationally and in my class. I don't know if anyone else bothered to use UWorld for the shelf, but I'm sure it helped me out a lot. Step Up was good, but it was a lot to get through, so I didn't use all of it.

I did 850 of the 1500 UWorld questions and I'm hoping they helped me . . . I'll have to wait and see.

i just took the shelf today. honestly, i thought it was hard but i have no idea how i would have studied or prepared any differently. there were a lot of questions with 'chose the next best step' where i was torn between 2 answers. and i was expecting there to be a lot of renal acid-base disorder calculations (delta/delta and all that crap) and there weren't.

i used MKSAP (seemed easier than the shelf q's), Step Up (ok, but kind of dense, not sure how much it helped), CaseFiles (thought this was really good, at least 40 of the 60 cases directly pertained to a shelf question), and USMLEworld step 2 CK qbank (did about 700 of the IM questions, thought these were more similar in difficulty to the shelf questions than MKSAP).

i am dreading getting my score back, since it counts toward more than half our clerkship grade and i'm pretty sure the only effect its going to have is bring my grade DOWN. ugh.

Finally got my score back 88.

Not the greatest, but good enough to matter.

I was getting about 70 on MKSAP and 80 on Qbook.

Good luck to all!

Just got my scores back today... did pretty well. The exam is hard, but doable. And I didn't have a ridiculous step 1 score. I read as fast as I possibly could, questions first then passage, and finished with two minutes to go and went back to a couple of questions. If you are not that fast of a reader, you could probably get away with skimming most of the questions. I used the following:

step up (but only a few chapters, it can be tedious)
mksap 3
700Q's from UWorld targeted to the exam breakdown categories posted on their website
conrad fischer's 200 mostly likely diagnoses for step 2
case files

If I had to do it over, I probably would've skipped step up and done more UWorld and finished all of case files. Good luck!

Got my scores back and had a got raw score of 86, which means I got honors. I HIGHLY suggest doing as many UWORLD questions and kaplan q-book questions as possible. The Kaplan questions were especially representative of the questions.

Got my score back today. I got an 85 which I was very surprised (see previous post about how much I thought the exam sucked!) and happy about because its good enough for Honors!!

I would also suggest the Uworld q's, as they are more like the exam than MKSAP. I didn't use Kaplan qbook, so those might be comparable as well.

CaseFiles + Uworld are my two highest recommendations. Take that as you will :)

when y'all say kaplan questions..are you referring to the Kaplan Step 2 QBook for CK? or is there a special kaplan qbook for IM? Thanks!

It's the Kaplan Step 2 CK question book. It has sets of questions for each rotation (I'm using for my peds rotation right now). It's good to help you with timing.

on the same note, is there a thread somewhere that correlates percent correct on UW with actual shelf score? I would be very interested to see where I really stand.

In case anybody else is trying to benchmark using uw, I got a 90 on the shelf and did about 700 UW questions, with an average of 62%.

Resources: -Step Up to Medicine - good but very dense
-"Medicine" by Fishman - well written and manageably sized textbook
-Consult Manual of Internal Medicine - if you can take the weight, it will fit in your whitecoat

I did one test out of Qbook, and while it was OK, it seemed much easier than UW. Probably useful if you have extra time or no UW access, but if possible, I'd focus on UW before going to Qbook.

I love it how pretty much everybody thinks that this test was terrible but end up doing really well

Just got my NBME shelf exam score back... 83%. I used Kaplan Q-book and Pretest with reference to Step Up for those questions with inadequate explanations (usually pretest did not have adequate explanations... Kaplan has pretty good explanations).

Oh, man, I GET IT. BLACK WOMEN GET SARCOIDOSIS. SARCOIDOSIS AFFECTS BLACK WOMEN. WOMEN, WHO ARE BLACK, GET SARCOIDOSIS. SARCOIDOSIS AFFECTS WOMEN WHO ARE BLACK.

Ugh, seriously. How many times does UW think they need to ask me?

Don't forget black person plus pain= sickle cell no matter what is going on with him and what other comorbidities he has. Newborn jew=tay sachs .Adult jew= crohn's.Mexican with cough=tuberculosis and mexican with abdominal pain= amoebiasis.UW=racism at its finest :)

Hello all. I've been thoroughly reading this thread, and thanks a lot for all of the great tips. I have a few questions...

1) I have taken the psych and ob/gyn shelf exams. My biggest issue by far is timing. I continuously get lost in all the information and find myself rushing to finish by the end. This is incredibly frustrating, because I know it is hurting my score. Any tips on a systematic approach to each question?
2) I realize that doing as many practice questions as possible will also help me get faster. To this end, I already have MKSAP 3, but should I invest in UW as well? From what I've read, everyone seems to think that both are great resources. But..do I realistically have enough time to do both properly? It's December 4th today and my shelf exam is February 6.
3) Lastly, I plan on going through Step Up thoroughly. Does it make more sense to read cardio chapters and then do cardio questions? Or...should I set a reading schedule and do a set of random questions each night?

Please help me out! I really want to do better on the IM shelf than I've done on my previous shelf exams, and I think I need a solid approach in order to do so. In fact, I'd like to ACE IT...so I need some advice. Thanks for reading this, and good luck to everyone with their exams and what-not. :)

Has anyone taken the shelf after working w/ MKSAP 4?

Hello all. I've been thoroughly reading this thread, and thanks a lot for all of the great tips. I have a few questions...

1) I have taken the psych and ob/gyn shelf exams. My biggest issue by far is timing. I continuously get lost in all the information and find myself rushing to finish by the end. This is incredibly frustrating, because I know it is hurting my score. Any tips on a systematic approach to each question?
2) I realize that doing as many practice questions as possible will also help me get faster. To this end, I already have MKSAP 3, but should I invest in UW as well? From what I've read, everyone seems to think that both are great resources. But..do I realistically have enough time to do both properly? It's December 4th today and my shelf exam is February 6.
3) Lastly, I plan on going through Step Up thoroughly. Does it make more sense to read cardio chapters and then do cardio questions? Or...should I set a reading schedule and do a set of random questions each night?

Please help me out! I really want to do better on the IM shelf than I've done on my previous shelf exams, and I think I need a solid approach in order to do so. In fact, I'd like to ACE IT...so I need some advice. Thanks for reading this, and good luck to everyone with their exams and what-not. :)

hey - i've taken both medicine and psych shelf exams so far. i know everyone has different tests, but in my case i found that psych was a lot more straightforward than medicine. i think, overall, the stems were longer on the psych exam, but the clues they provided were a lot more obvious. i finished psych with a decent amount of time left and i think i just barely finished medicine. i would recommend that you check out some of the chapters in step up to medicine. i feel like it really helped me for some things like rationale between what tests to use for what (ie, cholecystitis vs choledocalithiasis, etcetera). i used mksap 3 and not 4, but i thought mskap 3 was not very representative of the exam. i did a bunch of the usmle world step II medicine questions and i thought those were very useful. i know the exam gives you a listing of all the normal range lab values in the test booklet, but i also think it's a good idea to know the ranges of the more common ones off the top of your head. that helps you save some time, if anything. if i were you, i'd just spend time practicing doing timed questions. do usmle world timed and that should be very useful.

best of luck on the exam.

My "grade" was an 82 on the IM shelf exam. I am NOT a superstar med student by any means, I have a life outside medicine and I am very pleased with my score!

Below is basically what it says on the letter we get in our mailboxes. This "grade" is calculated from the subject exam score reported by the national board, using the formula approved by the Dean for the 2010 class.

We are able to take the grade and then use a chart to find our National Percentile Ranks of Scaled Grade. So, the grade of 82 at our school = 53% national percentile rank compared to examinees at other medical schools who took the subject exam.

We aren't given our raw score or the calculation for the grade, just the grade and the chart to find our percentile rank. Our school may grade harder or easier compared to other schools. I don't know how to figure that out other than going back and just looking at what others say their grades were.

So, hope that helps some folks asking about the percentiles, raw scores and grades.

Lots of advice out there, and it can seem overwhelming so below is what I tried to do and ideally what I think would help anyone trying to do well on this exam.

For the shelf, I knew it was hard and I was worried about passing. Looking back, below is what I think is the best way to prep.

1. Step-Up to Medicine. Comprehensive in nature, but make sure you know the major systems the way the book lays the chapters out for you. Cardio, Pulm, GI then do Renal, ID, and don't neglect the Ambulatory Medicine section. I didn't get to everything but know the major systems. This book has all the info you will need for the exam in one source. If you like the outline format then this is THE book to have! I have to understand thing for them to stick so this was my "reference book" when I studied. I needed something else to help me remember and understand the overall picture so that is why I use...

2. Case Files-IM. If you don't like the outline format of S-U, then this is a great way to LEARN about cases you didn't see in the wards but are test on. I liked this format and studied by reading cases by system then used Step Up to solidify the material.

3. MKSAP. After the Cases I read and looking up the chapters in SU, I would do the MKSAP questions. This helped me see how the info would be tested and the answers explain so much that I think it is a waste if people are using MKSAP for just the practice questions. You have to read why you got the question right and wrong to learn anything IMHO.

4. Kaplan Q-Bank IM question set. I saved this for the end. This is a great resource for those who have it. ~800 questions. Don't get worried about the % correct and all that like some do. Again, like MKSAP use it to LEARN the material and get ready for the exam. The time goes by quickly on this exam, don't get bogged down on a question. Know that there are sections that are tough and if you spend tons of time trying to rack your brain, you won't have time to get to the ones you could have answered easily. (My main problemo!)

Good Luck!

My "grade" was an 82 on the IM shelf exam. I am NOT a superstar med student by any means, I have a life outside medicine and I am very pleased with my score!

Below is basically what it says on the letter we get in our mailboxes. This "grade" is calculated from the subject exam score reported by the national board, using the formula approved by the Dean for the 2010 class.

We are able to take the grade and then use a chart to find our National Percentile Ranks of Scaled Grade. So, the grade of 82 at our school = 53% national percentile rank compared to examinees at other medical schools who took the subject exam.

We aren't given our raw score or the calculation for the grade, just the grade and the chart to find our percentile rank. Our school may grade harder or easier compared to other schools. I don't know how to figure that out other than going back and just looking at what others say their grades were.

So, hope that helps some folks asking about the percentiles, raw scores and grades.

Lots of advice out there, and it can seem overwhelming so below is what I tried to do and ideally what I think would help anyone trying to do well on this exam.

For the shelf, I knew it was hard and I was worried about passing. Looking back, below is what I think is the best way to prep.

1. Step-Up to Medicine. Comprehensive in nature, but make sure you know the major systems the way the book lays the chapters out for you. Cardio, Pulm, GI then do Renal, ID, and don't neglect the Ambulatory Medicine section. I didn't get to everything but know the major systems. This book has all the info you will need for the exam in one source. If you like the outline format then this is THE book to have! I have to understand thing for them to stick so this was my "reference book" when I studied. I needed something else to help me remember and understand the overall picture so that is why I use...

2. Case Files-IM. If you don't like the outline format of S-U, then this is a great way to LEARN about cases you didn't see in the wards but are test on. I liked this format and studied by reading cases by system then used Step Up to solidify the material.

3. MKSAP. After the Cases I read and looking up the chapters in SU, I would do the MKSAP questions. This helped me see how the info would be tested and the answers explain so much that I think it is a waste if people are using MKSAP for just the practice questions. You have to read why you got the question right and wrong to learn anything IMHO.

4. Kaplan Q-Bank IM question set. I saved this for the end. This is a great resource for those who have it. ~800 questions. Don't get worried about the % correct and all that like some do. Again, like MKSAP use it to LEARN the material and get ready for the exam. The time goes by quickly on this exam, don't get bogged down on a question. Know that there are sections that are tough and if you spend tons of time trying to rack your brain, you won't have time to get to the ones you could have answered easily. (My main problemo!)

Good Luck!

I don't understand how an 82 comes out to be only in the 50th percentile

This is my assigned grade that MY school gives me for scoring in the the 53% in the nation. Why I get a 82 and not a 70? I don't know the formula they use at my school for converting the %score to a grade for the shelf only, its not my entire rotation grade.

I just got my scores back and got 99th percentile on the IM shelf. To be honest, if you did well on Step 1, then this shelf should be a breeze.

I used Step Up and USMLE World Step 2 Qbank throughout the rotation. I did UWorld by subject in my weak areas. I did ~600 of the 1500 questions and read all of Step Up.

I also did MKSAP 3 after reading the corresponding chapter in Step Up and took notes on ALL questions.

The last 2-3 weeks I did MKSAP 4. I typed up notes/made charts on concepts I wanted to remember. By the end, I had around 60 pages of notes. The last week I read case files non stop and reviewed my notes over and over again in addition to glancing over First AID for step I in subjects I was weak in.

I also did 3 tests in Kaplan Qbook the last week. I recommend doing all of the tests if you can.

I highly believe in doing as many questions as possible. You will learn most of the info you need on the wards, but it's good to get in the habit of answering test style questions. Additionally, I am one who really learns from the answer explanations.

I finished the exam with 30 minutes to spare. I read the last line of each question, the answer choices, then skimmed the paragraph above. I highly recommend this method. I marked about 15 questions to go back to at the end as I always have extra time on the shelf exams. This was crucial for me as I had more than enough time to think about these harder questions.

In the end, I left the test thinking that I had done well but was worried about stupid mistakes from going too fast. I was pleasantly surprised when I got my score.

I thought this shelf was easier than the other I have taken. It really wasn't that bad guys. If you dedicate the last 3 weeks to hardcore studying (and I was still really busy with wards), then I think you will do well.

Good Luck!

Congrats on rocking the shelf Veggie! Since you used both MKSAP 3 and 4, perhaps you can answer my question: are the questions in each book completely different from each other? or is 4 basically just an updated version of 3?