Official Internal Medicine Shelf Exam Thread

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Originally Posted by NewAndImproved

Silly question.

When you guys say "raw score 95", has that number been in any way adjusted by the NBME? In other words, did you only miss 5 out of 100 on the shelf?

I really don't know why people use the term "raw score," because those scores are NBME scaled scores, with an approximate average of 70 and standard deviation of 8. The only two numbers the NBME reports are the scaled score and your percentile, and the percentile isn't included on individual reports, but your clerkship office should have access to the list of the correlation between scaled score and percentile. The percentile is broken down by the quarter of the year during which you take the exam (because an 80 in the first part of the year will be a higher percentile than later in the year, since people will have had fewer other rotations at the beginning of 3rd year).

Originally Posted by metallo

The percentile is broken down by the quarter of the year during which you take the exam (because an 80 in the first part of the year will be a higher percentile than later in the year, since people will have had fewer other rotations at the beginning of 3rd year).

I'm not sure why that is the case if the average is set to be 70 and the SD 8 for each testing. Wouldn't that lock in the percentiles? I think that it just means that an 80 late in the year means more than an 80 early in the year.

Am I doing myself a huge disservice by not using MKSAP and only using UWorld? I don't think I'll have time to do both so I think I have to pick one...

Originally Posted by NewAndImproved

Silly question.

When you guys say "raw score 95", has that number been in any way adjusted by the NBME? In other words, did you only miss 5 out of 100 on the shelf?

The raw scores are adjusted numbers and are not percentages/number correct. The NBME attempts to standardize the exam so that the mean is 70 with a standard deviation of 7. Scores roughly reflect that... however the different exams seem to have different means/distributions.

Originally Posted by ladybug711

Am I doing myself a huge disservice by not using MKSAP and only using UWorld? I don't think I'll have time to do both so I think I have to pick one...

I just took the exam last week, and I thought UWorld was a much better resource than MKSAP. MKSAP is pretty good for the basic concepts with the bread and butter of internal medicine (CHF, diabetes, pneumonia, UTIs, etc.), but it really lacks depth. As for the shelf itself, there wasn't much asked about the basic diseases and most of it focused on stuff not found in MKSAP. So in my opinion, UW is much better than MKSAP.

I have 2 weeks left to study. Haven't really studied much thusfar. I did ~500 world questions & I've skimmed parts of step up. Haven't read the cardio or pulm chps @ all yet. Should I try to read step up cover to cover or just finish world? Unfortunately I don't have time for both. Thx in advance!

Originally Posted by psych

I have 2 weeks left to study. Haven't really studied much thusfar. I did ~500 world questions & I've skimmed parts of step up. Haven't read the cardio or pulm chps @ all yet. Should I try to read step up cover to cover or just finish world? Unfortunately I don't have time for both. Thx in advance!

Two weeks should really be adequate time to do both, assuming you aren't hanging on every word of Step Up. I got through the entire book in a week, and I'm not a fast reader. If you're a really slow reader or have trouble not agonizing over details, I would at least recommend reading the cardio and pulm chapters (biggest two topics on the exam) and finishing UWorld. Like most others here, I can't stress enough how good the UWorld Medicine questions are for this exam.

Originally Posted by metallo

Two weeks should really be adequate time to do both, assuming you aren't hanging on every word of Step Up. I got through the entire book in a week, and I'm not a fast reader. If you're a really slow reader or have trouble not agonizing over details, I would at least recommend reading the cardio and pulm chapters (biggest two topics on the exam) and finishing UWorld. Like most others here, I can't stress enough how good the UWorld Medicine questions are for this exam.

I'm on inpt & my schedule is crazy. Plus, I still have 2 calls to do. Ill try to squeeze in as much as I can. Thx again.

Originally Posted by psych

I'm on inpt & my schedule is crazy. Plus, I still have 2 calls to do. Ill try to squeeze in as much as I can. Thx again.

Only one call a week? You'll be fine.

Originally Posted by Guile

I'm not sure why that is the case if the average is set to be 70 and the SD 8 for each testing. Wouldn't that lock in the percentiles? I think that it just means that an 80 late in the year means more than an 80 early in the year.

The reason the percentiles aren't "locked in" is because the exam isn't standardized to a mean of 70/standard deviation of 8 for each testing. Those numbers are based on, as the NBME puts it, "a scaling group of first-time takers from U.S. LCME-accredited medical schools who took this examination as a final clerkship examination under standard testing conditions." According to the NBME website, that group took the exam during the 1993-94 academic year. Presumably, like USMLE scores, students' shelf scores are increasing as schools admit more competitive applicants and students study more.

Originally Posted by metallo

The reason the percentiles aren't "locked in" is because the exam isn't standardized to a mean of 70/standard deviation of 8 for each testing. Those numbers are based on, as the NBME puts it, "a scaling group of first-time takers from U.S. LCME-accredited medical schools who took this examination as a final clerkship examination under standard testing conditions." We have no idea how long ago the standardized group saw those exam questions, and we certainly don't know what other clerkships they had completed before the exam or how far along those students were in their third year.

Thanks for clarifying.

Originally Posted by Guile

Thanks for clarifying.

No problem... I edited my previous post with updated info once I found it on the NBME site. Here's the link:

http://www.nbme.org/Students/SubExam...scoreint1.html

took the medicine shelf yesterday. it was hard but definitely doable. Medicine was my first clerkship. to be honest I'm still pretty burnt-out from step 1 and only studied the last two weeks or so of the rotation (along with paying attention on rounds, etc..). I read most of step-up and did ~800 UWorld questions. Uworld was by far the best resource for the shelf.

Hey... I haven't taken time to go back through this whole thread, so maybe this has been asked before...

I started UWorld for the IM shelf yesterday (I'm taking in less than three weeks), and my first few sets of questions, I scored around 60%, but my percentile rank was only 38th! Yikes! I am hoping those percentiles are mostly based on people studying for Step 2 who have been through a whole year of rotations already (I've only had 9 weeks of medicine so far.)

Should I be concerned about my standing on the shelf if I'm scoring 60% on questions? What percentages and/or percentiles should I be shooting for on the IM questions before taking my shelf? I would like to score above average on the shelf, if possible (80's would hopefully be a realistic goal!) Any thoughts?

coldweatherblue (or others who took it recently), would you recommend reading Step up to Medicine 1x full for the IM shelf and doing half of the IM Uworld questions, or not making it through all of step up (doing about half), but making it through all of the Uworld questions? Time is running out!!!

Originally Posted by PistolPete

coldweatherblue (or others who took it recently), would you recommend reading Step up to Medicine 1x full for the IM shelf and doing half of the IM Uworld questions, or not making it through all of step up (doing about half), but making it through all of the Uworld questions? Time is running out!!!

definitely do as many UWorld questions as possible. For me at least UWorld is by far the most efficient/productive/valuable way to learn and understand the material. Just read Step up lightly (a chapter a day is doable) and do questions. I spent about two weeks studying (about a week of that was solid studying) for the shelf using primarily UWorld (honestly did not study at all outside of those two weeks except for presentations and reading about patients) and was very happy with my score.

Originally Posted by coldweatherblue

definitely do as many UWorld questions as possible. For me at least UWorld is by far the most efficient/productive/valuable way to learn and understand the material. Just read Step up lightly (a chapter a day is doable) and do questions. I spent about two weeks studying (about a week of that was solid studying) for the shelf using primarily UWorld (honestly did not study at all outside of those two weeks except for presentations and reading about patients) and was very happy with my score.

Sonds like the consensus that UWORLD is money, but what kind of percentages were you getting on question sets that you obviously came away with a healthy margin to pull it off on the real shelf??

Originally Posted by 2thguy82

Sonds like the consensus that UWORLD is money, but what kind of percentages were you getting on question sets that you obviously came away with a healthy margin to pull it off on the real shelf??

I did all of MKSAP 4 plus about 500 UWorld questions, using Step Up for reference here or there (fell asleep every time I tried to read it, gave up after 11 pages). I averaged around 63% (never really went higher or lower as I proceeded) and ended up with a 91 on the shelf. UWorld is the best thing you can do. Hope it helps!

Originally Posted by 2thguy82

Sonds like the consensus that UWORLD is money, but what kind of percentages were you getting on question sets that you obviously came away with a healthy margin to pull it off on the real shelf??

I averaged ~77% for about 800 UW questions which is something like 86th%tile and my shelf was around 92%tile iirc.

What do most people think of the MKSAP 4 questions? Are they representative of the shelf? Too easy? Too hard? Trying to decide if I should attempt some of these in addition to Uworld, or just stick to Uworld...

I see a biostats section in uWorld. Are there biostats on the board exam?

Is this enough to get ~80th percentile:

1. Case Files
2. UWorld
3. MKSAP 4
4. Step Up to Step 2: I am annotating Step Up to Step 2 with World, and plan on using DIT. I want to use SUTM, but I don't know if I will have time to get to it. Is SUTM that essential?

Hi guys,

Quick recap. What's good for IM Shelf? I plan on using:

Step UP to Medicine
MKSAP 2 + 4
Kaplan Qbank IM questions

I know the UW is good for Internal medicine, but is it good for internal medicine like it's good for Step 1 or do you guys think I can get by with Kaplan. I have a year subscription and I'd hate to buy it just for this shelf but if it's that good, I'll pay for a 2 month subscription.

Can't lie. UW is pretty awesome for the medicine shelf. I would recommend it. Can you get by and do well with what you already have? I would bet so. That's a pretty hefty list there.

Originally Posted by vicinihil

Hi guys,

Quick recap. What's good for IM Shelf? I plan on using:

Step UP to Medicine
MKSAP 2 + 4
Kaplan Qbank IM questions

I know the UW is good for Internal medicine, but is it good for internal medicine like it's good for Step 1 or do you guys think I can get by with Kaplan. I have a year subscription and I'd hate to buy it just for this shelf but if it's that good, I'll pay for a 2 month subscription.

One of the MKSAP's should be fine, you may find that doing 2 of them is repetitive. This way, you have more time to get through UWorld which many on this forum have concluded as being a excellent source for the medicine shelf.

I've got the shelf on Friday, I'm currently working through UW. I'm at 68% through about 700 Qs so far. This is exactly 10% lower than my Step I UW average, so I'm pretty bummed about that, but some of these questions are freaking hard!! I'm hoping I've learned enough to get into the 90 range on the real deal, we shall see.

I've got mine on Friday as well...closing step up, closing case files, closing mksap

Just hitting UWorld like a demon for two days. God I hope this works...feels like a crazy gamble

Originally Posted by Blondnuttyboy

I've got mine on Friday as well...closing step up, closing case files, closing mksap

Just hitting UWorld like a demon for two days. God I hope this works...feels like a crazy gamble

A wise decision.

Originally Posted by Guile

A wise decision.

you felt like the questions from world were more representative yeah? What about the 'general medicine' section from mskap, no equivalent in world..

thanks, obviously im freaking out

Originally Posted by Blondnuttyboy

you felt like the questions from world were more representative yeah? What about the 'general medicine' section from mskap, no equivalent in world..

thanks, obviously im freaking out

Yeah I felt World was very representative. I didn't do the MKSAP questions.

Well, I got out of the exam a couple of hours ago.

The exam seemed very close in difficulty and scope to UW. Even with the time extension, I only finished about 10 minutes early. I felt I was working hard and trying not to let myself get caught up on questions for too long - I think had I taken the exam last year, I would not have finished. I don't know how previous years finished it.

I noticed a few of my classmates were scrambling at the end. I think a decent number of students either didn't finish or were at very least in a sprint at the end.

One of my good friends (who I suspect did well on Step 1 but I don't ask for specifics) used MKSAP 4 to prepare. He said the questions were not even remotely similar and felt unprepared for the exam both in terms of level of difficulty and time management.

Not sure how I feel about my performance overall - kind of similar to Step 1. I don't think I failed it, but I don't think I did particularly well. Time will tell but I feel I did about average on the exam.

Originally Posted by astrocreep96

Well, I got out of the exam a couple of hours ago.

The exam seemed very close in difficulty and scope to UW. Even with the time extension, I only finished about 10 minutes early. I felt I was working hard and trying not to let myself get caught up on questions for too long - I think had I taken the exam last year, I would not have finished. I don't know how previous years finished it.

I noticed a few of my classmates were scrambling at the end. I think a decent number of students either didn't finish or were at very least in a sprint at the end.

One of my good friends (who I suspect did well on Step 1 but I don't ask for specifics) used MKSAP 4 to prepare. He said the questions were not even remotely similar and felt unprepared for the exam both in terms of level of difficulty and time management.

Not sure how I feel about my performance overall - kind of similar to Step 1. I don't think I failed it, but I don't think I did particularly well. Time will tell but I feel I did about average on the exam.

If I had only used MKSAP, I would have been SCREWED. Those questions were just as hard as UW, maybe harder. Step I was a walk in the park compared to this thing...truly a beast. If Step II is this hard, I don't have a chance!

I finished with about 2 minutes left. I heard some people not getting to 20+ questions! This is not a test to screw around with, study hard people!

Originally Posted by lildave2586

If I had only used MKSAP, I would have been SCREWED. Those questions were just as hard as UW, maybe harder. Step I was a walk in the park compared to this thing...truly a beast. If Step II is this hard, I don't have a chance!

I finished with about 2 minutes left. I heard some people not getting to 20+ questions! This is not a test to screw around with, study hard people!

For perspective, this was the one shelf I remember that no one out of the block of 50 students taking it, finished early. I am pretty sure I noticed everyone still filling in answers to the last second, and this was the only time this class-wide time crunch happened the whole year of taking clerkship exams. Of course, we had the 2 hr 10 minute time limit, so consider yourselves fortunate to have an extra 20 minutes!

Originally Posted by Adelaide Nick

For perspective, this was the one shelf I remember that no one out of the block of 50 students taking it, finished early. I am pretty sure I noticed everyone still filling in answers to the last second, and this was the only time this class-wide time crunch happened the whole year of taking clerkship exams. Of course, we had the 2 hr 10 minute time limit, so consider yourselves fortunate to have an extra 20 minutes!

The extra time really made the difference. I wouldn't have finished without it. I don't mean to be an alarmist, but this test was freaking hard!!!

This exam was ridiculously long. I had heard that they not only increased time but they also increased length of clinical vignette. I finished with like 10 minutes left, but there was a 20 question block where I just don't remember anything lol. Now here's to the wait until the score.

How long does it typically take for the nbme folks to send score reports?

Took the IM shelf about 2 weeks ago. I am going to say that this was the hardest test of my life. WAY harder than Step 1. I BARELY finished, as in, I had to randomly pick an answer for the last question because I didn't even have time to read it.

The vignettes were ridiculously long. I also thought that the questions were very picky, much less clear than UWorld. The "read the last line and skim the question" method only worked once in a while, because they would throw in a key piece of information in the middle of that whole block of sentences, sigh...

I did about half of Uworld and read through the high yield sections of Step Up (cardio/resp/renal/GI x2) and still felt very unprepared. Not sure what I could have done differently.

Not sure how I did on this thing... just hope I passed!

I did all of the medicine section of UWorld, MKSAP 4, and Step Up and still felt pretty unprepared. I mean I would say the majority of the test I was very confident of the answers, but for the remainder I really had no clue of the answer. It didn't feel as if I had "seen" those questions before.

Originally Posted by Jolie South

I did all of the medicine section of UWorld, MKSAP 4, and Step Up and still felt pretty unprepared. I mean I would say the majority of the test I was very confident of the answers, but for the remainder I really had no clue of the answer. It didn't feel as if I had "seen" those questions before.

I did the same prep you did with out the MKSAP, and felt the same way.

I did get my score back today though, 90. Not sure what the raw score was, but that's the scaled score on my score report.

feels good to get an H in IM! all the hard work paid off

Originally Posted by Jolie South

I did all of the medicine section of UWorld, MKSAP 4, and Step Up and still felt pretty unprepared. I mean I would say the majority of the test I was very confident of the answers, but for the remainder I really had no clue of the answer. It didn't feel as if I had "seen" those questions before.

any thoughts on the relative strengths of mksap vs uworld? I have mksap 3 already, and would like to avoid getting uw if at all possible.

Originally Posted by Miss Alyssa

I see a biostats section in uWorld. Are there biostats on the board exam?

I believe I had two biostats questions on my IM shelf, and both were very straightforward.

Originally Posted by turkeyjerky

any thoughts on the relative strengths of mksap vs uworld? I have mksap 3 already, and would like to avoid getting uw if at all possible.

I felt like UWorld was much more broad while MKSAP was like the bread and butter stuff.

Originally Posted by Jolie South

I felt like UWorld was much more broad while MKSAP was like the bread and butter stuff.

Can I get away with just completing most of UWORLD medicine questions? I am concerned I am missing out on the bread and butter stuff by not doing MKSAP. But if I take the time to do MKSAP, I will probably not even get through half of UWORLD medicine questions.

Advice please fellow SDNers! Thanks!

Originally Posted by badasshairday

Can I get away with just completing most of UWORLD medicine questions? I am concerned I am missing out on the bread and butter stuff by not doing MKSAP. But if I take the time to do MKSAP, I will probably not even get through half of UWORLD medicine questions.

Advice please fellow SDNers! Thanks!

I don't think you have to choose. I made it through all of medicine UWorld and MKSAP 4 in my 3 month rotation. I would just do some questions every day while watching tv at home.

Originally Posted by Jolie South

I don't think you have to choose. I made it through all of medicine UWorld and MKSAP 4 in my 3 month rotation. I would just do some questions every day while watching tv at home.

My school as 2 months Internal Medicine during 3rd year! We do 1 more month in our 4th year... but obviously we take the shelf after the 2 months of Internal Medicine in 3rd year. That is why I feel like I have to choose.

Originally Posted by badasshairday

My school as 2 months Internal Medicine during 3rd year! We do 1 more month in our 4th year... but obviously we take the shelf after the 2 months of Internal Medicine in 3rd year. That is why I feel like I have to choose.

It's not that bad dude--our third year rotation is only 6 weeks long!

when you guys say UW, are you talking about the Step 1 question bank or the step 2 question bank?

Originally Posted by otacon88

when you guys say UW, are you talking about the Step 1 question bank or the step 2 question bank?

The Step 2 CK Qbank

Tier 1 -- Must use
USMLE World

Tier 2 -- Nice, but very much optional
NMS Casebook, USMLE Rx, Paying attention on rotation

Tier 3 -- Highly overrated
Step Up to Medicine, Casefiles, MKSAP3, MKSAP4

-----

I did World at a rate of 22 questions per day, redid the questions I got wrong, and then redid some sections I was weakest in.

I read about ~100 pages (mostly Cardiology) in Casebook. I tried doing some MKSAP 3, but gave up after getting halfway through.

If I did it over again I'd just do World, and read Casebook when a computer wasn't around. Casebook is overkill though, so don't stress the details. Just know the keys to diagnosis, and the cornerstones of treatment (i.e., surgery for Type A aortic aneurysm, beta blockers for Type B), and maybe a few mechanisms.

Having a strong STEP I foundation is very helpful. If you don't, I recommend doing all the Medicine questions in USMLE Rx Step 2 CK.

I got a scaled score of 97, which I'm happy with.

Overall the shelf is very straightforward. You don't need to read any books or have a high level of arcane knowledge. You need to do World intensely (spend about 1-2 good hours on those 22 questions), and test-taking skills. That's all.