Official Internal Medicine Shelf Exam Thread

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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.

Originally Posted by Kluver_Bucy

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.

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!

Originally Posted by Long Dong

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.

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.

Originally Posted by Kluver_Bucy

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?

Originally Posted by Pox in a box

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.

Originally Posted by Kluver_Bucy

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.

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

Originally Posted by Pox in a box

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.

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.

Originally Posted by mfrederi

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?

Originally Posted by Samoa

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.

Originally Posted by xaelia

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

Originally Posted by jojo14

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

Originally Posted by BlackNDecker

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

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).

Originally Posted by omarsaleh66

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

Originally Posted by xaelia

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....

Originally Posted by mfrederi

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.

Originally Posted by samyjay

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.

Originally Posted by RoccoWJ

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

I recieved a raw score on my surgery shelf.

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

Originally Posted by DoctorDoogie4

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.

Originally Posted by arthrodisiac

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!!

Originally Posted by TheRoach

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.

Originally Posted by ColdChillin

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!