Official Surgery Shelf Exam Discussion Thread

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Originally Posted by vicinihil

Hi all,

I'm new to the Clinical Rotations forum and my first rotation starting next month is Surgery. I'm browsing this forum and have essentially concluded that I need to buy

1. Recall
2. NMS
3. Find Pestana
4. And do some questions from a Bank.

My question concerns number 4. Many of you mentioned UW and some of you did the Kaplan Qbook. I was thinking of getting a 1 year subscription to Kaplan Qbank for CK and saving UW until when I'm prepping for the actual CK exam. What do you guys think? You are much more versed and experienced than I am for this. I look forward to the help.

Thanks!

I bought a year subscription to UWorld and I don't regret it one bit. I've been rocking shelf exams and UWorld has been a huge factor. With a year long subscription you do get to reset the question bank once. I plan to do so before step 2, which I will be conveniently taking right before the 1 year subscription expires.

As for "saving UWorld for Step II"... I know people that do this, but my arguments against this are the following:
-At least at my school, shelf exams are a significant chunk of your grade... they're definitely the most objective portion and generally represent the fine line between pass/high pass/honors. As far as the match goes, I'd say that it's a good idea to use the best resources you have to get honors in your 3rd year rotations as opposed to saving them to aim for a high step 2 score. This operating under the assumption that your 3rd year clerkship grades hold more weight than your step 2 score in the match.
-with a bank of 2000 questions, many of which you'll see only once over the course of a year, the odds are that if you get a question correct on a repeat viewing, I would say it is because you learned the concept... not memorized the question


just my thoughts, totally up to you.

Originally Posted by Depakote

-with a bank of 2000 questions, many of which you'll see only once over the course of a year, the odds are that if you get a question correct on a repeat viewing, I would say it is because you learned the concept... not memorized the question

Quoted for truth.

Thanks guys, it's also a hundred bucks cheaper!

Anyone else have comments regarding buying Kaplan Qbank v. UW and saving UW for the end before step 2?

Originally Posted by Depakote

I bought a year subscription to UWorld and I don't regret it one bit. I've been rocking shelf exams and UWorld has been a huge factor. With a year long subscription you do get to reset the question bank once. I plan to do so before step 2, which I will be conveniently taking right before the 1 year subscription expires.

I think buying Uworld early is a good idea as well, but I would consider buying it solely for the Medicine shelf and Step II. A little more than 1/2 of the questions are devoted to medicine, so you'll get more bang for your buck for that shelf. If you're lucky enough to have medicine last, you might be able to get away with buying u world for 3 mo and using it for the medicine shelf and then step II.

Originally Posted by vicinihil

Thanks guys, it's also a hundred bucks cheaper!

Anyone else have comments regarding buying Kaplan Qbank v. UW and saving UW for the end before step 2?

Yeah I would get UW too. It's great. And like Depakote said, you're not going to remember the questions. There are too many of them. I would pass on Kaplan Qbank.

Not to add a counterpoint to those listed above, but I did not use a dedicated question bank during third year and was still able to score highly on the shelf exams mainly by using other resources including those you've listed for your surgery rotation. So while helpful, I do not think it is necessary to subscribe to a question bank if you pick out solid resources for each rotation.

I agree with Mortal Lessons. I'm a cheapskate. And if you've already done you medicine studying all you probably need for Surgery will be: NMS, Kaplan, and maybe some trauma and perioperative mgmt Qs from whatever source you can get your hands on.

Did well. Used this thread as a guide, so thought I'd give back.

1- NMS Casebook is GOLD. I read it 2x thoroughly, and read 3/4 of it a 3rd time. It's great for knowledge period, regardless of shelf. It's also great for shelf because the whole book is in "what's the next step/mgmt" format which is essentially 90% of the shelf. It Teaches you to think in that manner.

2- I did A&L and Pre-test. Thought A&L was way harder than the shelf, Pre-test was very valuable I don't know why people don't put as much weight into it. I did Pre test the last week and saw a couple of questions on the exam from it.

3- Pestana review (the short version) x2

Took shelf today. As per usual, had some medicine questions masqueradating as surgery on the exam (i.e. none of the choices had anything to do with surgery or deciding to perform surgery - even some questions were about conditions that are not even managable by surgery).

1: Kaplan Step 2 Notes/Pestana (200pg version) was gold. Almost every question regarding surgery was at least mentioned. Several questions on the exam did go beyond the detail of these notes, especially with regards to perioperative management.

2: Pre-test was hard and covered some subject areas that didn't come up on the exam. The core sections related to GI and Trauma were helpful.

3: Case Files: good to read at the beginning of the rotation, but I got far more out of reading the Kaplan notes.

I had Appleton and Lange, Lawrence, NMS Casebook, and First Aid on hand, but ran out of time to study. NMS Casebook might have been useful during my skimming of it.

During the clerkship I used Surgical Recall and Grant's, but did not use them for the exam. I also bought the Mont Reid handbook, and didn't use it at all. Borrow a copy from the library and copy the common procedures section, that's it.

Originally Posted by Doctor&Geek

1: Kaplan Step 2 Notes/Pestana (200pg version) was gold. Almost every question regarding surgery was at least mentioned. Several questions on the exam did go beyond the detail of these notes, especially with regards to perioperative management.

Was this the "Kaplan-branded" note set for surgery (with Kaplan logos on each page) or some boot-leg Word document? Thanks.

Originally Posted by Guile

Was this the "Kaplan-branded" note set for surgery (with Kaplan logos on each page) or some boot-leg Word document? Thanks.

They're essentially the same document. Pestana wrote both, though the Kaplan review is more extensive.

Originally Posted by Jolie South

They're essentially the same document. Pestana wrote both, though the Kaplan review is more extensive.

Ok but the Pestana document is the Word document that is ~75 pages, and the "Kaplan Step 2 Notes/Pestana" is ~200 pages? Just trying to get my nomenclature correct. Thanks.

Originally Posted by Guile

Ok but the Pestana document is the Word document that is ~75 pages, and the "Kaplan Step 2 Notes/Pestana" is ~200 pages? Just trying to get my nomenclature correct. Thanks.

Yes

The Kaplan notes are written by Pestana and the first section contains about 70 pages of text that goes over the bulk of his review. The second section is the vignettes which simply puts information from the first 70 pages into vignette form so you have some sort of clinical context like the questions on the shelf. The Kaplan videos that people speak of are Pestana talking about all of the vignettes and adding in some key points here and there as he sees fit. The Pestana word document appears to be simply a typed up copy of vignettes similar to that in the Kaplan notes although I didn't spend time reading the whole thing to find out of they are actually all the same since I already had Kaplan stuff.

Had my surgery shelf today. I'm speechless. Some of those tests mentioned I have never heard of.
There were a bunch of questions, what is your diagnosis. Others were steps in management. Several which bacteria is it questions and treatment. Which surgical procedure to do.
1 question which really struck me was, a patient with parkinsons disease and the supposed surgical procedure to choose was pallidotomy. (go figure, never heard of it before)

-Used Kaplan Pestana notes 2x, section 2- clinical vignettes and some of the kaplan vids.
-Blueprints Q/A Step 2 Surgery- Pretty good question bank. Similar to the ones on the shelf.

Anyways good luck to those taking it.

http://medinfo.ufl.edu:8050/~med2010...ANA-Review.doc

Link to pestana 79 page review. Good luck everyone!

.

Originally Posted by medstud2012

jolie i was wondering how you did on the shelf, I have used much of the same study materials as you did and was wondering if once you got your score your feeling of 'wtf just happened' dissipated?

I haven't gotten my score back yet. My school is ridiculously slow.

haha i see, my school is the same way. actually, once my medicine score had been up for a week on our registrar site but none of us knew because they don't notify us, they just post the score. well, let me know how you did when you find out! thanks for your reply.

93 raw.

UW x1
Kaplan Surgery Notes x1
NMS Casebook x1
Platinum Vignettes x2 (quick read and utterly worthless, but it fit in my pocket and was fun to pull out and [re-]read while on rounds with the attending gazing at me with a look of indignation on his face.. Sorry, No I'm not doing wet to dry and I really don't care whether or not the patient farted today)

Haha Simply put, words cannot describe how much I DETESTED the rotation. And I really just couldn't be bothered to make any attempts to conceal that fact. I seriously could care less if I don't see the inside of an OR for the rest of my life (unless of course, I'm the patient ). Jesus Christ thank god that rotation is over.

Oh, and yes I had medicine right before that rotation. The exam definitely had it's fair share of basic surgery q's but for the most part, like everyone has mentioned, it did felt like a mini-medicine shelf. (which was great for me at least, 'cause I felt right at home lmao). It sucks that people actually interested in surgery who have a grand depth of knowledge on various surgical procedures for a given indication have to take such a diet medicine shelf. Over the course of my 2 month rotation I'd be surprised if I racked up more than 40 hours of OR time (you wouldn't believe the number of excuses I came up with to bail out mid-case ).


Hell, w/ the aforementioned study materials, you can probably do very well on this shelf without even taking the rotation.

Originally Posted by mTOR

93 raw.

UW x1
Kaplan Surgery Notes x1
NMS Casebook x1
Platinum Vignettes x2 (quick read and utterly worthless, but it fit in my pocket and was fun to pull out and [re-]read while on rounds with the attending gazing at me with a look of indignation on his face.. Sorry, No I'm not doing wet to dry and I really don't care whether or not the patient farted today)

Haha Simply put, words cannot describe how much I DETESTED the rotation. And I really just couldn't be bothered to make any attempts to conceal that fact. I seriously could care less if I don't see the inside of an OR for the rest of my life (unless of course, I'm the patient ). Jesus Christ thank god that rotation is over.

Very impressive. I know you mentioned you had medicine before that helped, but did you find the resources to have enough to do well and answer the questions that may be more medical (have surgery after psych which won't be very helpful)?

95 raw

I read case files and Kaplan notes early in the rotation, watched Kaplan (Pestana) vids throughout rotation.

in the weeks leading up to the exam:
NMS, some parts more than once
Kaplan notes again and Kaplan Qs
some Kaplan lectures again
about 75% of Lange Q&A
did perioperative and trauma Qs from Pretest

This one is very straightforward. I think NMS was the best resource overall. I had already done the medicine shelf, so I think your study strategy might be a little different if you do med before surg.

Originally Posted by youngin

Very impressive. I know you mentioned you had medicine before that helped, but did you find the resources to have enough to do well and answer the questions that may be more medical (have surgery after psych which won't be very helpful)?

Hm. Good question. lol. Yeh, I should modify my statement into, "w/ the aforementioned study materials [AND A GOOD IM FOUNDATION], you can probably do very well on this shelf without even taking the rotation."

I didn't exactly rape any of the books aside from platinum vignettes (which feels like it's like, 2 pages long, and of crappy "duh" material lol), so I can barely identify which books helped with which questions. Having a solid medicine background certainly helps, can't tell you if the books do a good job encapsulating that in and of themselves though. :-\

Did well enough to get a nice fat "H":

1) NMS Casebook - the single BEST resource. Read it through twice
2) Pestana cases - great last day prep/review, hit some topics missed by NMS
3) UWorld - great questions, very high yield
4) A&L qbook - far more complex questions than what I saw on the shelf but great to push you to think. I didn't do the whole book and wouldn't recommend it if you're short on time as its not super high yield.

Originally Posted by psipsina

Did well enough to get a nice fat "H":

1) NMS Casebook - the single BEST resource. Read it through twice
2) Pestana cases - great last day prep/review, hit some topics missed by NMS

The reviews on these two resources are so polarizing that it seems as if there are almost two versions of this exam: a "surgery" one and a "medicine" one, and your reviews of these resources parallels which exam you had. Some people have the exact opposite reviews of NMS and Pestana.

I read too many books, didn't do enough questions. Very happy with my score though - ended up with a 95 raw. This exam is a lot of "next step" questions. Especially know when and when not to get a CT.

Resources (read all of these through once)
NMS casebook
Deja Review Surgery (love this series!)
Case Files
Pestana notes

Also read through portions of Mont Reid and Surgical Recall on the wards or before cases.

I read random chapters out of several other books, including NMS surgery (the big one), Lawrence General Surgery, and BRS General Surgery (really liked this one).


Questions:
UWorld
Kaplan step 2 qbook

Originally Posted by psammomabody

I read too many books, didn't do enough questions.

Questions:
UWorld
Kaplan step 2 qbook

Just curious, what other questions would you have done?

Is there any consensus on NMS casebook vs Case Files?

Do both, Case files after NMS makes it go MUCH faster. There is stuff in case files that is verbatim on the shelf.

Originally Posted by turkeyjerky

Is there any consensus on NMS casebook vs Case Files?

I thought NMS was great. Haven't read Case Files. There seems to be a consensus here (minus a few but no opinion is held by 100%) that NMS is great for the shelf.

Originally Posted by Deferoxamine

Quoted for truth.

seriously, with over 2200 questions...that's called learning son!

how do you guys go about reading NMS casebook since its not in question format? I find myself reading through it like a textbook. I'm not sure how much I can retain from casebooks. Any suggestions?

Hi All!

Has anyone used First Aid for the Surgery Clerkship in their preparation for the shelf exam? I'm thinking of reading it, but I would like to know how useful it is. I have read Casefiles, NMS Casebook, Pretest, and Kaplan Step 2 Surgery notes. I plan on doing A&L and UWorld questions also. If anyone has thoughts on First Aid, please feel free to let me know...

Thanks!

mdapp06

I took the shelf last week. Prepped by reading:
Kaplan Surgery (long version) during the rotation, then once more 2 days b/f test
Case files 1x 3 days before test
Uworld 3x total throughout rotation
Looked through A&L
Did the 100q at the end of blueprints night before test


I felt pretty good about the test overall. I had lots of the classic trauma, several biliary tree questions, lots of basic medicine (some skin lesions, some electrolyte abnormalities, endocrine manifestations of tumor syndromes, etc), 2 ethics questions (Jehova's Witness and a ritard), several ENT questions involving cancer (mostly how do we make the diagnosis), and a few anatomy questions phrased in clinical vignettes. A little urology and neurosurg to round it out.

Fair test, very few "WTF are they talking about" questions. Would have bombed it if I didn't have medicine and peds beforehand. But we'll see...

Just had the surgery shelf 2 days ago and it was like everyone says...medicine test with a surgery title. A lot of the questions I felt were straight up questions that could've come from Step 1 or a Path exam. A lot of what is it diagnosis and a lot of what would you do next questions. I used:

Kaplan Qbank Surgery
Pestana vignettes and somes of Long Kaplan
NMS Casefiles

Okay, so for those of us who DON'T have IM before Surgery...

1) What would be the best, most efficient way to prepare for the Medicine-geared questions on this thing? I'm not trying to get 100% on the med-oriented questions, but I'd at least like to get a large chunk of them right... enough to get one of these 95th percentile scores I keep reading on here. On the otherhand, I don't want to miss some good surgery questions because I was busy studying medicine. But there's gotta be some kind of a happy medium here. It might be nice to hear from someone who did really well on the shelf without taking IM first (if they exist).

2) Are there any other rotations besides IM that could help prepare you for the medicine-geared questions? FM seems like it might help. Also, I've read a few people's posts that say some of the material from Step 1 shows up on this thing. So if you rocked step 1, will that help take the edge off some of these medicine questions?

Thanks guys/gals.

Originally Posted by FutrPharm

Okay, so for those of us who DON'T have IM before Surgery...

1) What would be the best, most efficient way to prepare for the Medicine-geared questions on this thing? I'm not trying to get 100% on the med-oriented questions, but I'd at least like to get a large chunk of them right... enough to get one of these 95th percentile scores I keep reading on here. On the otherhand, I don't want to miss some good surgery questions because I was busy studying medicine. But there's gotta be some kind of a happy medium here. It might be nice to hear from someone who did really well on the shelf without taking IM first (if they exist).

2) Are there any other rotations besides IM that could help prepare you for the medicine-geared questions? FM seems like it might help. Also, I've read a few people's posts that say some of the material from Step 1 shows up on this thing. So if you rocked step 1, will that help take the edge off some of these medicine questions?

Thanks guys/gals.

I would not freak out too much. I did surgery first and did pretty well on the shelf. I would get an actual text. Lawrence has sections that cover the medicine-y type stuff, which tends to be covered less in review books/case files. I also used Pretest to get a better grip on those types of questions. Pretest is not similar to shelf questions, but it helped me nonetheless.

I also used NMS Case Files and Kaplan Review right before the test.

Originally Posted by Jolie South

I would not freak out too much. I did surgery first and did pretty well on the shelf. I would get an actual text. Lawrence has sections that cover the medicine-y type stuff, which tends to be covered less in review books/case files. I also used Pretest to get a better grip on those types of questions. Pretest is not similar to shelf questions, but it helped me nonetheless.

I also used NMS Case Files and Kaplan Review right before the test.

Hey thanks for the advice. That's pretty much exactly what I was looking for... a surgery resource that covers some of the medicine stuff. I'm a pretty slow reader, so I might go with Pretest. Thanks again.

I have the same type of question about surgery before medicine, and I'm trying to nail down a book list. What I have so far...

Schwartz's Principles of Surgery: Print the first 10 or so chapters to read the first week of the rotation to get the basics down because of the lack of medicine knowledge. I'd use Lawrence but my library has Schwartz's for free.

NMS Textbook: After the overview with Schwartz using this as a primary resource and hopefully reading it at least twice. I'm the med student who hopefully did well on Step 1 by reading FA over and over so hopefully this approach can work again.

I'm still up in the air between NMS Textbook and Casebook, partly because half the reviews on here don't specify which one they used. It sounds like the text is more comprehensive and that's what I'm looking for, the go to resource like FA was for Step1.

Pestana: Planning on reading this twice.

Surgical Recall: Just a quick overview before each new case, not planning on this being a major part of my studying.

Question books: Still up in the air because none of the reviews have been promising and I'm reluctant to spend 4-500$ to get Kaplan/UW for an entire year. I guess at this point I'm going with Pretest and A&L and just doing the Trauma/GI/Perioperative sections, along with Kaplan Step2 QBook.

Any thoughts? Anything you'd add/remove/do differently? Thanks.

I would use NMS Casebook, because that's more how the questions are presented on the shelf.

You also can't go wrong with Pestana or Kaplan review. Both cover very common presentations in case format.

I would not use Surgical Recall. I had a very low-pimping attending. It was much more important for me to know the basics than know the gunnery pimp details. YMMV.

Thanks for the response, I guess I'll look into both and see which one I like better.

NMS Surgery and FIRST AID Surgery are detailed and excellent books

Question for people on this board:

I am just starting out on my 12 week surgery+ER rotation that notoriously gives us far more time to study than my next 12 week block (medicine). Essentially, our surgery block is only Monday-Thursday 6am - 6pm /w no call and about 6 hours of class each Friday and no weekends (as mandated by our clerkship director after students complained about terrible working conditions several years ago and as is apparently followed quite strictly by the various sites) whereas as medicine is essentially Q4 the whole time. So I want to try to get some medicine studying done at the same time to (1) help somewhat on the surgery shelf and (2) help me not get destroyed on the medicine shelf which I have heard is a complete nightmare.

My plan is as follows:

1) Study NMS Casebook as my primary text.
2) Along with each section in the casebook I'll read and try to really learn some sections of Step Up to medicine. I've picked out about 220 out of the 450 pages in Step Up that I think will be helpful. They are:
ALL of Cardio/Pulm/GI => 160 pages
+ Endocrine (except diabetes) => 20 pages
+ Fluids/Electrolytes/Acid Base => 20 pages
+ Anemia/Platelet/Coagulation/Anticoagulation => 20 pages
___________________
220 pages
3) I will add in the Pestana review but I'm not convinced it adds much more than what is in NMS, maybe I'm wrong though who knows.
4) Question sources => UWorld + QBook
5) Surgical recall => pre-reading on next day's cases ONLY

Please let me know your thoughts on whether I'll need any additional resources and specifically if you'd recommend additional sections from Step-Up. Noticeably, I've left out:
Diabetes, CNS/PNS, Connective Tissue/Joint, Renal/GU, Liquid Onc, ID, Skin, and Ambulatory. I'm really considering adding ID (50 pages) but aren't sure whether there will be time and I'm wondering if this is covered adequately in NMS.
And of course any general comments on the above.

Thanks in advance.

So if you haven't taken medicine, would NMS Surgery + Pestana + UWorld be enough to do well on the shelf? By well I mean 90+.

I don't have the time to get through and entire surgery text, my school tends to work us pretty hard. Lawrence is a required text, but nobody at my school really uses it, we just don't have the time.

Originally Posted by J U I C Y

So if you haven't taken medicine, would NMS Surgery + Pestana + UWorld be enough to do well on the shelf? By well I mean 90+.

I don't have the time to get through and entire surgery text, my school tends to work us pretty hard. Lawrence is a required text, but nobody at my school really uses it, we just don't have the time.

If you're using the big NMS surgery book, then you've probably got the right resources. If you're talking about NMS casebook then you're a bit thin for the score you're aiming for. The other resources are a bit light on the medicine you'll see on the shelf exam. Either way, without the foundation of a few other clerkships, I'd say it's probably unlikely you'll hit 90+ on your first shelf. Unlikely, but not impossible.

Originally Posted by J U I C Y

So if you haven't taken medicine, would NMS Surgery + Pestana + UWorld be enough to do well on the shelf? By well I mean 90+.

I don't have the time to get through and entire surgery text, my school tends to work us pretty hard. Lawrence is a required text, but nobody at my school really uses it, we just don't have the time.

If you want to hit 90+ on your first shelf, then get UWorld and do all the surgery questions 2-3x and do as many medicine questions as humanly possible during your clerkship. There is a ton of medicine on the surgery shelf, as well as straight up pediatrics and OB/GYN questions. Reading a big surgery text may teach you surgery, but I don't think it will help you achieve that score IMHO. Also read the Kaplan surgery notes beginning to end a few times.

Also, I will buck the trend here and say I don't think the NMS casebook is that awesome for the shelf. I think it's a good book and will help you learn surgery and can help with pimp questions and just knowing your stuff on the wards but I don't think it will help with increasing your score significantly. Basically, for the shelf you need to know the next step in diagnosis AND management for every conceivable surgical disease and for a myriad of trauma situations. World and Kaplan do the BEST job at cutting through the BS and getting down to what is most important and high-yield for the shelf. Honestly, I think you could know one of the big surgery texts cover to cover and not get the best score in your class on the shelf. It's more about knowing the buzzwords and what they think you should do next.

Typical shelf question:
- Painless thyroid nodule, what's the next step in diagnosis.
- Kid presents with classic presentation for intussusception, what do you do next
- Patient bleeding out from trauma AND is hypertensive, what drug do you give

Also know when to cut and when not to cut. It's impossible to know everything but UWorld and Kaplan will do the best job at training your gut to feel out the right answer. Good luck.

Reading BRS for now helps before doing a qbank. having a strong core knowledge is best because then u will be able to answer almost any question. Read a good textbook

Originally Posted by radiodoc99

Reading BRS for now helps before doing a qbank. having a strong core knowledge is best because then u will be able to answer almost any question. Read a good textbook

Reading a textbook is always helpful, of course. If you have time for both, that is great. Otherwise, don't sacrifice World time to read a book. World first, World again, then books if time remains.

What drugs are necessary for the surgery shelf exam?