Official Internal Medicine Shelf Exam Thread

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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.

Originally Posted by docjolly

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.

Originally Posted by bowels

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

Originally Posted by DreamRavyn

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.

Originally Posted by Long Dong

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

Originally Posted by RoccoWJ

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??

Originally Posted by climbingdocs

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

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.

Originally Posted by BlackNDecker

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 explaining the shelf exams:

Originally Posted by NBME

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.

Originally Posted by bowels

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.

Originally Posted by blz

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.

Originally Posted by bjackrian

This is incorrect. From the PDF available on the NBME site explaining the shelf exams:

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!!! 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...

Originally Posted by joe6102

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?

Originally Posted by DaveinDallas

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.

Originally Posted by ambiguous

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?

Originally Posted by TheProwler

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?

Originally Posted by bonnielass13

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.

Originally Posted by TheProwler

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?

Originally Posted by Samoa

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 .

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!

Originally Posted by Alex05

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.

Originally Posted by dilated

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.