Official Internal Medicine Shelf Exam Thread

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Originally Posted by TheProwler

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

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

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

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

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

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

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

Originally Posted by Rangoli

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

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

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

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

best of luck on the exam.

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

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

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

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

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

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

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

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

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

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

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

Good Luck!

Originally Posted by STAC

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

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

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

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

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

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

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

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

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

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

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

Good Luck!

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

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

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

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

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

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

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

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

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

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

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

Good Luck!

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

I would suggest using MSKAP newest edition, case file, step up X2, and step 2 usmle world.

Thanks for all the helpful tips! Hopefully, this will turn out better than the others...good luck with all of your respective endeavors (in med school and in life in general ).

Originally Posted by VeggieGal

I just got my scores back and got 99th percentile on the IM shelf.

REEEEE-Diculous.

Nice work!

hey guys,

I've just really started using my pocket medicine and by god what a fantastic book it is (can't believe i was oblivious to this until starting IM). I was wondering what if you critically read pocket medicine, would that be good enough for shelf exam? I ask this because I am pretty busy on the floors everyday and don't have much time for step up etc. let me know.

Originally Posted by InternationlDoc

hey guys,

I've just really started using my pocket medicine and by god what a fantastic book it is (can't believe i was oblivious to this until starting IM). I was wondering what if you critically read pocket medicine, would that be good enough for shelf exam? I ask this because I am pretty busy on the floors everyday and don't have much time for step up etc. let me know.

Pocket medicine is a fantastic reference and good for the wards and even subspecialty electives. The topics on shelf exams though tend to be a bit more eclectic and wide ranging and a little less detailed. And believe me, to learn everything in pocket medicine takes as long as reading a book like step-up or similar, and the latter would probably do you better for the shelf.

Originally Posted by VeggieGal

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

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

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

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

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

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

Good Luck!

Wow, congrats! I don't know how people manage to do so well. After the 7-7 workday, what little time I have left over after eating and sleeping generally goes to reading up on patients I saw so I can be pimped the next day. How do you have the time to do all the questions and reading of review books? I've done internal med & Ob/Gyn and am already so tired when I get home. Surgery will kill me before I get to the shelf.

Originally Posted by sunshinedoc

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

Got my scores today--88. Yay, right? Our class average was a 75, right around the national. And yet, somehow I end up with a pass for the clerkship. I didn't have any negative comments in my evaluations either. I hate this. Third year grading is such a capricious, arbitrary mind&%*@. Looking forward to my PM&R residency in North Dakota.

Oh, and if your shelf score actually matters at your school, I second the advice on the UWorld questions.

received my shelf grade and thought i would post to maybe help future test-takers.

my clerkship was 3 mo long and really conducive to success with lots of clerkship quizzes and tests; i had done psych and family before.

used step up to medicine as my primary source and really liked it. i had old goljan path notes i had made from step 1 (the rapid review book+his lectures in note format basically) and inserted these into an un-bound step up in a binder - this was mostly redundant but goljan has alot of good info in there so i liked to read the appropriate chapter of his notes first before tackling the step up chapter. some background knowledge i guess. probably got thru my binder 2-3 times total.

used usmleworld and mksap3 for questions. did all mksap 3 throughout the 3 months and 1300 or so uworld medicine questions. i thought both sources were outstanding and uworld was really right on the money - the teaching points in the answer explanations were great! ended up with like a 65% cumulative on those ?s. mksaps ?s were alot easier i thought than uworld but still great with good explanations.

that was pretty much it. ended up with a 95 raw = 98th percentile (according to last years score conversion chart) --> obviously thrilled, especially so as i will be going into internal.

and to the 82 person; an 82 RAW NBME score would NOT be 50th percentile. more like 79th percentile although i am just trying to remember the brief second i had with the actual conversion chart in my clerkship directors office.

Originally Posted by hsans23

and to the 82 person; an 82 RAW NBME score would NOT be 50th percentile. more like 79th percentile although i am just trying to remember the brief second i had with the actual conversion chart in my clerkship directors office.

In all fairness to that person, the school may have used its own curve system. I understand this to be the case with my school.

oh gosh ya i misunderstood the post oops!

Took this test last rotation. Did all 1500 U world medicine questions plus step up to medicine, got 95.

Originally Posted by shift_roro

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

I just finished IM last block, did pretty well on the shelf exam, and honored the rotation. I used a combo of PocketMedicine (know it well), some of StepUp, FirstAid Wards or IM, PreTest Medicine, Kaplan Step 2 CK Qbook, and MKSAP3&4. It also helped that I had FP prior to IM, so I had a pretty good grasp on the "IM special": DM2, HTN, HLD. Also some preventative medicine and public health issues. Our IM rotation is 11-weeks long; I started doing questions about halfway thru, took notes along the way why I got questions right/wrong, and reviewed my notes repeatedly in the final week.

The major difference about MKSAP 3&4 is organization. Version 3 is by organized by specific topics (ie, acute renal failure), which can be good in terms of easily finding questions pertaining to a certain case you saw on the wards that day. If you use it strictly to review material, you may get trapped thinking only "in the box" since the chapters are so highly specialized. Version 4 alleviates some of this by grouping these specific topics into organ systems (ie, nephrology), so at least you review the material by thinking a little more broadly. But for test taking purposes, the closest you can get to doing the shelf, IMHO, is going thru random questions & review answers. Also do it under time constraints if you find yourself more often than not pressured for time. I opted for the eight Kaplan Step 2 CK 50-question tests. I found it to be sufficient with excellent explanations. Others in my class used Kaplan Qbank online and USMLE World.

Hope that helps! Good luck!

Does anyone know the appropriate order of what medications to start in hypertension (for the shelf)? I feel that between reading casefiles, uptodate on the floors, and just hearing lectures from IM attendings, I'm very confused as to what is first line and what classes are contraindicated in certain conditions.

Anyone know?

thanks!

Originally Posted by maria219

Does anyone know the appropriate order of what medications to start in hypertension (for the shelf)? I feel that between reading casefiles, uptodate on the floors, and just hearing lectures from IM attendings, I'm very confused as to what is first line and what classes are contraindicated in certain conditions.

Anyone know?

thanks!

Know the contraindications or non-htn reasons for choosing certain antihypertensives...but you won't be asked what the first line is because there is always controversy...If you are for some strange reason, and patient has no comorbidities---the answer is probably a thiazide.

Anybody knows how the Kaplan Step 2 CK Qbook sets correlate to the actual shelf exam score?

I remember how back in August I posted I couldn't finish psych shelf well...

yea. I could not finish medicine shelf - 9 questions I just bubbled all B's or C's I don't even remember. But the 91 questions or so that I did attempt I did not find them supremely challenging. I felt pretty confident answering most of them. The funny thing is, during the exam, I had a sudden urge to defecate so I went out and shat - those 5 minutes could've been be used to answer atleast 5-6 questions in the end when I was hauling ass. oh well. Pretty depressed and dissapointed. Here is to hoping I pull an honors like i did in psych will post the score if I pull the miracle.

I used Step up and MKSAP 3 and that prepared me well for the questions...not speed

Originally Posted by InternationlDoc

The funny thing is, during the exam, I had a sudden urge to defecate so I went out and shat - those 5 minutes could've been be used to answer atleast 5-6 questions in the end when I was hauling ass. oh well.

Haha. Man, that's terrible.

when people post 82, 85, 90,95 do they mean raw score or percentile? I ask this because I remember in neurology average score was 69 and my raw was i think 82 which was then designated 99th percentile.

confused. and praying.

The raw scores and NBME scores are so confusing. Why can't they just make it easy and give everyone a single percentile score? It would be so much easier.

By the way, how do people get a 95+ raw score? That means they answer 95% of the questions correctly? That just sounds so humanly impossible lol

I took the exam Friday. It was a beast. I felt like my brain was gonna explode. Before the exam, I thought I had a chance at honors, now I'm only hoping for a pass. I wonder if I'm even going to get 50% questions correct. sigh

No, a 95 "raw" does not mean that you got 95/100 questions answered correctly. The "raw" score is a standard score i.e. it is curved by the NBME to fit a standard distribution. I think there is a thing you can find online that describes this quite nicely. I'll post it if I find it.

The percentile score is, ideally, calculated by knowing that the mean is 70 and the standard deviation is 8. The NBME maintains that because of the large number of students writing, a standard deviation is achieved for their tests; however, as other students have pointed out this isn't necesserily true.

Also, each school can modify the standard score and thus the percentile score based on individual assessment of exam results. So all in all, extremely confusing.

Also, one thing that is true is that if your school is giving you a grade on your transcript that correspons to the "raw" grade on your exam, then you are getting, generally a diservice done if you score above the mean, and a service if you score below mean.

Originally Posted by ubcredfox

No, a 95 "raw" does not mean that you got 95/100 questions answered correctly. The "raw" score is a standard score i.e. it is curved by the NBME to fit a standard distribution. I think there is a thing you can find online that describes this quite nicely. I'll post it if I find it.

The percentile score is, ideally, calculated by knowing that the mean is 70 and the standard deviation is 8. The NBME maintains that because of the large number of students writing, a standard deviation is achieved for their tests; however, as other students have pointed out this isn't necesserily true.

Also, each school can modify the standard score and thus the percentile score based on individual assessment of exam results. So all in all, extremely confusing.

Also, one thing that is true is that if your school is giving you a grade on your transcript that correspons to the "raw" grade on your exam, then you are getting, generally a diservice done if you score above the mean, and a service if you score below mean.

ubcredfox, you are correct. i called NBME. the "raw scores" term is misleading. let me just reaffirm.

when you get your shelf exam score back, only a single score is reported from the NBME to the medical school. just say it is a 80. this DOES NOT mean that you got 80 out of 100 questions correct. in fact, you will never know how many you actually got correct.

scores are curved and standardized by the NBME so that national avg is 70 with a SD of 8 for ALL exams. this is also described clearly at the NBME website. keep in mind that i am only talking about clinical rotation shelf exams, not basic science shelf exams (i.e. biochem, physio).

now for my own opinion. the medicine shelf is undeniably harder than all the other shelf exams, but yet people are still scoring in the 80s and 90s. that is only possible not because people do well on the exam, but because these people do better than everybody else on the exam. the medicine shelf is probably curved the most (along with surgery) so that national avg becomes 70.

this whole business of schools using their own systems to curve up shelf exam scores is cr*p. Its just flat out grade inflation that hurts the rest of the field. There should be nbme or lcme or whatever policy against it.

Well, I don't think it's total cr*p; each school has different reasons for changing the way the NBME marks their papers. For instance, at our school, our surgery rotation does not cover all the material covered on the NBME. For instance, orthopedics and anesthesia are examined seperately. Thus, those questions are removed from our surgery exams.

However, because hypocrisy also characterizes our school, other exams are not modified like this (or if they are, we are unaware). For example, we all know that the obs/gyn or peds or psych exams have internal medicine questions testing internal medicine material...yet somehow, these questions remain.

So in principle I would disagree, but because of the failure of transperancy and objectivity around this entire process, I'd agree with your sentiment.

And you know what, we shouldn't be jacking the thread! haha..Once I get my internal grades back, I'll post on here!

Originally Posted by scpod

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

Examination National Mean


Internal Medicine 75.2

Obstetrics / Gynecology 72.6

Pediatrics 74.6

Psychiatry 76.3

Family Medicine 72

Surgery 71.8

So, anybody understand how to interpret this data???

http://forums.studentdoctor.net/showthread.php?t=260046

I read Step Up to Medicine and Casefiles throughout the clerkship and now I'm finishing up MKSAP 4. I also used the Washington Manual, various Harrison's chapters, UTDOL extensively, and various websites like EMedicine and Wiki thoughout the clerkship. I bought the Kaplan Step 2 CK Qbook before the rotation started, but time was very limited so I couldn't get to doing those questions.

Shelf is tomorrow and I have about 3 chapters left in MKSAP. I'll let you guys know how I feel about the shelf and how my studying helped me prep for it tomorrow.

Originally Posted by InternationlDoc

I remember how back in August I posted I couldn't finish psych shelf well...

yea. I could not finish medicine shelf - 9 questions I just bubbled all B's or C's I don't even remember. But the 91 questions or so that I did attempt I did not find them supremely challenging. I felt pretty confident answering most of them. The funny thing is, during the exam, I had a sudden urge to defecate so I went out and shat - those 5 minutes could've been be used to answer atleast 5-6 questions in the end when I was hauling ass. oh well. Pretty depressed and dissapointed. Here is to hoping I pull an honors like i did in psych will post the score if I pull the miracle.

I used Step up and MKSAP 3 and that prepared me well for the questions...not speed

Got my shelf score back - 88 raw

I was expecting average as I did not even attempt the last 9 questions and 2 other ones that I just randomly bubbled = 11 questions (most with answers A-J; the last 10 ones i think) so I probably only got may be 2-3/11 and was sh!tting my pants after wards (though, I already shat during the test - see above - but still had more fecal matter!)

But of the 89-90 that I did attempt I answered confidently and thought they weren't too difficult. may be 2-3 tough questions.

Prep:
- Read step up lightly. Meaning I read Cardio, Pulm, Nephro, GI. These 4 are the core of medicine and most of patient complaints. ok may be add Heme/Onc in there too. I should have x2 step up but got lazy.
- Read the red book (pocket medicine) chapters of the main organ systems. Yes, I highlighted red book! I LOVE THIS BOOK. Skimming step up was just peer pressure. I really knew some good amount of detail in red book, specially cardio, GI and pulm. again, AWESOME BOOK! but an overkill for shelf. however, I did extremely well on floors thanks to this book.

Questions:
- Did about 850 USMLEWORLD questions - I averaged 79% overall. I did them untimed (MISTAKE!) and random. These questions are truly something; I mean I wish they made a 4000 question bank source - sh!t I'd shell out extra grand for such a quality resource.
- Did some MKSAP 3 - did not really like these questions as much as world

Take home message:
- Read fast. Read fast. Read fast....READ FAST. and by that I mean skip the bull in questions. Really read the answers first then skim questions, pick answer and move on.
- Common sense goes far on this test
- ABC's first
- Be confident
- Do well on wards - I got ~10 questions by just paying attention on wards
- Read fast

Originally Posted by agranulocytosis

I read Step Up to Medicine and Casefiles throughout the clerkship and now I'm finishing up MKSAP 4. I also used the Washington Manual, various Harrison's chapters, UTDOL extensively, and various websites like EMedicine and Wiki thoughout the clerkship. I bought the Kaplan Step 2 CK Qbook before the rotation started, but time was very limited so I couldn't get to doing those questions.

Shelf is tomorrow and I have about 3 chapters left in MKSAP. I'll let you guys know how I feel about the shelf and how my studying helped me prep for it tomorrow.

I finished with about 15 minutes to spare, but I'm a pretty quick reader to begin with. MKSAP 4 is golden for the shelf. I would say there were about 25-30 questions from my MKSAP run that I would not have been able to answer from elsewhere. It could be that learning from questions helped me to solidify info even further, but either way, I thought that the format and length of the questions in MKSAP 4 were pretty similar to the ones on the shelf.

It's a really doable test. The last 10 or so questions were a various assortment of matching questions that I thought were disproportionately difficult, but others may find those easy. They were the type that each answer could be used once, more than once or none at all. So if you're like me and find those questions tougher than the others, do those first.

I'll echo InternationalDoc's sentiment with paying attention on the wards. Very key for this exam. And great score, Doc!

Does anyone remember what percentage they were getting on MKSAP or World questions and then what they got on the shelf?

Originally Posted by marcus8

Does anyone remember what percentage they were getting on MKSAP or World questions and then what they got on the shelf?

ya, i had a 65% after 1300 UWorld medicine questions --> 95 raw on shelf. i did better than that on the MKSAP for sure but didnt really keep track. good luck!!!

Originally Posted by hsans23

ya, i had a 65% after 1300 UWorld medicine questions --> 95 raw on shelf. i did better than that on the MKSAP for sure but didnt really keep track. good luck!!!

Thanks so much. No one has really said and I like to know that I am doing okay before I go in to the test. I take the shelf on Friday!!

Did anyone get EKGs on their medicine shelf?

Ya da!! ("I did it" in Japanese.)
Got my shelf score back, and passed! So ecstatic right now! Just wanted to share my experience on that beast of an exam. Need to be 9th percentile or higher at my school in order to pass the shelf... which converts to about a 60 raw score.

How to Study: I didn't have a lot of study time given the q4 medicine nights. I highly recommend using Step Up to Medicine and MKSAP. The Essentials of Internal Medicine is an absolute waste of money... it is written by ACP members, but NOT writers for the shelf. I also used Kaplan Step 2 CK Qbook; I did 4 out of 8 internal medicine tests... each had about 50 Qs. The Kaplan was much easier than the real exam. With Step Up to Medicine, I knew that book cold, but I would only recommend that you dont read it into that much detail... just gloss over it. MKSAP was good because it enforces a lot of ACP guidelines (i.e. what % stenosis of renal artery is needed before stenting) that you can't find in a lot of review books. MKSAP is not exactly golden for the test, but it definitively gives you a sense of the way ACP bases their questions. I did not have time to use Case Files, but some in my class used it. With Case Files, you cannot use it as your sole study source. Think about internal medicine as a giant field; Casefiles only covers maybe 1/10th of that field really well. So you need to cover the other 90% somehow. So in short, use Step Up to Medicine, MKSAP, and some form of question book -- Kaplan Step 2 CK (can download for free if you know where) +/- USMLE world (I did not use this one). Medicine shelf also draws knowledge from other fields - such as OBGYN and pediatrics.

For CXRs, Step Up to Medicine has beautiful pictures throughout the book (i.e. pneumothorax) and then nice algorithms in the back on how to properly read a CXR... and how to tell a lung abscess from cavitary lesion suggestive of bronchogenic carcinoma. For EKGs, it is against rule here to say if they are on the test, but let me just say indirectly that you need to read a book. I know people read Dubin's, but I read The Only EKG Book You've Ever Need. Use this one!!! Only read chapter 11 of this book. It sums up the entire book in a single chapter and it gives you a nice algorithm on how to properly read an EKG. Before this book, I couldn't read an EKG if my life depended on it. I did well on our rotation exam where we had to read like 20 EKGs.

The Test: The shelf is 100 questions in 2 hours and 10 minutes. Time is definitely an issue. I know even the quickest readers had problems. Number one reason for failing the shelf is not finishing. Just from reading this forum alone, some people have left even 10 Qs blank. I've known people who have left 20 Qs blank before. I finished with about 5 minutes left, but made educated guesses on many questions. The key to speed on the test is to (1) cut through the bull**** in the stems, (2) memorize only the basic lab values (Na, K, Ca, Mg, etc.) so that you don't have to keep referring back to the lab value sheet, and (3) read the Q and choices BEFORE you read the stem. The shelf is completely different than any of the practice Qs I have done. The stems are god awfully long... several pages only had 2 questions on it. And you have to know the material. There were often A-K answer choices... and then you narrow it down to 2-3.. and you have to guess smart. Some people suggest you do the last 10 Qs first. I don't think it really matters unless you keep it in the back of your head that you have 10 matching in the end, and need adequate time to work through them. THe 10 matching were easier than the other 90 Qs.

The After Feeling: Honestly, I only knew about 40-45 questions for sure on the test. The rest were all educated guesses. You walk out feeling like you failed, because a lot of my classmates felt like they only knew about 50 Qs... and we need about 60 questions right on the test to pass. So you could see where the bad after feeling comes from.

Scores: One thing you should know is that the test is curved by the NBME. It is notorously the hardest of the clinical shelf exams. The test is curved so that national avg is a 70. Aside from me knowing because I called the NBME, they display it at their website. So what I'm saying is that you feel like you failed, but don't sweat it!

Anyway, PM me if you got Qs. I'm just glad I conquered this beast.

Originally Posted by caffeine37

Did anyone get EKGs on their medicine shelf?

if I did, they were very straight forward. I don't remember exactly, but any EKGs I've seen on any shelf/step have been pretty obvious.

So I took this beast today... ouch!

Will be able to tell if what I did worked when I get my score back

Just took it yesterday too. Ridiculously hard. MKSAP was almost entirely useless on this exam. Almost no bread and butter IM questions, and the passages were insanely long.

Gonna be a long 6 week wait until they tell us our scores..

Took it last week also. Definitely was a hard test, which is surprising given how many people above found it easy. There were at least 10 questions I know I got wrong, and another 20 I had to make an educated guess on. I guess I should feel fortunate that I at least finished the test (barely), because I know a lot of people didn't. Mksap didn't help with this one. Will be fun to wait this one out.

I promised that I'd post when I got a chance and since I use these forums quite a bit, I thought I'd help out.

94. Resources: Step Up, UWorld, Harrisons.

I studied almost every night of the clerkship, for a couple hours a night at least. I made sure that I read Step-Up - especially the key chapters: Cardio, Pulm, Nephro and Ambulatory Care. Don't neglect that chapter. The sections on HTN, Dyslypidemia etc. are pretty fair game. I made sure I had the differentials memorized for the most common clinical presentations. I made sure I knew how to interpret all the basic lab tests correctly. For some reason, my exam felt really nephro heavy so know your urinalysis interpretation; also know how to interpret pleural effusions (empyema's usually have a ph <7.2!!) etc. Uworld helped with some of the questions; I can't tell you how many exactly though. I would also focus on Infectious Disease - AIDS complications, Syphylis, CMV, Herpes, Pneumonia (including risk stratification) etc. I never bothered with the Neuro chapter in Step Up b/c of time issues. Hematology was big, so it pays to know how to work up anemia and the different types of leukemia. Know when you should be thinking PE and what hypercoag risk factors are. For some reason, they love amyloidosis and cholesterol plaque embolism (thanks Uworld). We had an EKG I think, but from what I recall, it was so easy that you would really have to be an idiot not to know it - perhaps AFib, but I'm not sure. Oh, and don't neglect fluid handling. If you want to learn anything, learn hyponatremia and SIADH.

Harrisons is a really good resource; I read it for major ward topics that kept coming up again and again i.e. Renal Failure, MI, HTN, etc..I think you could get by with Step Up just fine. UWorld is a must for practice, especially if this is your first NBME.

Cheers!

OK, got my score back, got 97th percentile. After the test, I thought of how many dumb mistakes I made so I'll take it!

Here's what I used:

1. Step-Up- for all its typos and whatnot, its a phenomenal book. I'm definitely going to hold onto it through residency. This was the central resource that I used. Yeah, some chapters were a bit long but it was definitely worth it. This book really helped solidify and crystallize a lot of the knowledge I learned in 1st and 2nd year (I wish I read it more when I was on the floor!). Must-have book for this rotation, maybe even for medical school.

2. USMLEWorld- used it sparingly for Step I (was more of a Kaplan user) but it was awesome in preparation for the shelf. I did about 900 or so of the IM questions. I took notes along the way too while doing the questions. I also didn't read the Ambulatory chapter of Step-Up and used the outpatient geared questions of World to prepare me.

3. Kaplan Q-Book- Good resource. USMLEWorld questions were probably more similar to the shelf questions, but I learned a lot from doing these as well. I did five tests in the Q-Book. It didn't take long and I recommend it.

Now, I never touched MKSAP or some of the other resources a lot of people have recommended in the thread. I bought Case Files and never touched it. I just used these three and felt very prepared for the exam. Step-Up and questions is what you need. Pay attention on the wards too, that helped.

Took it 2 weeks ago, got my score back today. Passed but did horrendously, my worst shelf grade so far! The test is a blurr at this point, I just remember that most questions were about shortness of breath or trouble breathing. Not much MI, HTN, renal failure...Answering correctly on a few questions required carefully reading the words used in the question, as I later realized....Who has time for careful word reading on a shelf? I barely had time to read, let alone think.
Step Up was useless, Kaplan Q-book useless, Case Files useless.... With the way I did on this test, I might have to reconsider my specialty of choice at this point. Any similar stories or encouragement?