Official Internal Medicine Shelf Exam Thread

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Took this several months ago, but I just recently made an account.

Raw: 96 (>99%tile)

Resources Used in order of importance:
MKSAP: No way around this one, these questions are the gold standard for the medicine shelf. If you do nothing else, this should be it. Its great for learning what they consider to be the correct guidelines and treatment algorithms. Its great for "what do you do next" type questions. Questions where you come up with a diagnosis are usually VERY easy, but its a good confidence booster. Looks like a lot of people on the thread don't like this very much, but I felt that it was helpful.

Step-Up - Great book, very comprehensive but long. Read it as you go through and highlight things you want to look over the days before the exam.

Case Files - Im not usually a fan of case files, however if you SKIM it they are great. Focus on the questions and the clinical pearls, any tables, and anything in bold. Don't read the whole thing, it gets really repetitive and usually a waste of time. It reiterates a lot of things that you should already know by now. The vignettes are super easy if you have been paying attention at all and are a waste of time to read unless you have trouble at diagnosing. Use MKSAP for "next step" in management because they won't always agree.

Pretest - Some questions are way too hard or test on minutia that will not be on the shelf. However, I did have a couple questions that were exactly out of pretest and got a couple questions right from things I learned in pretest and no where else.

Just like any shelf, pacing is key. Do the last 10 or so questions first because they usually go a-k which means if you run out of time you have a lower chance of guessing correctly. Those questions are usually very easy too, don't miss on on these free points.

Im sure UWorld is great, but I am saving it for step 2 so I haven't used it for any of my shelves.

The content and quality of questions on the step were not even close to MKSAP IMHO. MKSAP is a decent place to do questions that will teach you; however, I think the qbanks are better.

I would also argue for using First Aid for the Internal Medicine Boards. It's more bulky than Step Up by about 100 pages (includes sections on critical care, geriatrics, hospital medicine.) I like this book because I discovered it WAY TOO late to be useful for my internal medicine rotation. It's good for backward learners (like me) who really don't get the molecule to patho-phys to clinical model. I like the clinical model, THEN give me the molecular reason.

Step up was good - and the Neuro section works well as base knowledge if your school doesn't use the national step.

Are the questions at the end of the Step-Up book useful at all?

almost everyone on this site has posted raw scores that would be like 95th percentile or above. I don't think thats realistic. I think you people are lying about your scores

Originally Posted by FenderHM

almost everyone on this site has posted raw scores that would be like 95th percentile or above. I don't think thats realistic. I think you people are lying about your scores

People come post their scores to help and I suppose to show off a little, that's why there are so many high scores.

Originally Posted by FenderHM

almost everyone on this site has posted raw scores that would be like 95th percentile or above. I don't think thats realistic. I think you people are lying about your scores

Biased samples. Only dorks would spend their little free time in medical school on an online message board about medical training lol.

thanks everyone for posting their advice. I've gotten through UW IM q's once. What do you recommend as my next best step in management of this exam? (time is a factor for me, I only have a couple of days before the shelf) A) Read Step Up, B) MKSAP 4 q's, C) Kaplan Qbook q's, or D) redo the UW q's that I got wrong?

Took IM shelf in May. 86 raw. I did about 800 Uworld questions avg 68%. read step up about 3/4 of it. I really disliked that book it put me to sleep everytime. I was a big fan of the kaplan IM ck book and conrads audio. If I could do it again i would have done all of UWorld, never used step up and went through kaplan twice.

when did you guys start using Uworld? Did you wait after your finished reading Step-Up/case files? or did you just do a handful of questions a day from the very beginning? Personally, I only like to do questions after I've had a chance to study the material once but I feel like since I just recently took Step I, I know a lot of the information already so I was thinking maybe I can get started on the questions. Any input would be appreciated. Thanks

Originally Posted by jsong812

when did you guys start using Uworld? Did you wait after your finished reading Step-Up/case files? or did you just do a handful of questions a day from the very beginning? Personally, I only like to do questions after I've had a chance to study the material once but I feel like since I just recently took Step I, I know a lot of the information already so I was thinking maybe I can get started on the questions. Any input would be appreciated. Thanks

Start doing them NOW! I think the best way to use UW is as a learning tool, not an assessment. Think of it as your textbook in question form. You get busy with wards and other stuff going on, so make getting through UW your first priority, textbook reading second. Also always do questions in timed mode so you never get comfortable, b/c timing is definitely an issue for the shelf.

Originally Posted by TonyDaTigrUprct

Start doing them NOW! I think the best way to use UW is as a learning tool, not an assessment. Think of it as your textbook in question form. You get busy with wards and other stuff going on, so make getting through UW your first priority, textbook reading second. Also always do questions in timed mode so you never get comfortable, b/c timing is definitely an issue for the shelf.

Thanks tony for the advice. Does anyone else have any other thoughts?

Originally Posted by jsong812

Thanks tony for the advice. Does anyone else have any other thoughts?

Depends how soon your exam is and your studying style. I personally like to do all my UW questions closer to exam time because it reinforces rapid reading of questions, and I tend to remember small details for only a few days. That being said, there are so many questions for medicine that you could start almost two weeks out and still have enough questions, but by no means do you need to do all of them to do well. My other advice is to visit the NBME website and see the % breakdown of exam topics... I made sure to hit all the big representatives first (cardio, pulm, etc.), and save the little stuff for any extra study time later. As annoying as MKSAP was, I think I definitely picked up a few points from that too. It was my first shelf and this method worked very well. Good luck!

can anyone please comment on if there were questions on statistics asking about stuff like calculating likelihood ratios, etc?

Also anything about guidelines on cholesterol requiring memorization of numbers? I'm from Canada so the values are all foreign to me.

Originally Posted by jope

can anyone please comment on if there were questions on statistics asking about stuff like calculating likelihood ratios, etc?

Also anything about guidelines on cholesterol requiring memorization of numbers? I'm from Canada so the values are all foreign to me.

Stats questions are usually more along the lines of "a study is set up this way to study xyz. What is the flaw, error, etc?"

Know your lipid numbers. More LDL and HDL than TG though.

I don't see people posting their average MKSAP scores... It would be really nice to have a gauge of what sort of scores you should be getting on MKSAP if you want to do well on the shelf. So how 'bout it, you high percentilers? How were you doing on MKSAP? 80%s? 90%s? 110%s? Thanks for the help.

did all of UW IM once through and all 8 of the Kaplan Qbook IM tests. The Kaplan Qbook is worthless, alot of those questions were way too easy, unlike the shelf. The shelf questions were very confusing and time is definitely an issue. You only have time to read through the question and then pick an answer that jumps at you, no real time to think through it or else you run the risk of not finishing. And most of those answer choices aren't clear-cut. Overall, the hardest shelf of 3rd year I've taken.

Originally Posted by TonyDaTigrUprct

did all of UW IM once through and all 8 of the Kaplan Qbook IM tests. The Kaplan Qbook is worthless, alot of those questions were way too easy, unlike the shelf. The shelf questions were very confusing and time is definitely an issue. You only have time to read through the question and then pick an answer that jumps at you, no real time to think through it or else you run the risk of not finishing. And most of those answer choices aren't clear-cut. Overall, the hardest shelf of 3rd year I've taken.

I also took the beast today and would agree that the IM exam is the most difficult exam of the year and by a significant margin. Some of the questions were blatanly easy, but many could be narrowed down to two very good answers. Oh well, hopefully it went as well as previous shelf exams.
A big hoo-rah to all of my now 4th year colleagues that never have to study for another shelf exam.

is it worth it to buy mksap4 vs mksap3?

Took it today, and it was about what I was expecting. Lots of make the diagnosis, some of them were pretty obscure. The next step in management questions were pretty predictable for the most part (high yield conditions). There was a decent amount of pathophysiology questions as well, which was a little surprising (don't remember that on other shelf exams). Also, a few statistics questions, but very easy for the most part, just conceptual stuff no number crunching. There were a few WTFs, but I just tried to guess and move on. I used MKSAP 4 and Step Up. MKSAP scores by section:

Cards - 78%
Endocrine - 61%
GI - 74%
General IM - 77%
Hematology - 83%
ID - 71%
Nephrology - 86%
Neurology - 92%
Oncology - 73%
Pulm - 89%
Rheum - 71%

I took them all by section at different points in studying, but I will post my score later for people wondering how MKSAP scores correlate.

Edit: 95 raw. MKSAP + Step Up is plenty, never looked at anything else except pocket medicine on rounds.

Just getting started on IM rotation in our school. This question may have been answered before, but what is this MKSAP source? Is it an online Qbank? I've seen people have used anything from MSAP to MKSAP-2,3,4? Are these different versions? Is there one that is better? Also, is the Kaplan Qbook an actual book or is it like the step1 qbank? Just trying to find good sources and hopefully do better this year than the last couple years. Thanks in advance for the help!

MKSAP is a book. Multiple editions. Try amazon.

Originally Posted by whatnext86

Just getting started on IM rotation in our school. This question may have been answered before, but what is this MKSAP source? Is it an online Qbank? I've seen people have used anything from MSAP to MKSAP-2,3,4? Are these different versions? Is there one that is better? Also, is the Kaplan Qbook an actual book or is it like the step1 qbank? Just trying to find good sources and hopefully do better this year than the last couple years. Thanks in advance for the help!

I called the publisher and MKSAP 4 is definately different from MKSAP3. I used both.

What's the best question bank aside from MKSAP4. The reason I ask is because I plan to use USMLE World for Step II. Or is just MKSAP4 enough?

Thanks fellas.

So I'm planning to use UWorld to study for shelf exams, but then should I re-do UWorld again for Step 2 or should I get other qbanks? Is it still beneficial to repeat those questions again? any advice for this?

thanks I appreciate it!

This thread was a couple years old so I'll ask again just in case things have changed. I'm starting my IM rotation next week and with the elective I have built in between the inpatient and outpatient segments of IM I've got a lot of time to study. Since this will be my first shelf exam of 3rd year I'd like to go balls out and try to do well just so I know what it takes.. Some MS3/4's from last year told me that they liked the Case Files series for every rotation in addition to other materials, so I've already got my hands on those. What other books and/or practice question sets are highly recommended to do well on the IM shelf? Thanks

Originally Posted by kdburton

This thread was a couple years old so I'll ask again just in case things have changed. I'm starting my IM rotation next week and with the elective I have built in between the inpatient and outpatient segments of IM I've got a lot of time to study. Since this will be my first shelf exam of 3rd year I'd like to go balls out and try to do well just so I know what it takes.. Some MS3/4's from last year told me that they liked the Case Files series for every rotation in addition to other materials, so I've already got my hands on those. What other books and/or practice question sets are highly recommended to do well on the IM shelf? Thanks

Casefiles is pretty good for some rotations, but IM really is too broad for Casefiles to be super helpful. I would focus more on Step Up and MKSAP plus/minus if you decide to do UW. I didn't find UW necessary, but if you have a long time to study and you can get through the other two with time to spare, UW can do nothing but help (besides costing you $$$).

Can anyone explain to me the format of the IM shelf exam? How many questions? How many minutes/question do we get? Are stems similar to USMLE stems?

100 questions, 2 hr 10 mins, vignette style questions just like USMLE

Got 72s across the board on every shelf exam third year and then started UWorld to prepare for my last shelf (medicine). Finished all 1500ish questions getting 66-74s for the last 500 questions.

Medicine raw score: 94

Like Step 1, UW was a big-time help for the medicine shelf

I took the medicine shelf as my last shelf, which admitedly helped a lot. Before medicine, my shelf scores ranged from 77-87

Our medicine rotation was 3 months long which allowed for a very long time to study.

Resources:
Step Up to Medicine- great book. Kind dense but I felt like it was the only book during 3rd year that was also useful for the wards. So it was a nice mix of clinical and academic while most of the other review books are geared almost entirely toward the shelf. I highly recommend this book!

MKSAP 3- Did the whole thing. Questions ranged from utterly obvious to very obscure. Overall I thought it was a pretty good Q bank and broke up the monotony of just reading

MKSAP 4- did almost all of it. I thought this was easier than MKSAP 3 but the questions are different so I thought it was worth doing.

UWORLD- since it was my last rotation and I would be studying for the boards after, I decided to get UW for the last month or so. I did 700+ questions all in IM. I would very, very highly recommend this Q bank.

End result: Raw score 96

In the end I would recommend all the resources I used. Even if medicine is smack dab in the middle of your year, I would recommend getting UW, if only for medicine.

So I've gotten through about 700 UW IM questions and I have to say that I am very pleased with the quality and explanation of the questions. However, many of the m4's have warned me that the actual shelf questions are much longer than the UW question stems and that I'd be better off doing the MKSAP questions. I've already gotten through all of MKSAP 3 and personally, I'm not a huge fan. So i guess my question is with four weeks left before my shelf, should I try to finish the rest of UW? or should I switch over to MKSAP 4? I'm also trying to leave some time on the side so that I can make one more run through Step-Up. Thanks in advance!

I would recommend doing all 3- do some of MKSAP 4, Uworld and reviewing step up.

Originally Posted by Instatewaiter

I would recommend doing all 3- do some of MKSAP 4, Uworld and reviewing step up.

When you say "reviewing Step Up," do you just mean to read through it once? Right now I'm reading it chapter by chapter and doing the corresponding MKSAP 4 questions (which is what I have). I'm planning on getting UW as well at some point, but I'm not sure if I'll have time to do Step Up more than just once with all of those questions.

I ended up reading Step Up once, then going through a 2nd time and jotting down stuff I had trouble remembering. The last like, night before I just reviewed that. And I did pretty well on that shelf.

Originally Posted by Instatewaiter

I would recommend doing all 3- do some of MKSAP 4, Uworld and reviewing step up.

What was so different about the quetions in MKSAP 3 and 4? The fact that 4 is the newer edition makes me think that it would be best to finish it and do what I can of MKSAP 3? Can you please explain why you recommend 3 over 4? Thanks

Originally Posted by kdburton

When you say "reviewing Step Up," do you just mean to read through it once? Right now I'm reading it chapter by chapter and doing the corresponding MKSAP 4 questions (which is what I have). I'm planning on getting UW as well at some point, but I'm not sure if I'll have time to do Step Up more than just once with all of those questions.

Oh i was responding to the guy asking about what to do in the end of the rotation.

I would very, very highly recommend reading through all of step up once (at least). Then the days/week before the exam review step up briefly or notes you have made or whatever.

Originally Posted by kdburton

What was so different about the quetions in MKSAP 3 and 4? The fact that 4 is the newer edition makes me think that it would be best to finish it and do what I can of MKSAP 3? Can you please explain why you recommend 3 over 4? Thanks

I had 3 to start off with so I did that first. I thought 3 was harder than 4. I was getting >80% right on MKSAP 4. That could be a function of having read all of step up and done MKSAP 3 or it could be because it was easier. Personally I and the other people in my clerkship group felt like MKSAP 4 was easier even those who did it first.

MKSAP 3 was made in 2006 while 4 in 2008, so I wouldnt exactly say that 4 has any information that is appreciably "new" outside of the 450 new questions. 3 is not outdated and the questions are better. 4 had a ton of gimmes

Is there anywhere to find more info on the shelf? Like how is it scored? My syllabus says I need a 70 to pass the shelf exam. Does this mean I have to get 70% right?

Originally Posted by sime0n

Is there anywhere to find more info on the shelf? Like how is it scored? My syllabus says I need a 70 to pass the shelf exam. Does this mean I have to get 70% right?

Your school may be converting the NBME raw score to some other metric. I find it hard to believe that your school requires a 70 raw just to pass. 70 raw is supposed to be the mean, passing at most places is in the upper 50's to low 60's. The best thing to do would be to ask for clarification from your clerkship director.

My school gets our raw scores and "curves" them based on what quarter of the year we're taking our rotation in (new 3rd years obv aren't going to do as well on average as those who are taking it in the end of 3rd year). Does anyone know if the scores we get from NBME are curved already based on all the people who took it around that period of time? How exactly does the grading work on shelf exams is what I'm getting at? And when people on here are getting "9X raw" are they getting 9X% correct or are they scoring in the 90th percentile or what? It seems rather ridiculous that someone would get almost 100% on one of these exams haha

Originally Posted by kdburton

My school gets our raw scores and "curves" them based on what quarter of the year we're taking our rotation in (new 3rd years obv aren't going to do as well on average as those who are taking it in the end of 3rd year). Does anyone know if the scores we get from NBME are curved already based on all the people who took it around that period of time? How exactly does the grading work on shelf exams is what I'm getting at? And when people on here are getting "9X raw" are they getting 9X% correct or are they scoring in the 90th percentile or what? It seems rather ridiculous that someone would get almost 100% on one of these exams haha

90 raw score is neither 90% correct nor 90th percentile. The mean raw is 70 and the SD is 8. It's arbitrarily set by NBME.

Took it today and it was pretty hard haha. I had only 10 mins to spare after I finished which didn't give much time to go back and re-read the ones I thought were difficult on the first run through.

Read Step Up and did MKSAP 5
Read Step Up again and did all 1490 UW Internal Med questions

The questions seemed similar in difficulty to the UW questions I thought, but we'll see how I do. I was getting low to mid 70%'s towards the end of UW. Will update later...

Did anybody use MKSAP 14? The questions on there are much more challenging and the explanations are excellent.

Originally Posted by dantt

Did anybody use MKSAP 14? The questions on there are much more challenging and the explanations are excellent.

I'm not 100% sure but I think the questions are meant for internal medicine specialty boards (not the 3rd year clerkship). While the questions/explanations might be excellent it probably goes above and beyond what we're expected to know for the IM shelf

I just looked at the 20 sample questions for this exam on the NBME site. They seemed really similar to the MKSAP4 questions. Does anyone know if these sample questions are anything like the real test? Thanks!

Also, is UW good for any of the other shelf exams? I'm trying to decide if I should get it for the whole year or just for a month to study for the medicine shelf.

Originally Posted by remo

I just looked at the 20 sample questions for this exam on the NBME site. They seemed really similar to the MKSAP4 questions. Does anyone know if these sample questions are anything like the real test? Thanks!

Also, is UW good for any of the other shelf exams? I'm trying to decide if I should get it for the whole year or just for a month to study for the medicine shelf.

The sample questions are easier than the real thing.

I have heard UW is good for Peds and surg. I was unimpressed with the OB questions. I used UWISE for the OB questiosn (given to us by the school) and those were far superior for the shelf exam.

Originally Posted by Instatewaiter

The sample questions are easier than the real thing.

I have heard UW is good for Peds and surg. I was unimpressed with the OB questions. I used UWISE for the OB questiosn (given to us by the school) and those were far superior for the shelf exam.

Yes, I think the sample questions are just way too easy. I did the 20 questions yesterday and I timed myself. I finished 8 mins early and got them all right. There is no way the shelf is like this. I have been mainly using MKSAP 4 as my question source but I have heard that it is actually not very representative of the exam. But at the same time some people here say it is the closes you could get to the test. I have 12 more days to get ready for the shelf and I think I am gonna start using another question source (perhaps kaplan) just to make sure that I don't get too surprised on the shelf...

Originally Posted by Futuredoc1364

Yes, I think the sample questions are just way too easy. I did the 20 questions yesterday and I timed myself. I finished 8 mins early and got them all right. There is no way the shelf is like this. I have been mainly using MKSAP 4 as my question source but I have heard that it is actually not very representative of the exam. But at the same time some people here say it is the closes you could get to the test. I have 12 more days to get ready for the shelf and I think I am gonna start using another question source (perhaps kaplan) just to make sure that I don't get too surprised on the shelf...

Neither UWorld or MKSAP are like the shelf although the concepts they teach are well-represented. Use them for the concepts but expect the test to be very different. I think the best preparation for the shelf is having done previous shelves... either because you did some in 1st and 2nd year or because you're well into third year. The presentations are NOT classic and could easily be more than one diagnosis. The questions are in a very long SOAP note format which not what you find in any of the question books. If your taking it early in the year your score will in large part reflect your ability as a good test-taker in addition to time studied and ward experience.

does anyone know when the scores usually come back? (not that I am looking forward to mine, but would rather know), thanks

For most shelf exams it take 2-3 weeks. That said, depending on the clerkship director, it may take longer to get the results back.

Originally Posted by Instatewaiter

For most shelf exams it take 2-3 weeks. That said, depending on the clerkship director, it may take longer to get the results back.

thanks