How much work to crush shelves and other general MS3 struggles

[NWwildcat2013]

My school is one of those that only has H/P/F and only 10-15% honor. Our shelf is weighted very heavily and the cutoff for honors is high.

I am a good student and had a great Step 1 score, but so far I don't think MS3 is clicking for me. I read and do all of the relevant UW. I did the recommended books for my rotation, but I just took some NBME practices exams and was very average. This was a shocker for me especially coming off a high Step 1. I just don't get management questions at all! I didn't think UW did a great job preparing me and I have learned next to nothing relevant for the shelf from actually being at the hospital every day for 12 hours. Some of these questions I had no idea and don't know where I would have learned it from while some were from a totally different organ system than what was being tested (neuro).

Is this normal or am I going about this the wrong way? I've read that the neuro shelf can be especially tricky due to the potential breadth of material. I try to study about an hour a night and 6-8 hours on Saturday and on Sunday. I'd like to study more, but I am busy 100% of the time that I am at the hospital from 6a-6p. By the time I get home and eat dinner it is 7 and I am wiped so I only study for about an hour then get ready for bed in order to get up at 4:45. That is on days that I don't work out or do something else necessary to be a happy/healthy person.

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[Psai]

Yeah, there's only so much you can do. I had a great step 1 score and aced some shelfs, bombed others. You don't need to have all honors to get great interviews. The higher your scores, the better your grades, the nicer your evals, the better you will do. No one is good at everything except this one person I know who got 99% on almost every shelf.

Everyone else in the country is trying just as hard or harder than you.

 

[seminoma]

My school is one of those that only has H/P/F and only 10-15% honor. Our shelf is weighted very heavily and the cutoff for honors is high.

I am a good student and had a great Step 1 score, but so far I don't think MS3 is clicking for me. I read and do all of the relevant UW. I did the recommended books for my rotation, but I just took some NBME practices exams and was very average. This was a shocker for me especially coming off a high Step 1. I just don't get management questions at all! I didn't think UW did a great job preparing me and I have learned next to nothing relevant for the shelf from actually being at the hospital every day for 12 hours. Some of these questions I had no idea and don't know where I would have learned it from while some were from a totally different organ system than what was being tested (neuro).

Is this normal or am I going about this the wrong way? I've read that the neuro shelf can be especially tricky due to the potential breadth of material. I try to study about an hour a night and 6-8 hours on Saturday and on Sunday. I'd like to study more, but I am busy 100% of the time that I am at the hospital from 6a-6p. By the time I get home and eat dinner it is 7 and I am wiped so I only study for about an hour then get ready for bed in order to get up at 4:45. That is on days that I don't work out or do something else necessary to be a happy/healthy person.

What point are you at in MS3? Just starting? Shelf exams are more about how well you think through clinical scenarios than how much you've studied. I'm finishing up MS3 in a couple of weeks and I've largely relied on UWorld for shelf prep. Management questions are still a weakness for me as well. My prep and shelf scores are listed below.

Regarding neuro, I took it about a month after finishing step 1 and thought most of it was things I learned for step 1. I'm fairly confident the neuro shelf has the least "potential breadth of material"; it's essentially a subspecialty after all.

For all clerkships I read Uptodate and Medscape for every patient I carried. This helped with presenting on rounds (i.e. having an A&P) and I think it ultimately helped on shelf exams too. Also, anytime I overheard a resident tell one of my classmates to look something up for their patient I would look it up too. Things are much easier to remember if they're learned in the context of a real patient. Take every opportunity to learn while on wards.

Finally, one of my attendings once told me to "read with the goal of helping your patients". This is opposed to reading with the goal of answering things you think you'll get pimped on or think will show up on the shelf. This advice was huge for me as things got much easier when I started following it.

Neuro:
* Read 1/4 of Case Files
* UW x1
* 92%ile

Psych:
* Read FA Psych 1.5x, 1/2 of case files
* UWorld x1, majority of Lange Q&A (skipped 2-3 sections like the ones with legal stuff and ethics), and ~50 pretest questions. Was initially going to do Pretest, then realized I didn't like it and switched to Lange instead.
* Did all the practice NBMEs
* 94%ile


Medicine:
* Read 1/4 of NMS Casebook, maybe 50 pages of Step-Up
* UWorld x1; finished ~1000 questions in the 2 weeks leading up to the shelf because I couldn't find time for it early on in the clerkship.
* 93%ile

OBGYN:
* Read 3/4 of Case Files, 30-40 pages of Blueprints, also read a handful of the ACOG practice bulletins (cervical cancer ones come to mind.. ugh)
* UWorld x1 and about half of UWISE
* Did all the practice NBMEs
* 96%ile

Family:
* Read 1/2 of Case Files
* 100-200 AAFP questions. UWorld doesn't have FM questions
*81%ile. Lowest shelf of the year.. Likely because it was heavy on management questions (which I suck at) and there's no UWorld. Also my FM preceptor was not involved in the residency program and didn't really follow guidelines.. just did his own thing. So there was a lot of learning his guidelines in addition to the AAFP guidelines. Either way, I just sucked on this one.

Surgery:
* Read NMS Casebook x1, Pestana x1 (some sections twice), 1/3 of DeVirgilio book
* Listened to Pestana audio on the way to the hospital. Finished ~50% of it probably (all in the last week before shelf)
* UWorld x1, most of the Pestana questions, ~100 NMS questions (I think they're in the big NMS book, not NMS casebook), and about 100 Pretest questions.
* Did all of the practice NBMEs.
* 93%ile

 

[NWwildcat2013]

Yeah, there's only so much you can do. I had a great step 1 score and aced some shelfs, bombed others. You don't need to have all honors to get great interviews. The higher your scores, the better your grades, the nicer your evals, the better you will do. No one is good at everything except this one person I know who got 99% on almost every shelf.

Everyone else in the country is trying just as hard or harder than you.

Definitely realize this. I didn't mean to come off like I felt entitled to success, but I was just surprised that my usual method wasn't really working. Im sure other people are working hard. I know I can do well but I am admittedly very sensitive to lack of sleep so this transition has been very challenging. Im quite jealous of those who are less affected or can power through more effectively.

Im not aware how it works but can residencies see your score in a course past just H/P/F? Can they see how high in the P category you were?

 

[NWwildcat2013]

What point are you at in MS3? Just starting? Shelf exams are more about how well you think through clinical scenarios than how much you've studied. I'm finishing up MS3 in a couple of weeks and I've largely relied on UWorld for shelf prep. Management questions are still a weakness for me as well. My prep and shelf scores are listed below.

Regarding neuro, I took it about a month after finishing step 1 and thought most of it was things I learned for step 1. I'm fairly confident the neuro shelf has the least "potential breadth of material"; it's essentially a subspecialty after all.

For all clerkships I read Uptodate and Medscape for every patient I carried. This helped with presenting on rounds (i.e. having an A&P) and I think it ultimately helped on shelf exams too. Also, anytime I overheard a resident tell one of my classmates to look something up for their patient I would look it up too. Things are much easier to remember if they're learned in the context of a real patient. Take every opportunity to learn while on wards.

Finally, one of my attendings once told me to "read with the goal of helping your patients". This is opposed to reading with the goal of answering things you think you'll get pimped on or think will show up on the shelf. This advice was huge for me as things got much easier when I started following it.

Neuro:
* Read 1/4 of Case Files
* UW x1
* 92%ile

Psych:
* Read FA Psych 1.5x, 1/2 of case files
* UWorld x1, majority of Lange Q&A (skipped 2-3 sections like the ones with legal stuff and ethics), and ~50 pretest questions. Was initially going to do Pretest, then realized I didn't like it and switched to Lange instead.
* Did all the practice NBMEs
* 94%ile


Medicine:
* Read 1/4 of NMS Casebook, maybe 50 pages of Step-Up
* UWorld x1; finished ~1000 questions in the 2 weeks leading up to the shelf because I couldn't find time for it early on in the clerkship.
* 93%ile

OBGYN:
* Read 3/4 of Case Files, 30-40 pages of Blueprints, also read a handful of the ACOG practice bulletins (cervical cancer ones come to mind.. ugh)
* UWorld x1 and about half of UWISE
* Did all the practice NBMEs
* 96%ile

Family:
* Read 1/2 of Case Files
* 100-200 AAFP questions. UWorld doesn't have FM questions
*81%ile. Lowest shelf of the year.. Likely because it was heavy on management questions (which I suck at) and there's no UWorld. Also my FM preceptor was not involved in the residency program and didn't really follow guidelines.. just did his own thing. So there was a lot of learning his guidelines in addition to the AAFP guidelines. Either way, I just sucked on this one.

Surgery:
* Read NMS Casebook x1, Pestana x1 (some sections twice), 1/3 of DeVirgilio book
* Listened to Pestana audio on the way to the hospital. Finished ~50% of it probably (all in the last week before shelf)
* UWorld x1, most of the Pestana questions, ~100 NMS questions (I think they're in the big NMS book, not NMS casebook), and about 100 Pretest questions.
* Did all of the practice NBMEs.
* 93%ile

Great post! I'll definitely be referring back to this.

I think the point about reading to help you patients is spot on and would likely be the best way to improve my management knowledge. Unfortunately, I don't think I have seen enough pathology at the hospital to actually improve my score for this rotation. I was on a specific service and never actually saw a patient with epilepsy or a brain tumor even. I think that will try that method for the more core clerkships like OBGYN, Surg, and IM as I will have a more general exposure on those rotations.

 

[NWwildcat2013]

Are the practice NBMEs on par with the difficulty of the actual shelves?

 

[byaaaaaaah23]

Are the practice NBMEs on par with the difficulty of the actual shelves?

I think so. Def recommend UTD as I find the correct answers to NBME q's on UTD all the time. I also worry that textbooks are out of date with current management practices so IMO UTD is the way to go once you've read whatever textbook you used for a particular rotation.

 

[NWwildcat2013]

I think so. Def recommend UTD as I find the correct answers to NBME q's on UTD all the time. I also worry that textbooks are out of date with current management practices so IMO UTD is the way to go once you've read whatever textbook you used for a particular rotation.

UTD really is amazing. I didn't buy into using it until about half way through this rotation, and that was a mistake.

 

[Psai]

UTD really is amazing. I didn't buy into using it until about half way through this rotation, and that was a mistake.

It's a little lengthy, especially when you're looking for a quick answer like what's the indication for operative repair of a triple a. I like medscape, has good organization.

 

[NWwildcat2013]

It's a little lengthy, especially when you're looking for a quick answer like what's the indication for operative repair of a triple a. I like medscape, has good organization.

Haven't tried that, but I will give it a go. I do end up using ctrl-F a lot on UTD pages due to the lengthiness.

 

[byaaaaaaah23]

Scroll down to "summary and recommendations," usually has all you need to know or links to the parts you're looking for

 

[seminoma]

Great post! I'll definitely be referring back to this.

I think the point about reading to help you patients is spot on and would likely be the best way to improve my management knowledge. Unfortunately, I don't think I have seen enough pathology at the hospital to actually improve my score for this rotation. I was on a specific service and never actually saw a patient with epilepsy or a brain tumor even. I think that will try that method for the more core clerkships like OBGYN, Surg, and IM as I will have a more general exposure on those rotations.

Most of my shelf was headaches, strokes, seizure meds, and localization (just like step 1).

Obvious stuff like CT head w/o contrast first for strokes; MRI for posterior fossa masses; ethosuximide for absence seizures; valproic acid for myoclonic seizure; obese girls with headaches have pseudotumor cerebri; everything about the homunculus; benzos for status epilepticus; dominant = aphasia, non-dominant = neglect; etc etc etc.

Haven't tried that, but I will give it a go. I do end up using ctrl-F a lot on UTD pages due to the lengthiness.

I did the same thing. Lots of people just read summary & recommendations, but generally if you present that information on rounds and someone asks you a follow up question you won't have an answer.

 

[pd1112]

Definitely realize this. I didn't mean to come off like I felt entitled to success, but I was just surprised that my usual method wasn't really working. Im sure other people are working hard. I know I can do well but I am admittedly very sensitive to lack of sleep so this transition has been very challenging. Im quite jealous of those who are less affected or can power through more effectively.

Im not aware how it works but can residencies see your score in a course past just H/P/F? Can they see how high in the P category you were?

Depends on the format of your school's Dean's Letter but from what I've heard they typically see H/P/F +/- your shelf score and then your cumulative quartile for the first 3 years.

 

[seminoma]

Depends on the format of your school's Dean's Letter but from what I've heard they typically see H/P/F +/- your shelf score and then your cumulative quartile for the first 3 years.

Yeah this is completely school dependent. PDs see what your school includes in the MSPE.

 

[pd1112]

Yeah this is completely school dependent. PDs see what your school includes in the MSPE.

For sure. And the quartile is encoded. Probably one of the top 3 dumbest things about med school.