Official Internal Medicine Shelf Exam Thread

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vicinihil said:
Stuck in the 60s for Uworld. 4 weeks left. Ahhhhh.
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Just keep at it. Four weeks is a long time. Try to get through as many as you can, then redo the ones you missed.
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what is the difference between mksap 15 and mksap 4 - is one for internal medicine professional board exams and one for clinical clerkship board exams?
 
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Are there any dermatology or neurology or ophthalmology questions on this exam?
 
1) Is Case Files a worthwhile addition to Step Up or is it unnecessary?

2) Is the Ambulatory section relevant to the IM shelf or only the FM shelf?

3) Are the Kaplan Q book IM questions worthwhile (8 tests of 50 qs each)

Right now I plan to do all of UW and read Step Up once and certain sections twice.

On the fence about Case Files and Kaplan Q book questions. If it changes anything I have taken my Surgery (84 on shelf) and FM (no grade back yet) rotations thus far.

I am aiming for at least a mid 80's score (need 81 to get honors and don't want to cut it too close)

Thanks in advance
 
2012mdc said:
1) Is Case Files a worthwhile addition to Step Up or is it unnecessary?

2) Is the Ambulatory section relevant to the IM shelf or only the FM shelf?

3) Are the Kaplan Q book IM questions worthwhile (8 tests of 50 qs each)

Right now I plan to do all of UW and read Step Up once and certain sections twice.

On the fence about Case Files and Kaplan Q book questions. If it changes anything I have taken my Surgery (84 on shelf) and FM (no grade back yet) rotations thus far.

I am aiming for at least a mid 80's score (need 81 to get honors and don't want to cut it too close)

Thanks in advance
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i'm in the same position. the plan was to do MKSAP4, then kaplan qbook, then all of UW. i'm wondering about the utility of kaplan's questions.
 
2012mdc said:
1) Is Case Files a worthwhile addition to Step Up or is it unnecessary?
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Unnecessary.

2012mdc said:
2) Is the Ambulatory section relevant to the IM shelf or only the FM shelf?
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It is relevant to BOTH.

2012mdc said:
3) Are the Kaplan Q book IM questions worthwhile (8 tests of 50 qs each)
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Yes. Do each of them once as a set, score it, read through all the answer explanations, and move on. I did approximately one per week.

2012mdc said:
Right now I plan to do all of UW and read Step Up once and certain sections twice.
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Excellent strategy. Sections to read twice = Cardio, Pulm, GI, Renal.

2012mdc said:
If it changes anything I have taken my Surgery (84 on shelf) and FM (no grade back yet) rotations thus far.
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It does change things. Keep with the plan you outlined, and with these 2 subjects under your belt, you'll be in good shape to hit your goal territory. Good luck.
 
Deferoxamine said:
Unnecessary.



It is relevant to BOTH.



Yes. Do each of them once as a set, score it, read through all the answer explanations, and move on. I did approximately one per week.



Excellent strategy. Sections to read twice = Cardio, Pulm, GI, Renal.



It does change things. Keep with the plan you outlined, and with these 2 subjects under your belt, you'll be in good shape to hit your goal territory. Good luck.
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Thanks a lot. I was planning to 1-2 Q Book tests per weekend but I hadn't seen much about them when I glanced at this thread.
 
vicinihil said:
I've gotten mixed reviews regarding MKSAP. A good friend said her test was taking questions verbatim from MKSAP (she got >90) and other people on this forum have said MKSAP was a wash.

It seems like quite a few people didn't even use UW on this forum? Hmm. Maybe it depends on which day you're taking the test because it varies?
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I started to do UW questions when I started studying for the IM shelf, but stopped after about 100-150 q's. Why? Because I felt that the question stems were WAY too short compared to the stems I'd seen in the 2 shelf exams I'd taken previously. My practice question mainstays were MKSAP 3 and 4. A 4th year at my school recommended getting a used copy of MKSAP 3 in addition to 4 because MKSAP 3 is organized by presenting symptom as opposed to organ system. I felt doing both books, in addition to 2 runs through Step Up and Case Files were adequate for a good score. I earned an 89/94.
 
hi all,

can somebody post (or pm me) any data that you may have regarding the conversion of raw scores to percentiles? unfortunately, my school does not provide this information... it would be ideal if you took the exam recently (i.e. since 08/2010), but given the relative lack of information, anything would be appreciated.

thanks in advance!
 
So I just took the medicine shelf.
I did all 1420 (except biostats) questions of UWORLD and would look up the stuff I didn't know in STEP UP. I did about 20 to 30 a day on tutor mode and took notes on all of them. Then I went back and did all the ones I got wrong for Renal, Cardio, Pulm, and GI.

Also, I wasn't planning on doing MKSAP because I had heard such mixed reviews and then decided to do it the day before ( I had a day off). I went on rapid fast mode and did cardio, pulm, renal, gi, endocrine, neuro and some of the GENERAL IM.

The first ten questions and the last 10 questions were WTF questions! There was ALOT of cardio, resp, and renal. Know your murmurs and xray findings for pulm (lots of infiltrates). I had VERY LITTTLE GI, LIVER or HEME. One question on an anemia that was it not hemolysis, etc. I also had like 2 neuro, 2 derm, 2 optho, 1 biostats, 3 ortho type questions, 2 ethics, 3 or 4 prevention type questions, 1 diabetes, 5 or 6 endocrine. NO THYROID ON MY EXAM!!!

What makes this SHELF hard is that they don't present like classic uworld questions where you have ALL of the facts.
Take for example Sarcoidosis: A typical Uworld question will mention: an African American woman less than 50, Erythema nodosum, the constitutional symptoms, anterior uveitis, arthralgias and arthritis, bilateral hilar adenopathy, ACE levells etc.
On the shelf it will be like 2 of those findings and there will ALWAYS be another question that will be tempting to choose from. I could always narrow it down to two.

I don't feel too hot about this exam. But I don't know what else I could have done! Maybe read CASE FILES and then STEP UP to medicine throughly would have helped. If I would have changed anything maybe I would have tried to read a chapter a day in addition to doing the uworld questions.

TIME IS ALSO AN ISSUE because we only have 2 months and only guaranteed 8 days off with call every fifth night!

GOOD LUCK!!! Ill be back and let everyone know how I did
 
92 on the shelf.

Questions: I did MKSAP twice. I thought it had too much about indications for certain therapies. The IM shelf was more about diagnosis, but my memory might be failing me... Maybe 5 or 10 questions on the shelf were closely related to MKSAP.

Reading: Every day, I would have a topic, e.g. Acute Kidney Injury, Pneumonia, Cholecystitis, CABG vs. Stent, glycemic control and micro/macrovascular events, etc. If I didn't finish my topic of the day, I might give myself one more day to read the UpToDate article, NEJM review article, or section in Harrison's, but that would be it. Deadlines were key to getting myself to finish topics and move on. Looking back, this was way too much. I read a lot of journal articles (probably over a hundred) and almost none of it made it onto the Shelf. What a waste of paper.

Other: Didn't do Step Up or Case Files. I looked at them the last week before the exam, and they look like they're solid resources. I had no idea people were using UWorld... is this the Step 2 or Step 1 version? I thought the IM Shelf had some throw backs to Step 1.
 
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dienekes88 said:
I had no idea people were using UWorld... is this the Step 2 or Step 1 version? I thought the IM Shelf had some throw backs to Step 1.
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People are talking about doing IM questions on the Step 2 USMLEWorld QBank.
 
Any opinions on Step up to Medicine vs. Internal Medicine Essentials for Clerkship Students 2? I just want to study one of them. Which one do you think is better? Any input would be fabulous.
 
Step Up is awesome. I've never even heard of the second book.
 
Guile said:
Step Up is awesome. I've never even heard of the second book.
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Yeah it's put out by the American College of Physicians. A bunch of people at my school use it, and our administration recommends it. I think I'll stick to Step Up to Medicine though.
 
Score: 92
Resources:
1) Step-up to medicine, read as many times as I could.
2) UWorld Medicine questions

I really think that's all you need to do well on this thing. I never touched MKSAP at all since I heard pretty mediocre things about it. Focus on the above two and you'll do great, really.

That said, I do think that one piece that's missing from the above are some very surgery-like questions which I only was able to answer because of my previous surgery clerkship.

Some example topics:
Trauma
Urology
Small bowel obstructions

I do think that, because of the curve, there is enough room to do well without getting these 5-7 questions right. That said, when you see a very "surgery-esque" topic like SBO or tension pneumothorax in step-up, don't skip it.

In addition, this adds some interesting balance to those who say that you are best to take medicine before surgery -- I think you have something to gain no matter which one you take first.

Again, best of luck on this thing! Signing out from clerkship year :) :) :).
 
So I recently got my Surgery shelf score back and it was a good bit lower than I hoped/expected. I'm pretty bummed about this, and I really want to turn things around for my Medicine rotation which I just started. I think I've identified a few things that probably didn't work towards my favor in Surgery (not being able to pin down 1-3 key sources, spending a little too much time with my girlfriend, etc).

Basically I'm looking for a comprehensive, yet streamlined approach (isn't everyone?). I've been planning on using:

1. MKSAP4 (I have it on CD, is this the same as the book contents?)
2. Step Up to Medicine
3. UWorld

Any solid recommendations as to how to use these? I've browsed other peoples' posts and it seems like some like to use Step Up as a reference if needed, rather than reading it straight through. On my previous rotations, I've found that having a book like BluePrints to sort of guide me through my studying (I read it twice for both Peds and OB/Gyn) seemed helpful. But Step Up is so long, I'm not sure I can handle reading it straight through once, let alone multiple times. But ideally I'd like to be able to.

The consensus here seems to be that UW > MKSAP4, no? Should I perhaps work on Step Up (straight chapters) coupled with some MKSAP questions during the first month (we have 3 months), then maybe spend the last two months focusing on UW questions?
 
GuyWhoDoesStuff said:
The consensus here seems to be that UW > MKSAP4, no? Should I perhaps work on Step Up (straight chapters) coupled with some MKSAP questions during the first month (we have 3 months), then maybe spend the last two months focusing on UW questions?
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Hmmmm

I would say the following:
1) The surgery shelf is a really weird exam and most people really struggle what to study for it. So if you studied really hard and got around average (70-75) then that's just the nature of the beast, unfortunately.
2) For medicine, however, if you (a) really know step up and (b) do all the UWorld questions you'll do great. It's really that simple. We'll I can't guarantee that but it worked for numerous people above and Medicine was by far my highest score and that was really all I used. Honest.
3) Forget MKSAP4
 
zuiikin said:
Hmmmm

I would say the following:
1) The surgery shelf is a really weird exam and most people really struggle what to study for it. So if you studied really hard and got around average (70-75) then that's just the nature of the beast, unfortunately.
2) For medicine, however, if you (a) really know step up and (b) do all the UWorld questions you'll do great. It's really that simple. We'll I can't guarantee that but it worked for numerous people above and Medicine was by far my highest score and that was really all I used. Honest.
3) Forget MKSAP4
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Could not agree more. Medicine was my first shelf of the year and I used the same strategy that worked for Step I: come to SDN, identify key sources that people who did well used, use these sources REPEATEDLY instead of spreading yourself too thin with many disparate materials. Didn't touch MKSAP, which is tough given how everyone else seems to use it.

I did UWorld medicine q's 1.5x (repeated marked and incorrect questions until I got them all right, started in the 50-60% ended around 75%) and Step Up x2. Got a 98.
 
how does one convert the NBME score to its associated percentile? specifically, what score correlates to 1 SD over the normalized national mean? does the score report provide this information? my clerkship provides the total score, yet, the percentile is whats used for honors criteria, so we are sorta left in the dark. if its on the score report, i can call and ask, but if it isnt, how would i go about calculating it? thanks in advance
 
golfman said:
Any opinions on Step up to Medicine vs. Internal Medicine Essentials for Clerkship Students 2? I just want to study one of them. Which one do you think is better? Any input would be fabulous.
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Step Up is in an outline format, and can be a bit taxing to read, but is pretty extensive. IM Essentials is more narrative, and has some nice bits on guidelines, but is perhaps incomplete.

On a side note, there are some obvious errors in Step Up, so if something doesn't sound right check another source.
 
Got a 90-2nd highest score (highest was a 91).

STEP UP AND UWORLD were GOLDEN for this shelf. MKSAP not so much-those questions are a little bit harder than the shelf. I also did USMLE Rx questions but the hard ones on there were a bit crazy-I wouldn't use this as my primary source for questions but it did help.
 
It's so hard to pick and choose resources to study from when everyone is recommending every resource (Step Up, FA, uworld, Kaplan, MKSAP) and saying it's awesome. :confused:
 
Do people find that they generally have time to go through Step Up twice? I'm reading it through now for the first "pass" and part of me feels so overwhelmed, having to know and memorize all these new facts. I know the pathology and stuff from 2nd year/Step 1, but I feel like all the diagnosis/management stuff is getting so jumbled and I guess I feel like I'm having a hard time knowing every detail cold.

Or maybe its because I'm starting from the Cardio section, which has always been my worst, so it takes forever to read through one disease to understand WHY this is happening or, WHY choose this over that...
 
4th year med student here, just to interject with my 2 cents-

All you need for the medicine shelf is to do all the MKSAP questions twice.

I did that and scored 99%ile.

Forget Step Up. Its too general, and more useful for second year.
 
KissMyAsthma98 said:
All you need for the medicine shelf is to do all the MKSAP questions twice.
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how about UW?
from what i've seen so far, it looks like the UW medicine questions test multiple important concepts, but the questions might not be a full vignette with labs, like on the shelf.
it seems like all of the MKSAP questions have those longer stems built in.

:confused:
 
Anyone know if MKSAP 2 would still be useful for today's shelf exam? I have MKSAP 3 and wonder if I should also get the previous edition to cover more material. (Yes, I'm cheap and don't really want to pay the money for the latest stuff.)
 
go lakers said:
how about UW?
from what i've seen so far, it looks like the UW medicine questions test multiple important concepts, but the questions might not be a full vignette with labs, like on the shelf.
it seems like all of the MKSAP questions have those longer stems built in.

:confused:
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I would reserve UW for step 2 studying (as UW is ALL you need for step 2) If you had unlimited time, I would say you could add them to the mix. But I would give priority to MKSAP and really understanding the questions and answers.
 
I was thinking along the same lines with regards to saving uw for step 2 but soon realized this is wrong. My reasoning is this:

Medicine clerkship grade is more important than step II for obvious reasons unless your step I Is bad. This can be said for most rotations. UW is def the best resource for this shelf as well as other shelves which often determine clerkship grades. Kaplan is good but not as good as UW. MKSAP is too easy to mimic the actual lvl of the shelf.
 
vicinihil said:
I was thinking along the same lines with regards to saving uw for step 2 but soon realized this is wrong. My reasoning is this:

Medicine clerkship grade is more important than step II for obvious reasons unless your step I Is bad. This can be said for most rotations. UW is def the best resource for this shelf as well as other shelves which often determine clerkship grades. Kaplan is good but not as good as UW. MKSAP is too easy to mimic the actual lvl of the shelf.
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Agree. MKSAP is much easier and far less comprehensive than the shelf. I attribute all my shelf success to UWorld.
 
vicinihil said:
I was thinking along the same lines with regards to saving uw for step 2 but soon realized this is wrong. My reasoning is this:

Medicine clerkship grade is more important than step II for obvious reasons unless your step I Is bad.
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This is a very untrue statement.

I have been told by residency program directors themselves that the single most important factor in general ranking of an applicant is their step 2 score. Many academic programs request the score before rank lists are completed. It is the only measure where they can compare applicants across different institutions. An honors at one school is a low pass at another, and programs know this. Don't put all your weight on your clinical grades.

Your shelf grades will correlate with your step 2 score, but I assure you, putting step 2 on the back burner will hurt you in the end. No one wants a resident that can recite the kreb cycle, but can't manage fever in a post op patient.
 
KissMyAsthma98 said:
This is a very untrue statement.

I have been told by residency program directors themselves that the single most important factor in general ranking of an applicant is their step 2 score. Many academic programs request the score before rank lists are completed. It is the only measure where they can compare applicants across different institutions. An honors at one school is a low pass at another, and programs know this. Don't put all your weight on your clinical grades.

Your shelf grades will correlate with your step 2 score, but I assure you, putting step 2 on the back burner will hurt you in the end. No one wants a resident that can recite the kreb cycle, but can't manage fever in a post op patient.
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Who says that you can't use it for both? Do you really think you're going to remember all 2000 questions 6 months to a year later? I can't remember the stuff I studied for the pedi shelf a month ago.

Also, don't good clerkship grades make you more attractive to get interviews in the first place? Worrying about a rank list before interviews seems like putting the cart in front of the horse.
 
KissMyAsthma98 said:
This is a very untrue statement.

I have been told by residency program directors themselves that the single most important factor in general ranking of an applicant is their step 2 score. Many academic programs request the score before rank lists are completed. It is the only measure where they can compare applicants across different institutions. An honors at one school is a low pass at another, and programs know this. Don't put all your weight on your clinical grades.

Your shelf grades will correlate with your step 2 score, but I assure you, putting step 2 on the back burner will hurt you in the end. No one wants a resident that can recite the kreb cycle, but can't manage fever in a post op patient.
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I sincerely doubt the validity of that statement. If you look at 2010 Residency Director Survey on the NBME website, you'll see that Step 2 importance ranks far below that of Step 1, Honors in desired clerkship, and overall Clerkship grades in competitive specialties like Derm where majority of applicants have very high Step 1 scores. Furthermore, 29% of programs do not even require a Step 2 score to match and 20% said they just want you to pass step 2. 41% do not require Step 2 scores in Radiology and an additional 21% just want you to pass.

Call me silly but from these data, it seems like consistent Honors in multiple clerkships throughout the year is more worthwhile than getting a good score on Step 2 assuming Step 1 is ok.

That being said, Jolie brings up a good point, what are the chances of remembering all 2000 questions? Close to 0. Therefore get UW and use it throughout the year then use it again for Step 2. It's a win-win except for your wallet.
 
The purpose of the questions is not simply training to take a test. It is probably the most effective way to absorb the material. The NYTimes recently had an article about a study in Science that showed testing to be more effective than repeated reading or concept mapping, reinforcing our collective wisdom that UWorld and QBank are extremely valuable study aids.

According to the 2008 NRMP Program Director Survey, Step 2 scores are considered to approximately the same degree as clinical grades, with somewhat less weight on average. This might vary somewhat between specialties, but it is safe to say they are both important. However, if I took anything from my preparation for Step 1, it was that studying is much easier if you learn the material the first time around. Whatever you study during 3rd year will pay dividends when preparing for Step2. Why squander the opportunity to do well in two important categories to ensure performance in only one? If you are really worried about having questions for Step 2, just use UWorld during the year and Qbank for USMLE (or vice versa).

As a disclaimer, I have not used either question set this year. I used MKSAP for Medicine and did quite well. I did (somewhat less) well on Ob/Gyn and Peds exams using only books with questions in them. So I'm not saying it is necessary to use UWorld or Qbank for the clerkship shelves, simply that if you think they will help you, don't worry about saving them for Step 2.
 
Anyone use FA for Medicine instead of Step Up? The back of FA for wards has them both rated as an "A". I prefer the FA format somewhat. It seems like they have similar scope/focus/info? Any thoughts?
 
HopefulDoc2007 said:
Anyone use FA for Medicine instead of Step Up? The back of FA for wards has them both rated as an "A". I prefer the FA format somewhat. It seems like they have similar scope/focus/info? Any thoughts?
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So First Aid rated another First Aid book as an "A"? Imagine that.

I looked at it. Didn't think it was as good as Step Up. Why fix it if it isn't broken? Lots of people like Step Up. Use it unless you think FA Medicine is better for you personally.
 
I know, I know. But I think the ratings in the back of the book are based on student surveys, not the opinions of the authors. (Of note, they don't rate all FA books as the best books for each rotation.) Anyway, I agree with the "don't fix what isn't broken" mantra. I just don't like the Step up format that much and wondered if anyone had experience with both. Good luck studying everyone. Cheers.
 
I recently got an 82 on the IM shelf.. does anyone know what percentile this corresponds to? I'm guessing somewhere in the 70s but any insight would be much appreciated. And I know i didn't get a terrific score, but UWorld is money. It's basically all I did. Wish I would've read Step Up as well to boost me up a few points, but what can you do..
 
rdunba said:
I recently got an 82 on the IM shelf.. does anyone know what percentile this corresponds to? I'm guessing somewhere in the 70s but any insight would be much appreciated. And I know i didn't get a terrific score, but UWorld is money. It's basically all I did. Wish I would've read Step Up as well to boost me up a few points, but what can you do..
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The traditional thought is that the average is a 70 and the standard deviation is 7. I'm not sure how accurate that is for every testing. Best bet is to email your clerkship director and ask. They get a report of everyone's score with the percentile.
 
I thought the mean raw score was a 70, so wouldn't 82 be +1 standard deviation above the mean?

Just curious, is the Shelfs curved like the Step(based on previous administrations) or based on others(so if 99% of people are smarter than you, you fail)?
 
The testing center normalizes the average to 70. Thereafter, one standard deviation below the average is the cut-off for passing. Usually, the standard deviation is about 7~8 below 70. 7 is the better cut-off unit. But it can be as low as 1 below 70.
 
rdunba said:
I recently got an 82 on the IM shelf.. does anyone know what percentile this corresponds to? I'm guessing somewhere in the 70s but any insight would be much appreciated. And I know i didn't get a terrific score, but UWorld is money. It's basically all I did. Wish I would've read Step Up as well to boost me up a few points, but what can you do..
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I got an 84 on the Surgery shelf and that translated to the 92nd percentile. I would guess an 82 would translate pretty similar.
 
This is what I did
All of the UW questions and repeated all incorrect
All of the Kaplan Q book questions (the 8 IM tests w/ 50 questions each)
Step Up to Medicine - only once, glanced at some specific problem areas the day before the exam.
Step 2 Secrets - skimmed through sections like Cardio, GI, electrolytes the day before the exam

I was worried I didn't do enough reading going into the exam but really I think questions are the big key.

Got a 94 (98th percentile). Was expecting something 10 pts lower based on previous shelf exams but I guess the ~2000 questions paid off
 
Our IM clerkship is 12 weeks (two of those are vacation). IM was my first rotation as a third year student...starting about three to four weeks after I completed Step 1.

Start from the beginning...there was a tragedy in my family the week before IM began, so bad it almost kept me from starting my third year. These events had me dazed for weeks into the clerkship. I did not begin any formal study for the exam until about five weeks left (before shelf day).

I started with Step up to Medicine second edition, reading and taking notes page by page. With about three and a half weeks remaining, I purchased USMLE World for Step 2CK and began LOTS and LOTS of IM questions.

All said and done I completed all of Step Up except the ambulatory med chapter (didn't touch it). As with UWORLD, I had about 390 questions remaining.

We had 2hrs 30 min for the shelf (an improvement I've heard from the 2hr10min previously given). I have never, ever in my life felt pressed for time on an exam...not the MCAT, DEFINITELY not STEP1...but this exam left me sweating!! I had 4 questions left when ten minutes was called and I did NOT think I could do it.

It took three weeks to get the scores and I felt there was no way I would honor. I got a converted score (by the school) of 94, an NBME scaled score of 92. I was very pleased. It was the highest among those who took the exam with me at the school and qualified me for honors.

USMLE World was the best resource IMO. Step up is great but give yourself time to read it, it's time consuming and dry.

Summary: toughest part of exam--really it's the time limit
best resource--USMLE World Step 2 CK Qs
 
Just wanted to take a poll, how much time do you get for the internal med shelf at your school??

we get 2 hrs 30 mins for all our shelves
 
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