Official Internal Medicine Shelf Exam Thread

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
skylina said:
Alot of people have mentioned how much of uw, mksap, step up, theyve done, but how much time is feasible to do all of these? I have 8 weeks left in my IM rotation, what is reasonable to go through in that time? thanks
Click to expand...

You can definitely do step-up and 1/2 or more of UWORLD medicine questions in 2 months with moderate effort. That's what I did, reviewed incorrects for a couple days-->91.
Members don't see this ad.
 
Please please please start early on this.

I know internal medicine is really time consuming, but it will make you better to be studying during the rotation. It will affect BOTH aspects of your grade to know your stuff.
 
How well can I expect to do if I go with UW as my main source? I've done around 850 UW questions and should finish them by my exam. I have step up as well and just have been reading up on my pts from it. Don't think I'll be able to get through all of the book by the exam. Just no time to read...
 
Members don't see this ad :)
dude1344 said:
How well can I expect to do if I go with UW as my main source? I've done around 850 UW questions and should finish them by my exam. I have step up as well and just have been reading up on my pts from it. Don't think I'll be able to get through all of the book by the exam. Just no time to read...
Click to expand...

you'll be fine as long as know World well. Step Up is ok but I don't believe it's a must read (or a must finish to be exact). Know the high yield stuff though
 
any stats questions on the medicine shelf?
 
This is the hardest I think. Can you please share what the exam would be?
 
What % uworld are you guys getting and what did that correlate to on the exam?
 
2012mdc said:
Low to Mid 70's. 94 raw (98th percentile) on shelf
Click to expand...

I've just started studying for this beast that is in two weeks (yea I know.. complete slacker), and after 300 UW questions I'm at 65%. I'm thinking that if I get another 400-500 questions done I'll be sitting pretty with at least a 75 or something on the real test (70+ for us raw score gives us a chance at an A). What's the consensus? Is a 70 raw score really the national average?

I'm not sure how some of you get motivated to do 1400 questions for a stupid shelf exam, while maintaining the drive to wake up in the morning and go to clinic.
 
fahimaz7 said:
I've just started studying for this beast that is in two weeks (yea I know.. complete slacker), and after 300 UW questions I'm at 65%. I'm thinking that if I get another 400-500 questions done I'll be sitting pretty with at least a 75 or something on the real test (70+ for us raw score gives us a chance at an A). What's the consensus? Is a 70 raw score really the national average?

I'm not sure how some of you get motivated to do 1400 questions for a stupid shelf exam, while maintaining the drive to wake up in the morning and go to clinic.
Click to expand...

Yeah 70 is really the average.

I went nuts with questions on IM. Did ~1250 the first run through (had done GI and Liver questions for Surg), repeated all incorrects/marked (~400) and also the 8 kaplan Q book tests (400 Q's).

At my school it was 81+ or bust for honors. That combined with knowing that my grades in medicine and surgery mattered the most for my specialty were motivation enough. It also helped that I had FM the rotation before and treated it like a vacation :laugh:
 
I focused heavily on "step up to medicine" for the first month, and then I did 400 MKSAP 4 questions. Don't worry about what percentage you get on the MKSAP questions, I think I had a 75 percent overall lol but i think i could of done a lot better had I not been so tired when I studied. I only read half of casefiles and I was constantly looking stuff up on my patients in the hospital (very important).
I got a 98 raw score, 99th percentile

Good luck!
 
Delilah said:
So far I have read Step-Up (2 chapters left) and plan to finish the last 2 chapters this week. I've done 670 UWorld qs and half of MKSAP 3. My average on UWorld is averaging about 55 percentile. Is this super concerning? I have been working my ass off. My strategy was to do MKSAP 4 and finish UWorld in my last month. I am wondering what I should prioritize and how I should optimize my time. Any advice would be much appreciated.
Click to expand...

How did your last month of sudying go? I think I will be in a similar situation and wondering if this will work (need >80 raw score to honor). Clerkship is only 2 months so I have 7 more weeks to go. Done 200 UW questions so far averaging 56%, just started reading SUTM. I haven't had much time to read or do questions this past week and by the time I get home I am exhausted. Any suggestions would be appreciated.
 
Members don't see this ad :)
Rothbard said:
Hey guys, just started my IM rotation. What would you recommend for someone who hates doing questions? Is there any equivalent to FA for step 1, something that covers everything concisely? It sounds like Step Up to Medicine might fit the bill, but this was the top review on Amazon



Is that accurate? The same reviewer also recommends Pocket Medicine by Mass Gen. and the Washington Manual. Thoughts, overkill?
Click to expand...

I don't know how much truth I would attach to this review but my thoughts are that SUTM is an outline in bullet form of what you need to know. If you learn that way and it works for you, I am sure it would be a great source. If you liked Goljan for Step 1 you will probably be fine with SUTM.

For me, I need a book that flows, explaining why certain things are treated the way they are (i.e. an explanation of why Beta Blockers are contraindicated in pheochromocytoma as opposed to a bullet saying Beta Blockers contraindicated). I think case files w/ MKSAP will get you most of the way there while being efficient time wise. If you can throw in Pocket Medicine while on the wards and also get through some UWorld, you should be set.

In conclusion, use what works with your learning style. If you don't like SUTM and it doesn't work for you, don't use it because some guy in your class says it's the best. Keep in mind I have yet to take my shelf so I could very well regret not reading SUTM.
 
Rothbard said:
Hey guys, just started my IM rotation. What would you recommend for someone who hates doing questions? Is there any equivalent to FA for step 1, something that covers everything concisely? It sounds like Step Up to Medicine might fit the bill, but this was the top review on Amazon



Is that accurate? The same reviewer also recommends Pocket Medicine by Mass Gen. and the Washington Manual. Thoughts, overkill?
Click to expand...

So far for me Pocket Medicine has pretty much been a "must have in my pocket" sort of thing. I don't think it's a sit down read type of book, but if you want to quickly look up the differential for that anemia your patient has, how to work it up for your assessment & plan, this book works like a charm. SUTM and UW has been going fine for me with studying (albeit time-consuming); If you want management, treatment algorithms, etc, that's where UpToDate and my intern/resident comes in handy. Keep in mind I haven't taken my shelf yet either, just my experience so far.
 
What does it take to hit the 10th percentile? (number of questions correct) Serious question!
 
Can't decide if I should lay down the 4 hundy for UWorld. I already have Step Up and MKSAP 4, but if UWorld is really as good as a bunch of you are saying, then I can maybe justify the expense. Is UWorld any good for other rotations board exams?

Something to consider is that I'm in Canada and so my IM rotation is 2 months with zero dedicated NBME studying time (the rotation ends and literally the next day we write the boards). Would this affect the choice of UWorld or not?

Thanks.
 
Deanis said:
Can't decide if I should lay down the 4 hundy for UWorld. I already have Step Up and MKSAP 4, but if UWorld is really as good as a bunch of you are saying, then I can maybe justify the expense. Is UWorld any good for other rotations board exams?

Something to consider is that I'm in Canada and so my IM rotation is 2 months with zero dedicated NBME studying time (the rotation ends and literally the next day we write the boards). Would this affect the choice of UWorld or not?

Thanks.
Click to expand...

I am in Cali and have the exact same schedule (I would think most places don't allow decidated time to study for shelf exams, you have to make that time for yourself). I am using UW and SUTM currently. The beauty of UW is that whenever I have 20 mins or so down time in the hospital, I just hop on any computer and do a few questions. I also have MKSAP, my plan is to do questions from it the second month of my rotation. The thing for me is that I don't take the book around with me during the daytime, so the only time for me to do it would be when I get home at night. After a day at the hospital it's difficult to go home and do questions, so that's when I read SUTM or stuff about my patients.
 
DrDrToBe said:
I am in Cali and have the exact same schedule (I would think most places don't allow decidated time to study for shelf exams, you have to make that time for yourself). I am using UW and SUTM currently. The beauty of UW is that whenever I have 20 mins or so down time in the hospital, I just hop on any computer and do a few questions. I also have MKSAP, my plan is to do questions from it the second month of my rotation. The thing for me is that I don't take the book around with me during the daytime, so the only time for me to do it would be when I get home at night. After a day at the hospital it's difficult to go home and do questions, so that's when I read SUTM or stuff about my patients.
Click to expand...

Cool, thanks. I'm dropping the 400. Yowch.

Yeah, I just thought that US schools had 3 month IM rotations but I guess it's just school dependent.

Thanks again. And good luck with IM :thumbup:
 
Just got score:

87%, 92nd percentile;

Materials used:
Step up to Medicine (didn't really like to be honest)
UWorld IntMed--100% complete, 68% correct (only did one pass)
MKSAP 4--completed around 85-90%

I actually thought the exam was very difficult when I completed it. Many stems are very long and sifting through a lot of irrelevant patient data is a very necessary skill. Hope this helps people...
 
Quick question, apologies if previously answered: for those who have taken already, how do UW's internal medicine questions compare to the questions on the shelf?

Lots of us, myself included, thought that UW > Step 1 in terms of difficulty. Curious as to whether that applies here too.
 
Brewmeister said:
Just got score:

87%, 92nd percentile;

Materials used:
Step up to Medicine (didn't really like to be honest)
UWorld IntMed--100% complete, 68% correct (only did one pass)
MKSAP 4--completed around 85-90%

I actually thought the exam was very difficult when I completed it. Many stems are very long and sifting through a lot of irrelevant patient data is a very necessary skill. Hope this helps people...
Click to expand...

What was your raw score?
 
I ended up with a raw score that translates to >90th percentile -- was pleasantly surprised. A few things imo:

1. Stems are as long as everyone makes them sound.

2. I used UWorld 2 CK, some MKSAP, some Step Up (to Medicine, not Step 2), and some Pocket Medicine. Made it through 1/3 or so of the billion imed questions in UW, a spattering of MKSAP, a few higher-yield chapters in Step Up, and the green book when it applied.

3. I felt better after Step 1 than I did after the shelf -- the questions are just ****ing out there sometimes. UW has some long questions, but they're much more tolerable. The shelf questions felt like a chore somehow.

@silverpaw54: yes, there are biostats questions. Can't remember any ophtho questions specifically, but I could see one being at home there.
 
Last edited by a moderator:
score: 99

Resources:
1. UW (did about 800 random questions)
2. Step up to medicine
3. Patients/lectures/conferences during clerkship

I can count at least 10 questions that I got right only because of UW. Try to do all 1400+ questions if you have time. Skimmed through SUTM really quick in the last week. I'd bought MKSAP4 but never used it - everyone else on my rotation was using it but an upperclassman had told me that it was not worth it at all and I guess he was right!
 
raw score 86

1. case files
2. MKSAP (really nailed it in my opinion)

that's it. Some people here go nuts. It's really not necessary. I also reviewed FA for step 1 randomly while doing case files and MKSAP. Had pocket medicine on wards and read in free time there.
 
Everyone is doing pretty well. I've done about 300 questions (random IM) I'm sitting pretty low at 59% (46th percentile).

I started out with 52 on my first two attempts, but gradually went up. Only a few weeks to go....

Can anyone comment on the need to study for biostats?
 
Last edited:
I thought the test was fairly difficult, but thankfully I ended up with a 90 raw and a 96th percentile.

I used UWorld, MKSAP 4, Case Files, and Step Up (to med).

I would consider myself a slacker and only managed to pull it together in the last 2 weeks or so. I did UWorld @ 90% completion with an average of about 70% on timed random sets. I thought this was by far the most helpful for doing well. Do this if you are in a pinch. MKSAP is easy to finish with just 450 questions and was also really helpful, especially its focus on the differential for low back pain (had at least 4 questions alone on this topic). However, I thought the test was more similar to UWorld overall. Step Up was difficult to finish due to the bullet-point setup and denseness. While it is slightly overkill, I think that the one pass I was able to do was more than enough. Case files seems like it would have been really helpful, however, I never got inspired enough to use it somehow even when it was in my white coat. Went through 15-20 cases which were decent reviews of high yield topics.

Overall. UWorld - MKSAP 4 - Step Up. Should be more than enough.
 
Can anyone lay out the "official" shelf exam criteria for when to initiate treatment for TB?

A 40-year-old, asymptomatic female hospital employee is evaluated for a positive tuberculin skin test (10-mm induration). The patient was born in India and moved to the United States 10 years ago. She received bacille Calmette-Guérin vaccination as a child and remembers having at least two tuberculin skin tests in her teens that were positive. She has not been tested since that time, and has never received antituberculous medications. She has no medical problems, and takes no medications. She knows of no definite exposure to anyone with active tuberculosis. A recent chest radiograph was normal.

Which of the following is most appropriate for this patient?
( A ) No chemoprophylaxis
( B ) Isoniazid, 300 mg daily, for 9 months
( C ) Rifampin, 600 mg daily, for 4 months
( D ) Rifampin, 600 mg daily, and pyrazinamide, 2 g daily, for 2 months
( E ) N/A

The "official" answer is B, although that's utter bull**** in real life. A good friend of mine (MS-III) got the BCG vaccine and has had positive PPD's all her life. Whenever she has to get one placed that comes back positive, she gets a CXR to clear her and doesn't go on INH. A ****ing positive PPD is always positive, so it makes no sense to treat someone vaccinated with BCG who shows no symptoms of the disease, who has always been negative for the disease, and who has negative imaging for the disease. If the "official" answer from this MKSAP question were true in real life, my friend would be forced to be on INH for 3/4ths of the year, every year for the rest of her life (since every year she turns a PPD positive.. what a surprise)

Anyone know how exactly they want you to tackle PPD results on the test?
 
I'm in the same situation: the Pulmonologist recommended Isoniazid.

I didn't take his recommendation.
 
Tig2575 said:
Can anyone lay out the "official" shelf exam criteria for when to initiate treatment for TB?

A 40-year-old, asymptomatic female hospital employee is evaluated for a positive tuberculin skin test (10-mm induration). The patient was born in India and moved to the United States 10 years ago. She received bacille Calmette-Guérin vaccination as a child and remembers having at least two tuberculin skin tests in her teens that were positive. She has not been tested since that time, and has never received antituberculous medications. She has no medical problems, and takes no medications. She knows of no definite exposure to anyone with active tuberculosis. A recent chest radiograph was normal.

Which of the following is most appropriate for this patient?
( A ) No chemoprophylaxis
( B ) Isoniazid, 300 mg daily, for 9 months
( C ) Rifampin, 600 mg daily, for 4 months
( D ) Rifampin, 600 mg daily, and pyrazinamide, 2 g daily, for 2 months
( E ) N/A

The "official" answer is B, although that's utter bull**** in real life. A good friend of mine (MS-III) got the BCG vaccine and has had positive PPD's all her life. Whenever she has to get one placed that comes back positive, she gets a CXR to clear her and doesn't go on INH. A ****ing positive PPD is always positive, so it makes no sense to treat someone vaccinated with BCG who shows no symptoms of the disease, who has always been negative for the disease, and who has negative imaging for the disease. If the "official" answer from this MKSAP question were true in real life, my friend would be forced to be on INH for 3/4ths of the year, every year for the rest of her life (since every year she turns a PPD positive.. what a surprise)

Anyone know how exactly they want you to tackle PPD results on the test?
Click to expand...

They might be getting at the fact that BCG usually "wears off" after 20-25 years. Even if there's still a reaction, it probably wouldn't be 10mm. And since the CXR shows no active infection, she's from a TB prevalent country, I guess you assume exposure and treat prophylactically?
 
Took the shelf today and I was pleasantly surprised. After all the warnings about long question stems I was really worried about finishing but I got through the test. No clue how I did...

The biostats on my test was pretty straight forward stuff like that basically you just needed to know the definitions of specificity and sensitivity. I was a little bit surprised about the number of number of questions that had someone present to the ER and they wanted to know the first thing to do or the first test to order when everything listed is something that you need to do or test for in order to treat the patient.
 
hey guys I have about two weeks left before my im shelf and debating how I should approach it. I finished MKSAP 4, used it as a learning tool and read through 75% of step up to medicine. i didnt do any uworld question.

my question is, should I reread step up to medicine page by page in my last two week or should I read case files for internal medicine and do another run of MKSAP 4? Any advice would greatly be appreciated. Thank you!
 
Just got my shelf score (finally) and wanted to just say I got a 96 by doing all the UW questions. Kinda flipped through step up now and then but didn't spend much time with it.
 
Took it today. Main resources were Blueprints (x1), UWorld (x1), MKSAP 14 (most of it, 1x), and the highlights of SUTM. Think that was pretty much on target... Had I had time, another pass through World would've been the best bang for the buck.
 
I just got my subscription to world for the year:smuggrin:


Can anyone vouch for adding on the kaplan qbank to supplement it? It's only 199

Don't know where I'll find the time but I plan on doing world, kaplan, mksap and pretest

The pretest is a huge maybe
 
There is a really good question booklet by Dr Conrad Fischer. I think it is called Kaplan internal medicine question booklet? It has some good reviews; the only reason I didn't use it was because I didn't have the time. I wouldn't waste your time on buying an online kaplan Q bank for the internal med shelf exam. It is way cheaper.
 
med learner said:
Hi all,
I have been guilty of lurking to these posts t benefit from suggestions, and I feel I need to start benefiting others as well :)
First, a general word about the exam
I felt the medicine shelf had very long stems compared to other shelfs. So my first advice is to be quick. Read the last sentence it will help direct you to imp. info. in the stem
I did the following
MKSAP x1 overall decent B+ source. To me it is not enough as an only source for questions, but had a couple of useful explanations that I felt helped me answer some shelf exams
Case Files x2 over all B. I have developed the habit of doing case file for every exam. It is a nice review source, but not a primary source. Had some useful charts
Step up to medicine x2 overall A.
Excellent source, too much details, but more info. does not hurt. I felt it covered everything I needed for this shelf. This is probably the best primary source for this exam
First Aid step 2 (not medicine first aid, the overall first aid) Overall A-. I liked this source much more than I expected, it is very good for diagnosis and treatment questions, as it does good job detailing both
UWorld Qs x1 over all A. These are 1500 Qs, excellent cover all aspects of the medicine (diagnosis and next step). Probably with step up to medicine are the primary sources.
Final grade raw score 94.
I hope this is helpful if any one have specific questions please ask:)
Click to expand...


Where did u find the time to read all this?
 
2 weeks before shelf, almost done with MKSAP and SUTM. I have done some UW, but still have over 900 questions left and pretty sure I won't be able to get through them all. Any suggestions for which topics in UW are most high yield? I know I'll try to finish the cardiology and ID sections as those are my weak areas. Also, any value in repeating the MKSAP areas that i scored poorly in? Any suggestions would be greatly appreciated.
Thanks a lot!
 
I would suggest starting with the BIG sections on UW like Cards, Pulm, and GI. If you could, obviously finishing UW is best since most people agree its the best source for the shelf. There is probably no benefit in going back over MKSAP unless you get bored of UW or finish.
 
Got my grade back, got a 96 NBME score (mean 76, SD 8). I only used MKSAP3 and got through about half of MKSAP4. I feel like taking internal med first right after the USMLE (and having done well on the USMLE) was the majority of the prep I needed, in retrospect.
 
Ugghh, did shelf today and got destroyed...ran out of time and had to bubble in C for the last 7 questions. Hope I passed :xf:
 
Tig2575 said:
Got my grade back, got a 96 NBME score (mean 76, SD 8). I only used MKSAP3 and got through about half of MKSAP4. I feel like taking internal med first right after the USMLE (and having done well on the USMLE) was the majority of the prep I needed, in retrospect.
Click to expand...

I thought the scores were supposed to be adjusted so that the mean was 70 and SD was 8?

I used Step Up x1, UWorld IM x1, MKSAP4 x1. Ended up with an 87
 
Last edited:
When you guys say the mean is a 70, are you referring to the %ile or the raw score?

A few post up, someone mentioned an 86 raw = 92%ile???

My 80 raw = 72 percentile... Does each school have a different conversion?
 
Does anyone know where I can get a copy of the mksap questions (the software)
 
fuzzywuz said:
When you guys say the mean is a 70, are you referring to the %ile or the raw score?

A few post up, someone mentioned an 86 raw = 92%ile???

My 80 raw = 72 percentile... Does each school have a different conversion?
Click to expand...

See I don't think the report that the school receives has a percentile on it? All the examples on the NBMEwebsite give a 2 digit scaled score followed by an indication that the average is 70 with a SD of 8.

So I'm a little confused as well.
 
Anyone walked into Shelf with only low 50's on Uworld...and passed the beast? I started out sub-50's on UW, and later started getting 50's and 60's, but still ended up with low 50's for overall score.

Well anyhow...I just took the Shelf today, and walked out feeling completely beaten down. The worst thing is...I had to randomly fill the last 10 questions. The real thing is so much more convoluted than the UW questions.

Score comes out in 3 weeks, but I'm dying here from anxiety...
 
Last edited:
How much time are the people with 80s-90s on UW getting for the shelf? My school gives us 2h for every shelf but in the survey section I see an option for 3+ which seems like it would bend the difficulty curve significantly.
 
You must log in or register to reply here.
Next unread thread

Similar threads

G
May have failed internal medicine shelf...again
Replies
3
Views
3K
PikminOC
PikminOC
Paradise City
Internal Medicine Sub I NBME Exam 4th year, how is it different than the IM Clerkship one taken in 3rd year?
Replies
0
Views
2K
Paradise City
Paradise City
Fay1129
Step 2 and Shelf exam notes
Replies
3
Views
4K
pbsdrinkingwhale
pbsdrinkingwhale
Fay1129
Shelf exam notes free of cost (UW, NBME)
Replies
1
Views
3K
MILITARY OFFICER
M
J
Best books for Pediatrics Shelf Exam in 2022
Replies
3
Views
3K
Fay1129
Fay1129
Top