Official Internal Medicine Shelf Exam Thread

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Aphtalyfe said:
I thought the scores were supposed to be adjusted so that the mean was 70 and SD was 8?
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I'm reporting it how my school reported it. School score was a 99, NBME score was a 96 with a mean of 76 and an SD of 8
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We got an email about the scaled score thing. The scaled score is worthless. As one progresses through the year, the scaled score increases. Evidently, the scaled of 70 being 50% was in the 1990s and they just never adjusted it. There is fight to stop the BS with scaled scores on NBME junk since it is misleading...kind of like that 2 digit step 1 score.
 
MossPoh said:
We got an email about the scaled score thing. The scaled score is worthless. As one progresses through the year, the scaled score increases. Evidently, the scaled of 70 being 50% was in the 1990s and they just never adjusted it. There is fight to stop the BS with scaled scores on NBME junk since it is misleading...kind of like that 2 digit step 1 score.
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the official website says it was adjusted a few years ago (for difficulty purposes) but I assume they just set the scale of 70 being 50% nationally once a year. It goes up because I would assume they don't change the scale until the next year. But their scale does give national percentile ranks which is probably more important anyway.

also even if what you say is true it's not like students today are any smarter than in the 90s. Sure the material has changed but overall the intelligence is the same. If students in the 90s came to school today they'd be fine I'm sure.
 
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Tests scores have been creeping up in all areas. The scores are definitely not true to the scale stated. If that were the case, I'd be in the top .001% on one of my exams rather than the 95th.

It is a dated system and we were instructed to just ignore it by a guy actively involved in testing statistics stuff with the NBME.
 
Okay so paging through this thread a bit it seems that a popular combo of things is:

UW for step 2 CK, SUTM, MKSAP for Students.

So thats what Im probably using or shelf study....

I just have a question still though. What is a good pocket book to have for medicine? Either for just using for helping me on the wards and/or shelf studying during periods of down time. Or is there something good to run on an Ipod?
 
I purchased Pre-Test Medicine for iPod. I makes you do all the questions for a quiz, before seeing how you did, but then it gives rationale for the questions. Good go-to resource in-hosp.
 
officedepot said:
I would highly recommend "Pocket Medicine" and get the most recent edition. It literally has everything you need to know but it isn't something you can really study or memorize. However I did like to read through it when I had nothing going on or whenever I had a question about a patient. Likely all your residents have this.

You could also carry case files around but I would never go without pocket medicine.
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Agree. Let me make this concept more explicit:

Pocket Medicine is an awesome resource for ward work. It is a poor choice for the shelf. The specifics, even the information, is targeted for intern or resident level material. Its stuff you will be pimped on, its stuff you will have to know for life, its stuff that is worth learning on your rotation, but it is not the stuff you get tested on for the shelf. I second the recommendation to have this as a pocket book, but not for shelf studying, specifically.

Case Files is a weak resource for medicine, but is something you can carry with you easily. It could be your shelf-studying book. I realize that this means carrying two books (which takes up space and makes you look like a pack mule), but if your goal is success on the Shelf, you must have a shelf resource.

USMLE Secrets is another option. The Step 2 version is their strongest work. Parse through the medicine topics in the Step 2 book to learn the content the way you should know it and to the extent you should know it for the shelf. Honestly, I suggest USMLE secrets if you must have a pocket book for shelf studying.
 
does anyone know if MKSAP 5 comes with a CD-ROM like MKSAP 4? on the ACP site it looks like they only give you some online access, but it'd be nice to have an electronic version with me when i don't have web access...

-edit-
nvm...i found out no cd-rom or offline version. either book or web. oh well...
 
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Would you guys suggest going over incorrects/marked on UW again or doing MKSAP for the final week of preparation?
 
haven't touched much of step up to medicine and have about a week and half to go.... u guys recommend just doing u world at this point or try something quicker like casefile or keep trudging along with step up?
 
Took it today, overall felt mostly prepared. One thing I will say about shelf exams is that the questions on them seem to have a slightly different style than both qbanks I tried this time. Let me try and explain:

MKSAP4: This felt pretty easy. Generally there was only one correct answer if you could identify the disease process the question described.

UWorld: Sometimes it tries to trick you, but generally the questions seem fair. More often you have mutli-step thinking required to figure out the right answer, though.

Shelf: A lot of questions had you "comparing" two disease processes. For example, they would describe a patient with 5 symptoms. 4 out of those 5 could fit very nicely with answer A, but 2-3 could fit very nicely with answer B. I assume you just go with A since it fit better, but you are left scratching your head wondering.

Also, another theme I noticed with the shelf exam is that a question will describe a person with a disease and start listing their symptoms and give no indication whatsoever why that person has that disease. Random healthy people will have abscesses, for example.

Anyways, overall it felt fair. If I had to rank resources I would say: UWorld > MKSAP > Case Files.

Case files was helpful because it gives you the basic foundation you need to get the most out of a question bank, but isn't enough on its own.

If I could do it all over again I would have just used UWorld and Case Files.
 
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So casefiles and u world it is? Is mksap really better than uworld?
 
It was ridiculous. I've never seen so many bs questions. Nothing high yield. I used step up & mksap4. I have no clue how I did which was basically the sentiment from my classmates as well.
 
Hey guys,

I am not familiar with UWorld.

Is there a special section on there for the IM shelf?

Or do you just do the Step 1 questions?
 
NTF said:
It was ridiculous. I've never seen so many bs questions. Nothing high yield. I used step up & mksap4. I have no clue how I did which was basically the sentiment from my classmates as well.
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Same here...I walked in feeling confident having done most of MKSAP (averaged about 80% correct) and having multiple attendings and residents telling me "I would have no problem whatsoever" with the shelf based on their pimping. Looks like neither are a good predictor hehe.

In addition to tons of convoluted questions, the length and construction of many question stems were ludicrous and made things as confusing as possible...necessitating multiple read-throughs of the question. Thanks to this, I ran out of time--did 30 questions in 15 minutes at the end and had to bubble "d" for an additional 6 questions in the last minute. The four or five classmates I chatted with after also ran out of time and all had to randomly bubble in 3-5 questions at the end. Oy.
 
happylunchbox said:
Same here...I walked in feeling confident having done most of MKSAP (averaged about 80% correct) and having multiple attendings and residents telling me "I would have no problem whatsoever" with the shelf based on their pimping. Looks like neither are a good predictor hehe.

In addition to tons of convoluted questions, the length and construction of many question stems were ludicrous and made things as confusing as possible...necessitating multiple read-throughs of the question. Thanks to this, I ran out of time--did 30 questions in 15 minutes at the end and had to bubble "d" for an additional 6 questions in the last minute. The four or five classmates I chatted with after also ran out of time and all had to randomly bubble in 3-5 questions at the end. Oy.
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Yeah it was pretty rough. It seemed like there were always 2 or 3 things pushing one diagnosis and then a couple things pushing to a different answer choice. O pues, such is life.

Are yall still taking hand written tests?
 
I'm just glad that I am done with IM. Most of the questions on this NBME were lengthy and filled w/distractions. I think if you're good at eliminating useless information and allocating your time looking for buzzwords and what's relevant to the question being asked then you'll do great on this test. I was able to finish w/a few minutes to spare. I used Case Files x1, Step Up x1, and MKSAP x2. However, I felt reviewing w/my attending helped me out the most.
 
i just got my scores back

87/92

-read casefiles 1.5x- this book is golden. really. i would highly recommend studying from this book because it will get you the bread and butter questions correct. uworld will take care of all the aberrants. however, i do credit casefiles for giving me one completely random question about Felty's Syndrome.
-read about 2/3 step up (ugh this thing is such a time suck)- just try and read it but don't kill yourself memorizing it. i absolutely loathed reading this book.
-2x uworld (first pass all, second pass all marked [i marked all my incorrects and my lucky guesses/unsures], and randoms after that to keep me fresh)- this is where you should be studying during your second half of the rotation.
-100 questions from mksap- compared to uworld, mksap is much easier. if you have time, do mksap questions because it does cover some stuff uworld doesn't cover. but, i don't think it really hurts you if you don't do it.

doing uworld was definitely the most helpful. i was able to answer some questions just by looking at lab values and/or radiographs alone.

the test has really long question stems. you should DEFINITELY read the question first to focus your reading. my plan of attack was always to read the question first, glance the lab values, then peruse the question to find the pertinent positives/negatives.

if i were to do it over again? uworld and casefiles. that's solid.
 
NTF said:
It was ridiculous. I've never seen so many bs questions. Nothing high yield. I used step up & mksap4. I have no clue how I did which was basically the sentiment from my classmates as well.
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Got my score today. 92. I'm ecstatic considering how I felt afterwards. Average for my rotationmates was an 81.

I used Step Up to Medicine - 2 quick skim throughs
Mksap4 - 1 pass
Pocket Medicine & Uptodate - whenever possibly on patients I saw or were on my service
My school also made us do SIMPLE CASES (those online modules) as part of the rotation
 
I use this forum a lot and I try to post back when I can, this is what I did for the medicine shelf:

Step Up to Medicine
UWorld Questions
MKSAP 4
MKSAP 5
Case Files (Did 35/60 of the cases, it's good but I kind of lost interest in it)

Did all my marked questions in UWorld the 4 days leading up to the shelf

Ended up scoring 99 with 98th percentile.

Honestly I felt like this shelf was all about having done a TON of practice questions, almost every question I felt like I had seen before.
 
I guess as advice to future shelf takers (having taken my 3rd shelf) is that the value of finding time to do questions (pretest, lange, uworld, mksap, etc) can't be underestimated. No review book will be sufficient and the nuances that are expected from shelf questions just can't be divined from just content review. I'd say there were at least 15-20 questions I only got right because I saw similar questions in mksap that emphasized info I never would have committed to memory otherwise.

I got a 78 on ob/gyn, 95 in peds and 92 in medicine. The only change I made after ob/gyn was making sure to do more questions and spending less time trying to memorize a content review book.
 
I only used Uworld internal questions and Step Up to Medicine and ended up with an 87.

Definitely look at what your school requires for honors and go from there. I would honestly say just stick to both of these resources and although obviously you have to put in the time, you can pretty much achieve whatever score you need for honors in your particular school using Step Up to Med and Uworld internal med Qs.
 
I just started my 8 week medicine rotation, and was thinking of taking a different approach. I am a VERY slow reader, and have trouble getting through lengthy texts. I don't see myself finishing Step Up to Medicine and UWorld in this 2 months, especially with my rotation hours.

From reading the thread, I can see that questions are crucial in doing well on the shelf. I was considering doing the following:
-Reading Step Up to Step 2 (parts that are pertinent to IM)
-Doing Uworld and annotating into SUS2
-Possibly MKSAP 4 If I get the time

I am also considering watching DIT videos for the pertinent parts of SUS2. Has anyone used SUS2 for this shelf? Any thoughts?
 
Got my medicine shelf grade back: 97

Overall, probably the hardest shelf exam I've taken so far, but given that I enjoyed internal medicine thoroughly, studying for it wasn't such a pain in the neck.

Stuff I recommend:
- Did all the UWorld questions (1400 or so) and MKSAP questions. Felt that the questions were more in quality comparatively to UW but not really fully representative by either. MKSAP was better for wards and felt that it was better for learning concepts and thought processes.
- Read all of Step Up and annotated when I didn't understand stuff from UW.
- Study a little bit every day and of course read up on your patients. This was key for me and really helped me learn well.
- Knowing some obvious associations will help you on the exam (i.e. pain out of proportion to abd exam = mesenteric ischemia, corkscrew barium swallow = DES vs. bird's beak = achalasia, etc).
- this is so far helping me out immensely for Surgery. Definitely glad I took this clerkship before I did surgery, esp since I feel like all the OR teaching i've encountered so far has been more useful for the residents than the students.

Stuff I do not recommend:
- Case Files is a weak resource even though it's a good thing to have in your pocket... I liked it much more for Family Medicine and it was okay for Peds, but not great for Medicine. Avoid it in general.
 
sswang00 said:
I just started my 8 week medicine rotation, and was thinking of taking a different approach. I am a VERY slow reader, and have trouble getting through lengthy texts. I don't see myself finishing Step Up to Medicine and UWorld in this 2 months, especially with my rotation hours.

From reading the thread, I can see that questions are crucial in doing well on the shelf. I was considering doing the following:
-Reading Step Up to Step 2 (parts that are pertinent to IM)
-Doing Uworld and annotating into SUS2
-Possibly MKSAP 4 If I get the time

I am also considering watching DIT videos for the pertinent parts of SUS2. Has anyone used SUS2 for this shelf? Any thoughts?
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Anyone?
 
Question for folks that studied using USMLE World qbank...

did you do ALL the questions under the "internal medicine" section?

under "internal medicine", there are subsections on detailed things like "neurology" and "opthalmology" that I have been doing, they are admittedly pretty difficult. Some people in my class advocate not doing those more specialized questions.

what do you folks think? do I need to know the difference between and open angle glaucoma and narrow angle glaucoma for the internal medicine shelf?

many thanks.
 
I've been doing all the questions. I don't have official rotations in neuro, optho, or derm but I do encounter those patients in clinic. Most of the questions aren't too bad. There are the scattered random ones that are sneaky or I haven't heard of, but once I miss it, I have officially heard of it!
 
can someone please tell me which MKSAP to buy? people keep mentioning 3, 4, and 5. and what is the difference between them? :confused: should i buy more than one? please let me know asap! thanks!
 
DrPathodifficle said:
can someone please tell me which MKSAP to buy? people keep mentioning 3, 4, and 5. and what is the difference between them? :confused: should i buy more than one? please let me know asap! thanks!
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i haven't taken the shelf yet (currently studying for it), but i'm currently working on MSKAP 4 (half thru) and will be trying to get thru MKSAP 5 by the time I take the test.

i dont think it really matters which one you do, just get one and plow through it. if u have the time, do 2 versions.

more question you do, the better.
 
Got the shelf score back today: 93. I think our average was a 79.9.

Step Up to Medicine and UWORLD questions are what I used. I went through Step Up once (try not to get bogged down in the Neuro section, just skim through it) and probably did about 1200 of the UWORLD questions. The shelf felt a lot easier than the question bank so it's a really good prep.
 
just bought it. thanks! hopefully i can finish the Uworld questions im working on in the next 1.5 weeks (got like 450 questions left) and tackle the MKSAP.
 
All the mksaps are pretty easy to work through. They are a mix of painfully easy questions and random little esoteric things, but the explanations are all good.

MKSAP 3 has very short question stems. I just skimmed it and haven't done any of it.

MKSAP 4 and 5 are very similar with a few crossover questions I think. I did the online MKSAP 5 which was ok.

So far, I've found uworld questions the best (not surprising). Many of the kaplan step 2 question book ones aren't too bad either.

I'm a question studier since I can get through all of about 10 pages of step up without daydreaming.
 
For those debating about MKSAP, I would highly recommend UWorld questions instead. I did all of MKSAP 4 and several hundred UWorld questions when I was studying for this shelf and found that UWorld was by and far better. I think this is because MKSAP has random way too easy questions that waste time. Also, UWorld explanations are better (more thoroughly explained). MKSAP had less consistent quality in the question explanations.
 
pitt1166 said:
Question for folks that studied using USMLE World qbank...

did you do ALL the questions under the "internal medicine" section?

under "internal medicine", there are subsections on detailed things like "neurology" and "opthalmology" that I have been doing, they are admittedly pretty difficult. Some people in my class advocate not doing those more specialized questions.

what do you folks think? do I need to know the difference between and open angle glaucoma and narrow angle glaucoma for the internal medicine shelf?

many thanks.
Click to expand...

I got very, very few neuro questions on my medicine shelf and they were on very easy high yield topics (Duchenne's, Parkinson's). It was not necessary for me to do the neuro questions. That said, do them if you have the time, since it's possible they could still turn up.

I was actually given a question about acute angle closure glaucoma but it was a "diagnosis" question - nothing about management (which would prob be straightforward stuff like pilocarpine drops, acetazolamide, in preparation for the ophthalmology team to do surgery).
 
Mace1370 said:
For those debating about MKSAP, I would highly recommend UWorld questions instead. I did all of MKSAP 4 and several hundred UWorld questions when I was studying for this shelf and found that UWorld was by and far better. I think this is because MKSAP has random way too easy questions that waste time. Also, UWorld explanations are better (more thoroughly explained). MKSAP had less consistent quality in the question explanations.
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I'm just doing them all, along with Kaplan step 2 question book and an internal med review book. :p
 
Mace1370 said:
Then you have way more willpower than I do or have way more free time during your clerkship (or both), haha.
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I have an ipad with the uworld app, kaplan step 2 qbook and then the mksap 5 page saved. Whenever I have downtime or am stuck in mandatory lectures, I just do questions. It is pretty easy to rip off 30-40 a day that way and then I may do another 300 over the weekend if I'm not rounding.

I'm a question learner/study person though. I look up stuff in step up once in a while, but I feel I get much more out of thinking through problems.
 
I have a few quick questions:

How high yield is neuro for this exam? I know the basics of diagnosis and treatment for ischemic hemorrhagic strokes, meningitis etc..but I did not spend time learning specifics about what specific findins you see on stroke of particular arteries or specific brain tumors. And how about specific orthopaedic injuries (radial vs ulnar nerve injury etc).

-Also, if i don't get time to finish all of UWorld, what sections should i focus on? I was thinking cardio, resp, and GI. My plan is to finish all of MKSAP4 and do as much of uworls as possible...2 weeks to go.
 
I'd just keep it random on uworld. Get a nice mix of topics.

Mksap is pretty quick to get through really. I did a lot of it in one weekend.
 
MossPoh said:
I have an ipad with the uworld app, kaplan step 2 qbook and then the mksap 5 page saved. Whenever I have downtime or am stuck in mandatory lectures, I just do questions. It is pretty easy to rip off 30-40 a day that way and then I may do another 300 over the weekend if I'm not rounding.

I'm a question learner/study person though. I look up stuff in step up once in a while, but I feel I get much more out of thinking through problems.
Click to expand...

I'm mostly the same way, but we weren't allowed to read/use ipads during lectures. It was "unprofessional." During downtime it was ok, but there just wasn't that much of it. By the time I got home I was so exhausted I was only able to read or do questions for about an hour before my willpower gave out.
 
Ah, we only have one "lecture" day per week in the afternoon and that is usually when I get a good 20 or 30 questions done!
 
how many EKG's do you usually have to interpret on the IM shelf? I am asking because my EKG reading skills are not the best. I'm wondering if I should spend a few days brushing up on them.

And when and EKG is given, are all of the leads given? Or only the pertinent ones needed to make the Dx?
 
sswang00 said:
how many EKG's do you usually have to interpret on the IM shelf? I am asking because my EKG reading skills are not the best. I'm wondering if I should spend a few days brushing up on them.

And when and EKG is given, are all of the leads given? Or only the pertinent ones needed to make the Dx?
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I had one EKG and it was a very obvious anterior wall STEMI. They're not gonna be ridiculously tough EKGs and yes all of the leads were given (though I can imagine for an EKG showing something like peaked T waves for hyperkalemia you don't need all the leads).
 
ArcGurren said:
I had one EKG and it was a very obvious anterior wall STEMI. They're not gonna be ridiculously tough EKGs and yes all of the leads were given (though I can imagine for an EKG showing something like peaked T waves for hyperkalemia you don't need all the leads).
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ok great, thank god. Because these EKGs on MKSAP4 are killing me. They have a bunch of them that I wasn't able to identify. I really hope the shelf doesn't have this many, or questions where you rely on the EKG for an answer (insufficient H&P)
 
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