Official Internal Medicine Shelf Exam Thread

[change77]

Topics that you would highly recommend reading or were surprised were on the exam?

Nothing really surprising. The stuff I didn't know were some random derm questions where they described the rash instead of showing it to you. I would say know renal well. I feel like I got 10 questions on acute kidney failure and the glomerular nephropathies. Cardio was big too. A couple ekgs and chf questions. Uh if you have specifics just PM me.

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[abc12341]

Nothing really surprising. The stuff I didn't know were some random derm questions where they described the rash instead of showing it to you. I would say know renal well. I feel like I got 10 questions on acute kidney failure and the glomerular nephropathies. Cardio was big too. A couple ekgs and chf questions. Uh if you have specifics just PM me.

Just PM you a bit ago.

 

[vsl5]

when you guys mention UWorld as a study resource for this exam, are you talking about the Step 2 CK Qbank or one of the other ones? Thanks.

 

[abc12341]

when you guys mention UWorld as a study resource for this exam, are you talking about the Step 2 CK Qbank or one of the other ones? Thanks.

Step 2 qbank

 

[Evil_Abed]

How important is knowing the Ambulatory section of SUTM? I'm running a bit behind on the reading and, if possible, skipping those pages would save me a bunch of time. Based on the NBME website's breakdown of the exam, I've been focusing mainly on the big 4 -- cardio, pulm, GI, and renal. They seem to comprise, at the minimum, 50% of the exam.

 

[Wordead]

For me, at least, medicine was a pretty random breakdown. There was no big 4 focus and shockingly little cardio overall. There was a ton of rheumatology that stood out in my memory. But everyones test is different, so if you want to skip stuff you're kinda rolling the dice.

 

[CaptainSSO]

I need some help from the first NBME:

1. A 22 year old man remains in the hospital 2 days after admission for a closed head injury sustained in a motor vehicle collision. A CT scan of the head on admission showed no abnormalities. He was initially confused, but he has become well oriented with normal vital signs during the past 12 hours. He is currently receiving 5% dextrose in 0.45% saline (50 ml/hr). He has started to eat solids during the past 6 hours. His average urine output has been 50 ml/hr during the past 24 hours. He is alert. Vital signs are within normal limits. Examination shows ecchymosis over the frontal region. The remainder of the examination including neurologic examination, shows no abnormalities. His serum sodium concentration is 120 mEq/L and urine osmolality is 340 mmOsmol/kg. Which of the following is the most appropriate next step in management?

A. Fluid restriction
B. CT scan of the head
C. ADH vasopressin therapy
D. Bolus 0.9% saline
E. Bolus 3% saline

Thanks!

Fluid restriction since he's got SIADH secondary to head trauma. CT won't really help since there's no acute change in symptoms that would justify it, vasopressin would exacerbate the problem, NS wouldn't help. It would be better to try fluid restriction before hypertonic saline since with SIADH you're hyponatremic/hypervolemic. If someone was hyponatremic/hypovolemic such as like diuretic overuse hypertonic saline would be a good first choice.

 

[meliora27]

Any consensus for SUTM vs MTB 2 (IM) for the shelf vs actual step 2 studying?

 

[Lavan]

Any consensus for SUTM vs MTB 2 (IM) for the shelf vs actual step 2 studying?

SUTM for the shelf exam.

For Step 2, you may not need a dedicated text book if you've studied for your shelves. UW is more important. Step up to Step 2 is not great. MTB is fine.

 

[deleted581876]

I'm starting cores real soon.

Anybody have any advice on what books I should be getting for self study? I have Master the Boards for Internal Medicine (which I later realized is only good for the ABIM) and I have First Aid Step 2 CS on the way. Thanks.

 

[jayareus]

I'm starting my first rotation, and I was wodnering what the deal was with MKSAP - should I just get MKSAP5 since it is newer? Or is 4 worth doing? Are the question books enough or should an online MKSAP be used too?

 

[Ugen]

I'm starting my first rotation, and I was wodnering what the deal was with MKSAP - should I just get MKSAP5 since it is newer? Or is 4 worth doing? Are the question books enough or should an online MKSAP be used too?

I never understand why people use old versions of books when newer ones are available. Guidelines change, treatment algorithms change, test content changes, of course you should buy the latest one. It's not like a fifth edition book of a static subject that hasn't changed in decades, they are not just trying to get your money You are leaving points on the table if you use the old one so yes use MKSAP5. Hell, even the lipid guideline ATPIII questions in MKSAP5 recently became obsolete and will no longer show up on your exam. There's a reason the residents have 16 versions of MKSAP.

For your second question, you will be fine with just MKSAP5. I used all of MKSAP5 and UWorld IM once through (thoroughly) and scored a 99, along with reading about my patients.

 

[DCBFan]

I never understand why people use old versions of books when newer ones are available. Guidelines change, treatment algorithms change, test content changes, of course you should buy the latest one. It's not like a fifth edition book of a static subject that hasn't changed in decades, they are not just trying to get your money You are leaving points on the table if you use the old one so yes use MKSAP5. Hell, even the lipid guideline ATPIII questions in MKSAP5 recently became obsolete and will no longer show up on your exam. There's a reason the residents have 16 versions of MKSAP.

For your second question, you will be fine with just MKSAP5. I used all of MKSAP5 and UWorld IM once through (thoroughly) and scored a 99, along with reading about my patients.

Because I spent over a grand all told on step 1 and I need to save money.

 

[Wordead]

Because I spent over a grand all told on step 1 and I need to save money.

What % of your tuition is 50 bucks doggie

 

[drmd123]

PLEASE. NEED URGENT HELP.

Ok, now that I've hopefully gotten someone's attention, I need advice on how to study. I have almost exactly 2 weeks before my SHELF and have pretty much not studied at all (did about 300 UW sporadically). I've been going through some personal issues that have really gotten in the way and am now trying to make up for lost time. What resources/study strategy would you use? Realistically, I plan on studying for an avg. of 4hrs/day (I still have to actually show up for my clerkship).

Now, I know this SDN and all but keep in mind that I'm not that great of a student (probably bottom 1/3 of my class) so I won't already have everything memorized like some robots I know that pose as medical students at my school. I'd take a pass at this point tbh, but I'd prefer to get an average score if possible.

I don't post here much but I am in need of help and and I would greatly appreciate any honest advice.

Danke

 

[drmd123]

Anyone...

 

[Evil_Abed]

Anyone...

Personally, with 2 weeks left, I'd recommend doing your best to get through all the UWorld and MKSAP questions. I'm a fan of practice questions and learn/retain more from them than straight-up reading. I only read 5 chapters in SUTM and ended up doing well on the exam. I did, however, finish all the UWorld IM questions and most of the MKSAP questions. I don't think 2 weeks is sufficient time to make a good pass through SUTM in addition to practice questions. Hopefully, you've been reading up on your patients on Up-to-date or something. Good luck!

 

[boogaloo]

PLEASE. NEED URGENT HELP.

Ok, now that I've hopefully gotten someone's attention, I need advice on how to study. I have almost exactly 2 weeks before my SHELF and have pretty much not studied at all (did about 300 UW sporadically). I've been going through some personal issues that have really gotten in the way and am now trying to make up for lost time. What resources/study strategy would you use? Realistically, I plan on studying for an avg. of 4hrs/day (I still have to actually show up for my clerkship).

Now, I know this SDN and all but keep in mind that I'm not that great of a student (probably bottom 1/3 of my class) so I won't already have everything memorized like some robots I know that pose as medical students at my school. I'd take a pass at this point tbh, but I'd prefer to get an average score if possible.

I don't post here much but I am in need of help and and I would greatly appreciate any honest advice.

Danke

I only did UW but didn't finish all of the IM questions by the time I took the shelf. I still scored >90 raw (caveat: I'm a good test-taker and had a strong foundation from doing well on Step I). My advice is to do as much UW as you can, and try to understand the concepts from the explanations--I wikipedia'd to fill in the blanks.

 

[drmd123]

@boogaloo & @krafty934 thanks for the tips. I think I will take your word on trying to finish UWORLD. Down to 700 now. will try to get through as much as I can. thanks again.

 

[jbs125]

Are people using MKSAP online or the textbook format? Any thoughts on if one version is preferred to be used in conjunction with Uworld?

 

[deleted550937]

-IM was my last cohort of third year. Did UW IM 1.5x, and all of MKSAP. No outside reading, just questions.
-Took both self assessments, missed around 5/50 on each.

-99 raw, 95th percentile. Fair exam. PM for any questions

 

[RoboChicken]

For those like me who didn't have time to read a text...just got my score: 89. Did mksap and all but like 200 of the uworld internal med questions. Read about patients on uptodate and stuff throughout but could not stomach step up to medicine...

 

[sammiii26]

Which sections of UWORLD would be most importnat for the IM shelf exam?
I've done

 

[Dr. USMLE]

Which sections of UWORLD would be most importnat for the IM shelf exam?
I've done

Do the "core" questions first...cardiology, GI, pulmonary, nephrology.


Radiology Resident
Step 1: 265+
Step 2: 265+
Step 3: 265+

 

[FattySlug]

Should I get mksap book or the online version?

 

[gp04]

Just started IM. Any tips on how to begin studying for the shelf? Or, would anyone be able to PM me a sample study schedule they used? ( My shelf will be end of October) What did ppl find helpful that they did on a daily basis?

Thanks!

 

[doctosaurus]

How do UWorld scores correlate with the real deal?

I'm scared as s#!%, getting around average percentages on UWorld (60s) but need a 70 to pass at my school.

 

[Apoplexy__]

How do UWorld scores correlate with the real deal?

I'm scared as s#!%, getting around average percentages on UWorld (60s) but need a 70 to pass at my school.

They don't. Your school most likely converts a raw score to a percentage to determine your grade. The average (not passing) of this raw score is somewhere around 65-75. I'm sure your school wouldn't cut off the fail score at a national average.

The raw score from the NBME also is not a percentage correct, so it again doesn't correlate to UWorld percentage.

An example for the Psych shelf (only one I've taken so far):
82% correct on NBME self-assessment =
88 predicted NBME raw score =
93%+ grade at my school

Ask your school for their NBME score conversion to % grade.

 

[Handinhand]

Quick question:

In cases of hyperglycemia >200 where you begin to correct Na+ levels (say glucose is 300, you correct Na+ 1.6); let's say you were also going to calculate an anion gap, do you use the uncorrected or the corrected Na+ in this calculation?

 

[doctosaurus]

They don't. Your school most likely converts a raw score to a percentage to determine your grade. The average (not passing) of this raw score is somewhere around 65-75. I'm sure your school wouldn't cut off the fail score at a national average.

The raw score from the NBME also is not a percentage correct, so it again doesn't correlate to UWorld percentage.

An example for the Psych shelf (only one I've taken so far):
82% correct on NBME self-assessment =
88 predicted NBME raw score =
93%+ grade at my school

Ask your school for their NBME score conversion to % grade.

We just use the raw score (the number that comes on the NBME performance report), the school doesn't do any conversion. And we do set our passing grade at/around the national average--most rotations require 67-70 to pass.

 

[Apoplexy__]

We just use the raw score (the number that comes on the NBME performance report), the school doesn't do any conversion. And we do set our passing grade at/around the national average--most rotations require 67-70 to pass.

That's pretty intense. In that case, use the NBME practice test as a more reliable indicator -- UWorld is skewed by people studying for Step 2.

 

[doctosaurus]

That's pretty intense. In that case, use the NBME practice test as a more reliable indicator -- UWorld is skewed by people studying for Step 2.

So UWorld %s are harder or easier than the actual Shelf? I'm trying to gauge how I'm doing here, can't compare to my classmates' %s because they are all superhuman.

 

[drake19]

ARe the Internal medicine NBMEs (online / the practice ones) reflective of the actual exam ...

I found the first one pretty hard and a grab bag of alot of things mostly esoteric stuff. I did notice a focus on renal questions maybe 5-6, very few cardio

 

[drake19]

Hey everyone this is my 2 cents on the IM Shelf.

-In general i use questions books as my main resource +/- stuff that I need from textbooks

-The IM exam is a crapshot because it covers everything.
-The key to the exam is doing as many questions as possible specifically from UWORLD becuase it is much more representative of the exam in terms of question-stem style.
-the question stems are very long and you have to practice reading fast via UWORLD (you have about 1.5 min for each question - my exam was 110 for 2 hr/45 min)
-MKSAP does NOT ask the question in the style of the NBME so I would avoid it and focus on UWORLD IM since there are already more than enough questions.
-The exam was on par with the difficulty of UWORLD, I recommend purchasing the 2 practie NBMEs because they have always been a pretty good predictor of my acutal shelf grades

Here is how I used UWORLD:
-major organ systems - CV, GI, GU, pulmonary, endocrine
-other systems - rolled the die and went with optho, ENT, prevention, ID, heme-onc because I didn't have too much time.
-skipped on UWORLD (regreted this): neuro, derm, rheumatology

-actual exam:
-lots of Cardio, pulmonary
-very few renal/GU/endocrine/ID
-2-3 heme-onc questions (total waste of my time going through all of heme-onc)
-At least 10-15 quesitons from derm, rheum, ortho/rhuem/MSK - at least 3 derm picture questions, at least 3 ortho-X-ray questions
-alot more neuro than I expected - approx. 5 questions
-2 optho questions
-few random questions from other fields - surgery, OB-GYN, but no peds
-3 easy EPIdemiology question, 1 ethics question,

-summary: exam is crapshoot and covers everything, I would try to get through all of UWORLD IM thoroughly and don't understimate derm, rheum/MSK, and neuro.

-the key to the exam is tons of practice esp. with UWORLD and whatever bank you feel is ncessary because the actual shelf has mostly long-question stems all with a crap load of lab values and you have to get used to reading quickly through them

 

[1dayatatime]

I have no idea what's going on with this clerkship but I know my exam is in 3 wks. Glad to see some familiar sn's (Kirby, Diggidy) in here! For those of you who have tried Step up to medicine - how am i supposed to read this book? I've been trying to read it the way I read Rapid Review Goljan Path (also outline format) but for some reason SUTM is...different -- not even sure i'm getting anything out of it. People have told me "just know everything in that book" - yeah...really helpful...

 

[Apoplexy__]

I have no idea what's going on with this clerkship but I know my exam is in 3 wks. Glad to see some familiar sn's (Kirby, Diggidy) in here! For those of you who have tried Step up to medicine - how am i supposed to read this book? I've been trying to read it the way I read Rapid Review Goljan Path (also outline format) but for some reason SUTM is...different -- not even sure i'm getting anything out of it. People have told me "just know everything in that book" - yeah...really helpful...

I kinda feel the same way. The words just kinda bounce off me, more so than any other review book I've read. After 2 chapters I basically just gave up and just dove into UWorld. People in this thread have been saying UWorld > SUTM in terms of priority anyway, so I figured it was most important to get that down. I try and read the section of SUTM pertinent to what I'm annotating from UWorld as I go along, so it's a little more digestible.

 

[1dayatatime]

Just a thought that I wanted to run by people on here - the real NBME doesn't ask for drug doses and regimens (i.e. BID, TID, for 6-8 weeks, etc.) right? I've so far only done the 1 practice test and didn't seem to find q's asking that sort of info but just wanted to confirm with others.

 

[operaman]

Just a thought that I wanted to run by people on here - the real NBME doesn't ask for drug doses and regimens (i.e. BID, TID, for 6-8 weeks, etc.) right? I've so far only done the 1 practice test and didn't seem to find q's asking that sort of info but just wanted to confirm with others.

Nope, I can't remember ever seeing that on a shelf. I have seen things such as "treatment dose of X" vs "prophylactic dose of X" but that's about as far as it went.

 

[1dayatatime]

thank you operaman!

 

[Dharma]

Just started IM. Any tips on how to begin studying for the shelf? Or, would anyone be able to PM me a sample study schedule they used? ( My shelf will be end of October) What did ppl find helpful that they did on a daily basis?

Thanks!

You gotta find what works for you, but I say pick up Case Files ASAP, start reading a couple of cases every day. Take notes. Dive into UWorld and get moving. Case Files is a nice little warm up and great for those in-between moments when you need to get something done but don't have enough ticks to really hunker down with a Qbank.

 

[0919mmk]

Ugh this shelf kicked my ass. Is there a consensus on how accurate the %iles are relative to real life? As in, I scored in the 80th %ile on step 1 like 2 months ago, and then apparently I scored in the 15th %ile on this shelf. FML. Did I just have a really bad day, or are those %iles bogus?

edit: I ask because the %ile is obviously not "real time" relative to the other test takers - it's supposedly based on "past performance", but I also assume that each test is new?

 

[Cytarabine]

Need to score >0.75 standard deviation above the mean to qualify for honors, hovering around 75% right in UW on random. Any opinion on if this a decent place to be at 4 weeks out from the test? Appreciate any input

 

[acw68]

I just finished the first week of my 8 week internal med rotation. My goal is to get through Step Up to Medicine and UWorld (internal med Qs) 2 times but considering how dense and long both resources are I'm thinking this might be overambitious. At the same time, going through everything once doesn't seem like enough. Does anyone who used UWorld and Step Up to Medicine have a study schedule that they'd be willing to share? It would be helpful to see how others divided up their time!

 

[Apoplexy__]

I just finished the first week of my 8 week internal med rotation. My goal is to get through Step Up to Medicine and UWorld (internal med Qs) 2 times but considering how dense and long both resources are I'm thinking this might be overambitious. At the same time, going through everything once doesn't seem like enough. Does anyone who used UWorld and Step Up to Medicine have a study schedule that they'd be willing to share? It would be helpful to see how others divided up their time!

Definitely hugely overambitious. If you can just get through UWorld once (not even SUTM also), you're at an advantage.

Does anyone know if biostats is on this test?

 

[1dayatatime]

So I think it is...I just did NBME 2 and it had 1 biostats q on it (SN and SP).

Shield your eyes if you haven't done any of the NBME's yet - I have some q's I'd like to bounce off others - my test is this friday and really don't have time to look all of this up although I'm trying to... thanks in advance!!!

"which of the following is the strongest predisposing factor for perioperative MI in this patient"
A. age
B. ECG findings (five PVCs/min, no ischemic changes)
C. Hx of CABG
D. Hx of HTN
E. Hx of smoking
F. MI w/i past 6 mos

I put D and it was wrong.

HIV+. CD4 is 110. Toxo ab's + ; hep B sAB +. which of the following is the most appropriate next step to assess patients risk for illness related to opportunistic infections?
a. PPD
B. sputum cytology
c. urine CMV ag
D. stool culture of MAI
E. CXR

I put E cuz I was thinking of PCP but I kinda knew it was probs wrong. Is it PPD? I just thought CD4 had nothing to do with PPD.

37 yo with 2 day hx of abd cramps and diarrhea. Vomited blood 2x. takes ibuprofen for knee pain. appears pale. is afebrile, pulse 130, RR 22, BP 11/70. lungs are CTAB. abd soft and nt. stool is dark and tarry and test for occult blood is positive. two liters of 0.9% saline are administered.

HCt 18%
Leuk's 6200
Platelets 250k
PT 12
PTT 35

the most appropriate next step in management is administration of which of the following?
a. given another 2l of nml saline
b. ffp
c. h2-blocker
d. octreotide
e. prbc's

I put d. but is the answer c?

after 6 hours of chest pain, a 76 year old man collapses at home. in the ed, a diagnosis of acute anterior wall MI is made. Pulse 104, SBP is 80. ashen gray and has clammy skin. Diffuse b/l pulm crackles are heard. Heart tones are muffled and s3 is audible. WHich of the following is the most likely cuase of his hypotension?
a. 3 degree av block
b. dec'd intravas vol
c. dec'd myocardial contractility
d. dec'd ventricular filling p
e. pulm edema

is it B? I put e.

15 year old girl comes to physician because of a 2 week history of intermittent, fleeting pain under her L breast. She has had no cough, Nausea, or SOB. Her uncle and dad had MI's age 40 and age 38. Afebrile, pulse 96, RR 25, 120/74. Lung CTAB. Cardiac exam shows normal S1 and s2 and midsystolic click. There is no Chest wall tenderness. Pulse ox on room air is 96^. ECG is normal.
A. give BBlocker
b. outpt stress test
c. reassurance
d. sublingual ntg

Is the answer C? I put stress test...I wanted to see ECHO but that wasn't a choice. I was concerned about HOCM.

Also sorry to admit this but I forgot how many cm below the costal region a spleen can be palpated before it can be called "enlarged"?

 

[chucktown]

So I got my raw score but wasn't given any averages or percentiles. Any idea what the average is typically or how to figure out percentile?

 

[1dayatatime]

anyone willing to answer my q's before friday?

 

[operaman]

So I think it is...I just did NBME 2 and it had 1 biostats q on it (SN and SP).

Shield your eyes if you haven't done any of the NBME's yet - I have some q's I'd like to bounce off others - my test is this friday and really don't have time to look all of this up although I'm trying to... thanks in advance!!!

"which of the following is the strongest predisposing factor for perioperative MI in this patient"
A. age
B. ECG findings (five PVCs/min, no ischemic changes)
C. Hx of CABG
D. Hx of HTN
E. Hx of smoking
F. MI w/i past 6 mos

I put D and it was wrong.
The revised cardiac risk index is what we generally use for perioperative evaluation. I like to remember it with the mnemonic RISCCI (pronounced "risky"). Risk of surgery, Insulin use, Stroke hx, CHF hx, Creatinine >2.0, Ischemic sx. Based on this and without the vignette, I would say 'F' is the right answer as that denotes ischemia. My guess is the vignette showed the CABG was awhile ago.

HIV+. CD4 is 110. Toxo ab's + ; hep B sAB +. which of the following is the most appropriate next step to assess patients risk for illness related to opportunistic infections?
a. PPD
B. sputum cytology
c. urine CMV ag
D. stool culture of MAI
E. CXR

I put E cuz I was thinking of PCP but I kinda knew it was probs wrong. Is it PPD? I just thought CD4 had nothing to do with PPD.
Hard to say without vignette. Assuming the question was simply going after the basic screening workup for a new HIV dx, the answer is A. Since they told you about toxo and Hep B serology, I think this is probably where they were going. CXR says nothing about future risk; ditto for MAI cx. No clue why they would want sputum cytology so probably just a distractor. Other possible right answers: RPR, urine chlamydia/gon pcr, etc.


37 yo with 2 day hx of abd cramps and diarrhea. Vomited blood 2x. takes ibuprofen for knee pain. appears pale. is afebrile, pulse 130, RR 22, BP 11/70. lungs are CTAB. abd soft and nt. stool is dark and tarry and test for occult blood is positive. two liters of 0.9% saline are administered.

HCt 18%
Leuk's 6200
Platelets 250k
PT 12
PTT 35

the most appropriate next step in management is administration of which of the following?
a. given another 2l of nml saline
b. ffp
c. h2-blocker
d. octreotide
e. prbc's

I put d. but is the answer c?
Just eyeballing it the pt is severely volume depleted 2/2 bleeding ulcer. They already gave 2L. Next step is most likely to give PRBCs (choice E).

after 6 hours of chest pain, a 76 year old man collapses at home. in the ed, a diagnosis of acute anterior wall MI is made. Pulse 104, SBP is 80. ashen gray and has clammy skin. Diffuse b/l pulm crackles are heard. Heart tones are muffled and s3 is audible. WHich of the following is the most likely cuase of his hypotension?
a. 3 degree av block
b. dec'd intravas vol
c. dec'd myocardial contractility
d. dec'd ventricular filling p
e. pulm edema

is it B? I put e.
This patient has cardiogenic shock 2/2 MI and maybe sHF. Answer is C. Definitely not a volume issue; if anything, the bl crackles suggest volume overload.

15 year old girl comes to physician because of a 2 week history of intermittent, fleeting pain under her L breast. She has had no cough, Nausea, or SOB. Her uncle and dad had MI's age 40 and age 38. Afebrile, pulse 96, RR 25, 120/74. Lung CTAB. Cardiac exam shows normal S1 and s2 and midsystolic click. There is no Chest wall tenderness. Pulse ox on room air is 96^. ECG is normal.
A. give BBlocker
b. outpt stress test
c. reassurance
d. sublingual ntg

Is the answer C? I put stress test...I wanted to see ECHO but that wasn't a choice. I was concerned about HOCM.
Patient sounds like she has MVP. HOCM does not have a midsystolic click. Usually I would say reassurance, especially if it were only exam findings without s/sx. Here she has Sx, exam finding, tachy-ish, and no chest wall tenderness. I would probably start her on a BB (choice A).

Also sorry to admit this but I forgot how many cm below the costal region a spleen can be palpated before it can be called "enlarged"?

Off the top of my head and without the rest of the stems....answers in the quote above.

If I can feel the spleen at all, it's enlarged. Not sure how many cm that is.

 

[Zedor]

Took the medicine shelf a few weeks ago. Got thru most of Uworld (about 200 qs left) and about 75% of SUTM. I didn't use MKSAP or any other sources. IMO, the single best thing you can do is Uworld questions, and actively follow your patients throughout your rotation. IM was my first rotation, and was for 8 weeks. I'd say the majority of my studying was done in the final 3-4 weeks. The exam had a lot more freebies than Uworld. I started in the 60s in Uworld and was scoring in the 80s towards the end. My average was 76% at the time I took the shelf. I ended up scoring in the 98th percentile. FWIW, recently took Step 1 in June and scored a 261. If anyone has any questions, I'm here to offer any advice I can.

 

[buffpenguin]

Took the medicine shelf a few weeks ago. Got thru most of Uworld (about 200 qs left) and about 75% of SUTM. I didn't use MKSAP or any other sources. IMO, the single best thing you can do is Uworld questions, and actively follow your patients throughout your rotation. IM was my first rotation, and was for 8 weeks. I'd say the majority of my studying was done in the final 3-4 weeks. The exam had a lot more freebies than Uworld. I started in the 60s in Uworld and was scoring in the 80s towards the end. My average was 76% at the time I took the shelf. I ended up scoring in the 98th percentile. FWIW, recently took Step 1 in June and scored a 261. If anyone has any questions, I'm here to offer any advice I can.

So I have a few questions. I am 8 days from my shelf, but I have been getting destroyed with very little time to study. I am basically just starting. Any advice on what to do. I'm hoping with a 250 on step and maybe doing crazy amounts of uWORLD i can pass. Any advice is welcome? I got lazy and after IM i came home and slept or hung out.