concerns regarding shelf exams

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Senior Member
7+ Year Member
15+ Year Member
Oct 6, 2002
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Hi all,

I have completed four clinical rotations by now and done poorly on each of the shelf (below average on all). I have tried to improve and learn from each but nothing seems to work for me. I feel like my scores are not representative of my medical knowledge in the subject as I have never felt that stupid on the wards. I have also been noted to have good clinical skills and a good foundation for medical knowledge on most of my evals but have not honored any due to poor scores. On my last eval I received a very good eval from the director but he noted a sentence regarding my poor ability to perform well on standardized tests. I am concerned that the poor scores and comments such as this may hurt me as far as residency is concerned. Its not that I want to do anything all that competitive, i am interested in IM at an average univ program and curious to know how shelf scores play a role in gaining residency at such places. Is there any thing that I can try to do at this point; my step I score was a little above average and I intend to work hard for step II to make up for poor shelf.


Full Member
10+ Year Member
Sep 28, 2006
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Shelf scores in and of themselves don't count a lick for residency applications. Unless your school put them into your Dean's letter (and most won't, unless it can portray you in a positive light i.e. 99th percetile), residency programs will never see your scores.

Having said that, as you alluded to in your post, poor (or even average) shelf score performance will prevent you from honoring your rotations. My advice on taking on these exams:
  • Do LOTS and LOTS of practice questions. Common concepts will come up time and time again in both practice questions/review books and in the shelf.
  • These exams are not tricky! Over and over I saw people trying to overthink these questions. If you are reading a question that seems simple, it probably is! If you find yourself narrowing down the choices to two or three choices, and then saying "yeah, but sometimes..." or "they can't be looking for something so obvious, they must be looking for something obscure...." you are probably overthinking the exam and costing yourself valuable points. These exams are overall trying to test your knowledge of basic concepts that is the basis of a medical student's knowledge base, not a resident or attending, so back away from the obscure or "sometimes this is the case" answer. To be fair, will there be some trick or poorly worded questions? Sure, but overall if you read carefully and go with your gut, you will get far fewer questions wrong than if you overthink them.
  • Oftentimes the shelf will ask the same concept multiple times on a single exam. Again, just go with your gut and don't be afraid to pick the obvious answer even if you think this was already tested.
  • Pace yourself. These can be long exams in a finite period of time. Again, read carefully and go with your gut and you likely won't run out of time.

Hope this helps!