frustrated with shelves

[bubblesmd]

Hey guys, i'm two rotations in and I'm just so frustrated with the shelves. I feel like I'm doing everything people say to do--case files/pretest/uworld, and yet am still not doing that well. My school has a cutoff so I'm pretty sure I'm going to narrowly miss being able to HP peds, which is what I'm thinking of going into currently. Any advice? What should I expect residency-wise if I only pass Peds and go into it?

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[exeunt]

i agree with this post 100%.. incredibly frustrated with shelves right now..

 

[secants]

Not much advice but you can look at the outline for what each shelf is gonna focus on via the NMBE website. Also, they now have old NMBE questions for shelf exams somewhere on there as well.

 

[235009]

the best way to study for the shelf is to gain a breadth and depth of clinical experience. are you at a university hospital? are you actively participating in rounds, reading about your patients' ailments, trying to come up with the next step in management? are you preparing topics to discuss with your residents and attendings? it sounds like you're doing the right things when you get home but you may not be making the most of your time at the hospital (which is understandable, it takes 3rd years a while to get the hang of learning in this new setting)

as for peds specifically....i found it to be one of the hardest and least forgiving shelf exams. A pass in peds isn't the end of the world if you want to go into it....what's done is done... just do your best from now on and then rock your peds sub-I

 

[45408]

Agree with skinMD. You probably have a good chance to redeem yourself on your peds sub-I. Make sure you have a good sub-I, with people who can write you meaningful LORs (ask around).

 

[OveractiveBrain]

Hey guys, i'm two rotations in and I'm just so frustrated with the shelves. I feel like I'm doing everything people say to do--case files/pretest/uworld, and yet am still not doing that well. My school has a cutoff so I'm pretty sure I'm going to narrowly miss being able to HP peds, which is what I'm thinking of going into currently. Any advice? What should I expect residency-wise if I only pass Peds and go into it?

The Shelves, much live the Step exams, are not a test of your clinical accumen or your experience on the wards. They are a test of your medical knowledge. This is often very frustrating to medical students who experience the wards in a very different way. Most of the time, wards are dedicated to doing right for your patient: coordinating nursing, social work, PT/OT. MOst of the time its preparing how to do a good presentation (so you sound smart). And, no matter how broad your differential, you can't possibly touch all the diseases or diagnoses in a given field in the 2 months you are on service. You learn all the OTHER skills of being a good doctor by being on the wards, but often the medical knowledge just isnt covered. You read on your patients, sure, but there is a whole lot more being tested than what your patient or five had.

As such, the advice I give to medical students who are struggling is to focus on the material that is designed to get them scoring on the test. Depending on your learning style, there are a number of options.

If you are a video/audio person, I recommended onlinemeded . org a free video website organized a la carte.

You're doing questions through Uworld. That's huge. But let me emphasize that it is NOT about doing the questions. It is about reading the explanations, then reading about them in whatever your primary text is.

You do need a text. It varies for different rotations.
- Surgery = NMS or recall,
- Medicine = MKSAP and Essential ACP or Step Up,
- Ob/Gyn = Blueprints,
- Peds = ?,
- Neuro = Case Files.
- PSych = First Aid Step 2 (not First Aid Psych)
But you have to have a book you are reading.

Let me make it explicit. Performing on shelves is about medical knoweldge. Its about doing multiple choice questions. You perform well by using resources that are designed to give you the knowledge you are supposed to know for the shelf (opposed to in life, in general) and the skill at MCQ.

 

[OveractiveBrain]

the best way to study for the shelf is to gain a breadth and depth of clinical experience. are you at a university hospital? are you actively participating in rounds, reading about your patients' ailments, trying to come up with the next step in management? are you preparing topics to discuss with your residents and attendings? it sounds like you're doing the right things when you get home but you may not be making the most of your time at the hospital (which is understandable, it takes 3rd years a while to get the hang of learning in this new setting)

I whole heartedly disagree. This is an important step in becoming an advanced practioner, and a skill you need to be a resident. Participation is crucial. Differentials are crucial. You are training more than "knowing stuff" and this sort of engagement makes you a good doctor. But this is the trap medical students fall into. They belive that if they do all of this that they will somehow acquire all the knowledge the need. It won't happen.

Medicine (all fields) is about experience. The more experience you have, the better you are at it. The more "reps" you do, the stronger your mental "muscle." But as an MS3, you just aren't there in the way of reps. You handle 1? 3? patients? The interns have half the service. THe resident has everyone. As you get better at it you get more responsibility, and with more responsibility, more reps. When a resident is a third year, if she has read on her patients every time, she will have quite the repitoire. How many MEN2a will she have seen? How many pituitary adenomas? How many Sideroblastic anemias? Probably few, if any at all. Which means you have to extend yourself BEYOND your patients.

That is why I recommend sites like onlinemeded and supplemental texts that are designed for the shelf.

as for peds specifically....i found it to be one of the hardest and least forgiving shelf exams. A pass in peds isn't the end of the world if you want to go into it....what's done is done... just do your best from now on and then rock your peds sub-I

Now this I agree with. Peds was my hardest shelf (abeit my first). And choosing a field like pediatrics means that you are not competing with the ENTs, Orthos, and Ophthos who have to get all honors in every rotation. If what you want out of life is to be a good pediatrician, you DONT have to go to a top brand school; they breed researchers and fellows more than they do clinicians, and you can get solid training at a tier 2 program.

Dominating the socks off of your sub-I is crucial. On that end, its about being a good doctor, and there is no Shelf to cloud your potential as such. If you've done the right things in teh way of your team, your patients, and your rounding, you will do more than quite well in your sub-I.

Also have some bull story in your personal statement about personal growth and coming into your own, ready to tackle residency, burden of transitions out of the classroom and blah blah, to make it sound like this "failure" (which it isn't, really) was really an "opportunity" (which it isn't, really, either, except to teach you how better to prepare for multiple choic exams)

 

[KnuxNole]

In my experience, reading was the absolute best way to prep for the shelf. That and practice questions if time permits. The questions can be harder because a lot of it is more "what is the next best step?" That is something that 3rd years aren't used to, so that thinking can be tough.Like people said above, peds is brutal.

Rotations are meant to teach you about the specialty, and to train you in coming up with differentials/plans, etc. which can help a little. People's experiences might be different. Some say that being in the hospital is the best way and some say reading. To me, unless the place you go to covers every disease in 6 weeks, and you discuss the management and diagnostic criteria of it all, being in the hospital is sometimes a waste of time in regards to the shelf. It's definitely not a waste of time in general, and thus a balance of two interests.

 

[DrGERD]

Shelf exams are ridiculous. I was routinely disgusted with my scores on them, in spite of my inordinate amount of study time...

 

[EM2013]

Pick a resource (whether it be a text, videos or both) and then concentrate on questions, questions and more questions. The floors are not in any way for learning the material on the shelf exams. People say that actively participating and going home and reading about you patients ensures shelf exam success. BS. The floors are for nodding, smiling, being a gopher and doing whatever else to get clinical honors. The shelves are MCQ tests and measure ability to muddle through seemingly worthless history/physical/laboratory data, pull out what you need and distinguish between very similar diagnoses and management options. Do get good at this you need to get in the question makers minds and the best way to do this is to do as many questions as you can.

Below is what I used for each shelf and the percentile I scored:

Peds: World, PreTest, qBook, BRS, Kaplan videos...95th
Medicine: World, mksap, step up...92nd
Neuro: World, kaplan videos...97th
Ob/Gyn...World, qBook, Casefiles...98th
Surg...World, qBook, NMS, Pestana, Kaplan videos...97th
Psych: World, qBook, FA for Psych Clerkship...90th

Hope this helps...PM me with any specific questions.

 

[Girfaroo]

I hate shelves too! My school makes them a HUGE part of our grade and takes the percentile, which sucks. So on family and IM I got the same raw, but on family it was good and IM it was crap. Meanwhile, my IM evals are amazing, but it doesn't matter.

 

[secants]

What's qbook?

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