Guys. Focus.
The shelf exams are hard, especially if you want to honor. But you have to realize from now until you die that there is a difference between doing well on the boards and doing well in clinical setting. So don't let faculty lead you into thinking that you will ace your shelf, and don't let your board scores think you will be a great physician. These are two entirely different things.
The shelf is very similar to Step 2 CK, except that the CK is much more involved. As far as resources are concerned, all the clerkship resources are very good (Blueprints, A&L, Pretest, etc.). And obviously doing practice problems are key. A lot of times, it's not the material you're having trouble with... it's TEST-TAKING SKILLS.
http://www.nbme.org/programs/subjexamsclin.asp
Look through the sample questions in the printable outlines, analyze the question and how they ask it. It all boils down to 4 types of questions NBME will ask:
1. Promoting Health and Health Maintenance: These questions basically ask you whether or not the case they present is normal or what is the next step in preventive medicine. Or what risk factors a patient might have the predisposes them to a particular disease.
2. Understanding Mechanism of Disease: These questions will present a case and then you'll have 4 answer choices that describe a mechanism. So your job is to figure out what the patient has and figure out which of the 4 mechanism corresponds to that disease. These questions will usually ask what is the cause of a particular condition or finding or lab result.
3. Establishing a Diagnosis: This question asks what the next step is in diagnosis... meaning how do you work this patient up. You'll usually have lab values and you need to figure out what subset of a disease someone has... usually you need to memorize a flow chart for this. It also asks how do you NAIL DOWN a diagnosis, or basically what ONE test do you order to know what this patient has. Or they will just ask, what is the most likely diagnosis based on H&P.
4. Applying Principles of Management: These questions ask you what your next step is going to be. Your choices will usually include: Nothing and follow up, a Diagnostic Test, an Imaging, Empiric Therapy, Go Straight to Surgery. These are tough questions because sometimes if a patient is acute, you can skip all the diagnostic stuff and go straight for treatment. But that's how they ask these types of questions.
My advice would be to always read the question FIRST. If you need to nail down a diagnosis, start thinking that way. If you have an ethical/behavial health question, you can skim the case very quickly. Sometimes they simply ask you to explain one lab value, so you should read through the case very quickly.
My last piece of advice is TIME. It is your enemy. Which means that when you have 10 minutes left to do 10 questions, you do NOT want to be stuck reading A-Z choices or have 500 lab values to interpret. DO THE LAST 20 QUESTIONS FIRST.
Good luck.
