how bad is failing an nbme shelf?

[Misfit!]

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I still don't really understand how 3rd year works. Out of curiosity, how big of a deal is failing an nbme shelf? (assuming you pass it the second time and end up passing the rotation) Is that the type of thing that always appears on a dean's letter, like failing an entire class/rotation?

 

[Doctor Bagel]

It depends on your school and on the rotation. At my school, some rotations require you to pass the shelf to pass the rotation, but some don't. Also, the shelf ranges from determining 50% of your grade (psych) to 12.5% (surgery) here. So at my school, you can fail the surgery shelf, still pass the class and have no negative comments related to it in your dean's letter. However, if you fail the ob/gyn shelf here, you have to retake it and cannot score higher than a C in the class. I'm not sure if comments about failing that shelf would appear on your dean's letter, but you will be stuck with that C. So, really, it depends.

 

[GreenShirt]

It depends on your school and on the rotation. At my school, some rotations require you to pass the shelf to pass the rotation, but some don't. Also, the shelf ranges from determining 50% of your grade (psych) to 12.5% (surgery) here. So at my school, you can fail the surgery shelf, still pass the class and have no negative comments related to it in your dean's letter. However, if you fail the ob/gyn shelf here, you have to retake it and cannot score higher than a C in the class. I'm not sure if comments about failing that shelf would appear on your dean's letter, but you will be stuck with that C. So, really, it depends.

What else do they grade you on? At my school the Shelf is P/F and then there's just a simple evaluation at the end by the preceptor. I think the school plans on giving us a year three grade based on how many "above average" boxes get checked on the eval form.

 

[njbmd]

I still don't really understand how 3rd year works. Out of curiosity, how big of a deal is failing an nbme shelf? (assuming you pass it the second time and end up passing the rotation) Is that the type of thing that always appears on a dean's letter, like failing an entire class/rotation?

At my school, if you passed the clinical evaluation portion of a rotation but failed the shelf, you would have to retake the shelf exam but the highest grade that you could achieve in the rotation would be a 71 (Pass). If you failed the shelf a second time, you repeated the entire rotation again with the highest grade you could achieve being a 71 (Pass)

If you failed the clinical evaluation portion of the rotation but aced the shelf, you had to repeat the rotation and would be given a 71 (Pass) after repeating provided you passed the clinical eval the second time around. If you didn't pass the clinical eval or failed the shelf in the retake (second chance at either), you would be dismissed from school.

All of these things would be mentioned in the Deans Letter.

 

[Doctor Bagel]

What else do they grade you on? At my school the Shelf is P/F and then there's just a simple evaluation at the end by the preceptor. I think the school plans on giving us a year three grade based on how many "above average" boxes get checked on the eval form.

The shelf isn't just pass/fail for us. We actually get a grade for it, usually with a curve that varies based on the rotation. Then x percentage of our grade is clinical evaluations from attendings and usually residents. Other rotations have part your grade determined by oral exams and presentations. Here are some breakdowns --

psych -- 50% clinical evals, 50% shelf. Curve for the shelf was something like 1.2 times the two digit score.

surgery -- 1/3 clinical evals, 1/3 evaluation of participation and knowledge in lectures, 1/6 shelf, 1/6 oral exam

ob/gyn -- 40% shelf with curve (had to pass the shelf to pass the course), 20% oral exam, 10% writeups, 30% evals -- I might be a little off here because I don't remember the exact breakdown.

internal medicine -- 50% evals (25% from your 2 attendings and 25% from your 2 seniors), 25% written exam (departmental exam instead of shelf), 15% writeups graded by attendings, 10% presentation

 

[ANCAdoc]

If you fail a NBME shelf, it will most likely be on your Dean's letter. My med school put them in. So long as you take it as practice for the Steps, study that area extra hard, and get a decent Step 2 score, then it should not have much weight for at least mid-tier residency programs. Can't speak for top tier programs.

Just make sure to take adequate time to study during rotations. It stinks as a student because, yes, after a full day of work you have to go study, but it will be worth it in the end. Surgery and Internal Medicine are the toughest shelfs, perhaps because of the volume of information and the lack of time to study in a rested way (sleeping helps to consolidate your thoughts).