How to study for Family Medicine NBME shelf exam?

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aagarwalmd

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I am having the hardest time trying to figure out how to study for the nbme family medicine shelf exam. Is the exam very similar to the uworld internal medicine questions?

Not sure which resources to use.. if you can list out the top resources to study for this exam I would greatly appreciate it. Thanks!

Also would Current Diagnosis and Treatment Family Medicine 4th ed. be overkill?
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i used casefiles, the ambulatory section in Step Up to medicine, and some sections of uworld (preventive medicine)
 
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Thanks guys, I had this question too. This is perfect. Not sure how you guys do it, but here we take it at the end of the year, no matter when you had the clerkship. Gives you more exposure, but 4 weeks of outpatient family medicine is very....superficial.
 
Case Files. Also used Blueprints for IM, and focused on non-acute outpatient topics.
 
So generally everyone agrees that Case Files, AAFP questions, uworld, and ambulatory chapter in step up is enough?

I'm a little worried about this exam because it's my first rotation and first NBME of 3rd year, so basically I have no idea what to expect. Everything I read says something along the lines of "make sure you take it later in the year after IM, OB, and Peds" but that's not really an option for me. How bad is it as the first shelf of 3rd year?
 
hallowmann said:
So generally everyone agrees that Case Files, AAFP questions, uworld, and ambulatory chapter in step up is enough?

I'm a little worried about this exam because it's my first rotation and first NBME of 3rd year, so basically I have no idea what to expect. Everything I read says something along the lines of "make sure you take it later in the year after IM, OB, and Peds" but that's not really an option for me. How bad is it as the first shelf of 3rd year?
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Just quoting you to bump this thread as I am in the same boat. Good luck, let me know what you figure out.
 
Just purchased Uworld, there is no "Family medicine" subsection. Should I just choose all the rest (Medicine, Ob/Gyn, Peds, Psych)-maybe all besides surgery) and do as many of those as I can?
 
UCA2390 said:
Just purchased Uworld, there is no "Family medicine" subsection. Should I just choose all the rest (Medicine, Ob/Gyn, Peds, Psych)-maybe all besides surgery) and do as many of those as I can?
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My post was unclear, it should have said uworld, fam med questions which are the online aafp questions that someone posted. I think those are the best because uworld takes forever but you can go through those questions in a month easily
 
I just took the family medicine shelf yesterday. It was my first shelf/rotation and I have to say I found it difficult, just because it was SOO random. I had a little bit of everything some peds, psych, derm, endo, heme/onco, ethics questions where they give you scenarios and ask you what is the best approach, some preventive questions (vaccines, hypertension, weight loss, screening etc), 1-2 gyno questions, and like 3 biostats. I essentially did everything I could for this shelf..AAFP questions (theres like 1000 or so I ended up finishing 600ish), I did all the pretest questions (500Q), blueprints Qs ( they have 100 questions on the back of the book), I read ambulatory section of Step up medicine twice, read some pertinent chapters in step 2 secrets and I've read through case files once. Overall, I would rate it based on a value of 10 being the most helpful: case files (7/10), AAFP questions (8/10) and if you have time do the blue print questions (6/10). But even then some concepts were not even in the things I've covered. I had to tap back into my knowledge for step 1 to answer some questions that were mor basic science type questions (anatomy, behavioral type questions etc). I feel if I had done internal med rotation before this I would have found it pretty easy, since there was some endo, pulmo, GI, heme/onco, topics in this shelf asking you next best step or some very specific details. Good luck to everyone taking this shelf. Hope this is helpful! 🙂
 
Hello, LTR, FTW here with a few thoughts on studying for the family medicine shelf (80 question version).

Family medicine was my first clerkship (4 weeks in length, mostly outpatient) of M3 and I started the clerkship after finishing my PhD.
My studying strategy was partly dictated by the order of my clerkships (I had IM after family medicine).

What I used to study:

Helpful resources (in my opinion):
- Case Files - Family medicine - A broad overview of outpatient medicine. I thought it provided a frame with which I had to fill in details
- Step-up to Medicine - Started with the ambulatory care (last) chapter. Found this to be very helpful in filling in the gaps of Case-Files. I managed to read the entire book by the end of the clerkship, but I did not think it was absolutely necessary.
- Pocket medicine - Family medicine - used ONLY as a reference while in clinic. Did not "study" from this book.
- UWorld - Did ~150 IM (random, timed) questions
- Random resources - USPSTF recommendations, etc.
- AAFP questions - limited utility, too advanced, but each question had good explanations

Resources I thought were not very helpful for me:
- Med-U - Our school provides us with this resource. The cases are too long, too tangential, and sometimes with errors. I did not think it was a productive use of my time.
- Swanson's Family Med. Review - Too advanced, not reflective of the level of knowledge that is expected for the family medicine shelf.

My impression of the test: (my breakdown is in %s)

- 35% More emphasis on pathophysiology of diseases (characteristic findings, precursor lesions, downstream sequelae) than billed on the NBME website
- 5% questions on development (tanner stages) and how to counsel patients on the development of their children
- 10% Vague screening-type questions - Whether or not to screen someone for disease X was muddied by lots of "fluff" in the vignette.
- 8% Vaccination questions
- 7% questions on "next best step" (breast mass discovered by 27 year old v. 63 year old female)
- 25% Know first-line antimicrobials, when to start statins, common drug interactions
- 10% questions on biostats, empathy, communication, etc.
- 0% OB-GYN questions and
- Some elements of geriatric medicine thrown in there

I thought my studying did not prepare me for questions on child development, and I thought some of the questions on screening questions were vague.

Score: 95th %-ile

I hope that helps! Good luck everyone!
 
Firecracker (flagged topics based on what was covered in case files)
AAFP questions (about 400 random questions)
Pretest FM (finished all the questions)

No UWorld or actual reading of case files. Also, I had the peds shelf prior to this, so that probably helped a bit.

Ended up with an equated percent score = 87% (they didn't give us the current score interpretation form but I think thats well into the upper 90s percentile)
 
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The family medicine shelf was my hardest by far. I did around 100 AAFP questions, All pretest questions (500), some of case files. It focused a lot of derm (like tinea versicolor, tinea xyz), some peds, minimal ob/gyn, LOTS ON COPD and the first line treatment for COPD/Emphysema, not too much diabetes, some psych, but mostly medicine. I performed really well clinically and focused a lot on the patients that I saw but still my equated percent score was only 64% :/ (my lowest scoring shelf).
 
Sharing since people's advice and experiences on these types of threads have helped me.

Just got my FM shelf score back. My equated % correct score was 87 which I believe is >95th percentile. I'm really excited! This was my best shelf score so far.

Our FM rotation is 8 weeks long. We take the 100 Q test (FM + chronic disease + MSK).

I mostly used Case Files. It's one of the better case files books IMO despite being the longest. I read it all the way through twice and then went back and re-read cases if they were particularly complicated or high yield (eg, COPD).

I did maybe 150 or so AAFP questions. And I read up on the stuff I'd see in the clinic in Step Up to Medicine.

What I wish I had figured out sooner is that you need to know more than you're probably used to for the big topics like COPD, diabetes, HTN, etc. You need to know acute and chronic complications of those conditions, risk factors for them, and what they are risk factors for. Also 1st and 2nd line treatments and contraindications/adverse effects of those treatments.

PS Look at pics online of common derm stuff right before the test.


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So, I'm trying to use the AAFP practice questions and am having no luck- the link just sends me to this page, and there is no pop-up window or button to start the test. I've tried it on a couple different computers to see if maybe it was something up with my laptop, but no luck. I guess I can just stick with Case Files, but I was really hoping for some practice questions...
 
Mad Jack said:
So, I'm trying to use the AAFP practice questions and am having no luck- the link just sends me to this page, and there is no pop-up window or button to start the test. I've tried it on a couple different computers to see if maybe it was something up with my laptop, but no luck. I guess I can just stick with Case Files, but I was really hoping for some practice questions...
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Would like to know what is going on as well... Can't access the questions.
 
michiganpsych08 said:
As soon as I click on the link the questions are there :/ did you create an account? You have to be registered to view the questions
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I did create an account a couple weeks ago as a medical student. Did you register as a resident?
 
Milotic said:
I did create an account a couple weeks ago as a medical student. Did you register as a resident?
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Nope as a medical student. That's weird because like I said the link you posted works for me and takes me directly to the questions. Maybe call them? Sorry you're having such a difficult time
 
Ugh, now we get the answers we need. I send the AAFP an email and they never got back to me, guess I should have called. Well, going into that shelf pretty much raw, we'll see how it ends...
 
Honestly thought this was one of the easiest shelfs, but only if you've already done your IM shelf. Just relied on my old knowledge and did brief peds. ob/gyn and msk reviews.
 
mymembernames said:
Is it helpful to do IM Uworld for this shelf?
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I used Case Files (gives a nice overview of some of the pertinent / high yield material) and the AAFP questions when I took it around 1.5 years ago and did well on the test. IM Uworld questions might help some but may not be as efficient. This test is not as difficult as the IM shelf, in my opinion.
 
Just took this.

Score: 85th percentile. Peds is what hurt me since I didn't have peds yet.

Shelves taken previously: psych, obgyn, IM.

Sources:

case files - only good for seeing what you're responsible for for the most part, I don't feel like this source makes stuff stick.

Online med- I have to say one of the better and underrated sources out there. Get hold of their schedule for FM and watch/study the videos they deem relevant, even the ones they say are lower yield for FM. They have a magical way of presenting the bare minimum that all seem to appear on shelf exams.

Step up to medicine - derm and ambulatory medicine chapters: I hated this book and didn't use it for internal med, but used these two chapters for FM and found them very good.

Pretest for Family med (2012): an older gem. Hit the high yield topics and I just studied anything that was mentioned in a question in this book. Disclaimer: for the preventative section just ignore the older guidelines

Uspstf guidelines: make them into anki cards and bomb through them 1x per week and the night before the exam just to hammer the 1-2 questions you'll see.

AAFP questions: hands down the worst and most overrated source. I was worried I only did 300 questions of these but honestly half of them are just things that aren't on the test as well as testing you on outdated info. Use at your risk and only if you didn't have IM yet. Just my 2 cents.
 
Anicetus said:
Just took this.

Score: 85th percentile. Peds is what hurt me since I didn't have peds yet.

Shelves taken previously: psych, obgyn, IM.

Sources:

case files - only good for seeing what you're responsible for for the most part, I don't feel like this source makes stuff stick.

Online med- I have to say one of the better and underrated sources out there. Get hold of their schedule for FM and watch/study the videos they deem relevant, even the ones they say are lower yield for FM. They have a magical way of presenting the bare minimum that all seem to appear on shelf exams.

Step up to medicine - derm and ambulatory medicine chapters: I hated this book and didn't use it for internal med, but used these two chapters for FM and found them very good.

Pretest for Family med (2012): an older gem. Hit the high yield topics and I just studied anything that was mentioned in a question in this book. Disclaimer: for the preventative section just ignore the older guidelines

Uspstf guidelines: make them into anki cards and bomb through them 1x per week and the night before the exam just to hammer the 1-2 questions you'll see.

AAFP questions: hands down the worst and most overrated source. I was worried I only did 300 questions of these but honestly half of them are just things that aren't on the test as well as testing you on outdated info. Use at your risk and only if you didn't have IM yet. Just my 2 cents.
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Interesting perspective. I thought PreTest was just terrible, riddled with errors, ridiculously out of date (much worse than AAFP), and gave up on it pretty quickly (and I've used and pretty much liked PreTest for previous rotations). AAFP questions, while not great, is the only reasonable question source for FM imho. For what it's worth we scored similarly on the shelf exam.

I used Case Files, SUTM, and AAFP and thought they were decent. Peds should only trip you up on developmental questions, and the correct answer is always all normal, or one thing is abnormal. Otherwise it's something you should know from IM or Step 1.
 
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I don't really want to honor it so I plan to just wing it since I've done well on my previous shelves.

Prior to this rotation I had peds, psych, and OBGYN all in a row so I feel comfortable I can get those questions. I haven't had medicine yet (been keeping it fresh on surgery and ambulatory), but I imagine I will be fine as long as I casually do some IM UW and brush up on screening recommendations and vaccine schedules of adults/kids.

That is my plan. I'll let you know if I fail.
 
NWwildcat2013 said:
I don't really want to honor it so I plan to just wing it since I've done well on my previous shelves.

Prior to this rotation I had peds, psych, and OBGYN all in a row so I feel comfortable I can get those questions. I haven't had medicine yet (been keeping it fresh on surgery and ambulatory), but I imagine I will be fine as long as I casually do some IM UW and brush up on screening recommendations and vaccine schedules of adults/kids.

That is my plan. I'll let you know if I fail.
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Lol - you won't fail it.
 
Walter Lance said:
Lol - you won't fail it.
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Good to know. Im experimenting here. I have IM next so I figure just easing into some IM questions will serve the dual purpose of helping for family and reducing the amount of work I have to do on IM.
 
I guess I should update this since my last post here was almost 2 years ago. Adjusted score in the 80s (don't even remember exactly now).

Case Files, AAFP (like 700 of them - super easy to get through fast), and memorizing the USPSTF A and B recommendations table were pretty much all I really did. A lot of people recommended the Preventive Med section in Step Up, but I didn't really bother with it. It's not too bad.
 
There's also an iPhone and Android app called ABFM exam prep which is free, and may be helpful. It's full of old retired ABFM ITE questions, and designed as a Family Medicine board prep tool.

It has a icon that looks like this:
 

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Took this a while back and scored at the 100th percentile on this shelf. Had IM before this but haven't done peds or obgyn
1. Casefiles - I hated reading this at first but it was definitely good to do so I recommend it. You can skim through it again pretty quickly for the big topics. Warning - its over 650 pages so read quickly
2. Pretest - Did this 1x plus my incorrect ones - skip the first section - not useful - and just focus on the acute and chronic disease sections. To calm some people - I got absolutely crushed on certain sections aka like 13/15 questions wrong in a stretch sometimes so don't feel too discouraged if it's not going that well. Doesn't matter your score on practice tests. Just learn from your mistakes because the actual shelf is all that matters
3. AAFP questions - I did a few hundred but gave up after a while - so many minute details that are interesting but won't be on your test. I'd say ~30% fall into that category. Reading AAFP guidelines, though, was definitely helpful if I got a little confused about the management of certain conditions for my patients so it was helpful for both clinic and the shelf
4. UVA FM questions - these were great but there are only 125 of them - probably the closest thing to the actual Shelf
5. UWorld - did not touch during this clerkship but went through this pretty extensively for IM and Surgery
6. USPSTF guidelines - Know this cold and you'll get a lot of questions right - there are some great quizlets online that other people have made that I used
7. SU2M - read the ambulatory section - can't really say if this was that useful but it's pretty quick to get through
8. Online MedEd - did not use so I can't comment on that.
9. Did not bother memorizing the peds vaccination schedule at all
10. Know alternative antibiotics in case of allergies - a few of these may pop up on your test
11. Know the treatment for different categories of asthma severity - you will have a couple of these on your exam for sure.

That's pretty much it. I usually don't come out of Shelf exams feeling very good but with this one, for some reason, I felt very confident coming out with those resources I listed above. Good luck everyone!
 
jpwsurf21 said:
4. UVA FM questions - these were great but there are only 125 of them - probably the closest thing to the actual Shelf
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I just started these after reading your post and really like them. IMO this is as close as you can get to having 125 dedicated Family Medicine UW-style questions.
 
NWwildcat2013 said:
I just started these after reading your post and really like them. IMO this is as close as you can get to having 125 dedicated Family Medicine UW-style questions.
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Same, thanks for the tip. I did over 200 of the AAFP questions but I think the UVa ones are better in terms of clinical vignettes and TESTABLE trivia (as opposed to the untested trivia on AAFP)

Also, requesting that a moderator move this thread to the clinical rotation subforum so that this advice is easier to find for people doing shelf prep.
 
So I just finished taking it so here's my advice. First off, KEEP IT SIMPLE. There are no gold standards like UWorld or SUTM like with IM and you only have a month (or at least that's how it worked at my school).

My strategy: I already had IM right before so I was a bit lucky. I got through Case Files once (it's pretty large). "Google 274 Step 2 Reddit". One of the top hits is a guy who's outlined lots of good resources for shelves including Case Files for Family. After that, I read the Ambulatory section of SUTM once as well. For questions, there's no NBMEs and there's no UWorld. You can use AAFP but I didn't because I heard they vary in quality and many are too detailed in the wrong way. If you do want to use them, make sure you register now because it takes a few days for them to approve your access. For questions I think the BEST resource is the 2012-2015 inservice exams. Our school provided them to us on Blackbord. They were 240 questions each and were pretty short less time-wasting questions compared to IM/Uworld which was good for my ADHD brain and the explanations in the seperate PDF answer keys were better than UWorld frankly. I learnt a lot from them and I think it got me a few points. Other than that, be aggressive and see lots of patients. Ask your residents loads. FM residents know tons of information about everything so they're really good resources to ask, but make sure you do so at appropriate times.

Also may be random but this has happened 3/3 times in rotations. On rotations some attending/resident pimps me about a minutiae that seems ridiculous and says this will be on some board for you down the road. Turns out that was directly on my shelf and turned into a gimme question I would have made an incorrect guess on. After that, review pediatric milestones with a good table, review USPTF Grade A/B guidelines (you should already know most from Clerkship). For vaccines know when the adult ones are given and which ones can't during pregnancy. As for pediatric vaccines, DONT memorize that schedule. If you must, look at trends, like for example Measles and Varicella are given a bit later than DTap/HepB and you can somewhat reason through it. Then review MedBullets for Pediatrics Step 2/3. That'll give you a good idea of the common childhood rashes/infections like HHV-6, Epiglottitis, Bronchiolitis as well as management. Most are supportive but some like Measles have tiny things like Vit A which decreases mortality. Know Centor's criteria for Pharyngitis because that's very high yield on Clerkship and Shelf and know which antibiotics are first line for various things and then which to use next. Had three questions where the person was allergic or first line was contraindicated. Also, you should be strong in Diabetic work up after a month but if you're not, review that as well as well as what preventions need to be done. For MSK, you need a detailed review and SUTM does a good job with those. Lastly, COPD/Asthma stages and each corresponding therapy should be memorized. That's the bulk of it.

The FM shelf was on the easier side and so far my difficulty rating would be:

(1)OB>>>>>>>>(4)IM>(5)Family=(2)Neuro>>(3)Psych. That being said, I did OB first and Family after Internal.

Also, on the shelf be careful because with a few you can't change answers and I had 8 on mine which were part of sets so I got 2 wrong there so I don't know what to think of that...Time wasn't a huge issue compared to IM/Neuro/OB so take your time. Always go with the less invasive procedure if stuck and for behavioral questions never say anything even borderline offensive to the patient and ask them the politically correct open-minded questions.

Edit: 91st percentile! Highest I've scored on a shelf thus far. Only wish I'd honored Internal instead, but that's ok.
 
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Im usually a decisive test taker. I move through exams really quickly and rarely second guess myself, but this was not the case on the FM shelf. There were tons of questions where none of the options felt great or where two felt equivalent.

Time will tell how I did.
 
So thanks to everyone who has given their advice in this thread already! I am starting third year next week. My first rotation is 4 weeks "general primary care" and then 4 weeks family med. I'm addition to the obvious doing well in clinic and the wards, I want to do really well on the shelf exams. Which resource should I start with? I have basically 8 weeks until the family med shelf, and I'm fine with studying a little bit every night. If someone can help me make a guide of which resources to study every day, that would be awesome!
 
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