Medicine shelf (please help)

[studentMD]

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I just took my very first shelf exam last week. It was the medicine shelf and I'm 95% sure I failed it. I've read Blueprints and PreTest cover to cover twice but that help me at all. I didn't expect the questions to be so long on the shelf; some of the questions were half a page long. I'm not a quick reader so by the time I finish reading the questions, I had maybe 10 seconds to think about and answer the question, a very difficult task for me. Evey question contained so many distractors that I had problems figuring out what the important info is. I also didn't know that lab value interpretation was such a critical part of the exam (about 15-20% of the questions had 5 or more lab values to interpret). Neither Blueprints nor PreTest had enough coverage on lab value interpretation.

I was so down and frustrated after the exam that I was ready to drop out of med school. I did so poorly that I can't see myself even coming close to passing it when I take it again in 3 months. But after thinking about all the hard work it took to get to this stage, I wanted to give it one more shot before calling it quits.

I've looked at many other review books but none had questions that mimic the length and style of the shelf exam. The closest match were the questions at the end of Bluedprints in Medicine. The PreTest questions were simply too short and easy compared to the shelf. I checked out Blueprints Q&A for Medicine, but there again, the questions were too short and straightforward with few distractors. I find that the questions on the Harrison's website and in NMS Medicine goes too much in depth and is beyond the scope of the shelf.

Does anyone know of a source of practice questions that more closely resemble shelf exam questions? How about a high-yield review book that is more comprehensive than Blueprints but short enough (unlike NMS) to be read in a month during the clerkship? I'd greatly appreciate any suggestions or advice you may have about the medicine shelf exam. I need all the help I can get. Thanks a bunch.

 

[Brewster]

I wouldn't get too discouraged. What are your school's policies for failing a shelf? At my school, one just retakes the exam, not the whole rotation. Also, you don't know your score yet. I felt that way about a couple of the exams, but ended up passing.

One useful test strategy for the shelfs is to read the last part of the vignette (the actual question) first. Frequently you do not need the rest of the story to answer the question, although you can skim it for clues. This can help you save valuable time.

 

[southerndoc]

I've been told that the shelf exams are scaled.

Don't say you failed until you get your score.

 

[PimplePopperMD]

The shelf exams are tough.

Good thing is that the more of them you take, the easier that they get (regardless of the material)... because you get used to the exams themselves; and all this translates into a relatively easy step II, because the shelves prepare you adequately for that.

The answer to your question:

The MKSAP for students is a phenomenal study tool, and I highly recommend it. Written by the same folks as those who write the shelf exam, this is a perfect practice book.

good luck!

 

[Castro Viejo]

Originally posted by studentMD
I just took my very first shelf exam last week. It was the medicine shelf and I'm 95% sure I failed it.

So long as you completed the exam, that's an unqualified statement.

I also didn't know that lab value interpretation was such a critical part of the exam (about 15-20% of the questions had 5 or more lab values to interpret). Neither Blueprints nor PreTest had enough coverage on lab value interpretation.

Well what was it that you did during your clerkship? Assuming your medicine clerkship is somewhere between two and three months in length, I'd assume your resident or intern went over lab interpretation and stuff. Didn't you have a patient with an abnormal lab value that generated like three of four differentials?

Did you not have a patient with a high calcium?

No book will teach you to interpret lab values, as this is something I think most people will pick up during their clerkship. Blueprints is too flimsy to be of use for medicine.

I was so down and frustrated after the exam that I was ready to drop out of med school.

Don't do that. That's what they'd want to see. Don't let them beat you down just because of a silly shelf exam. Drop out if you find a better job. 🙂

The PreTest questions were simply too short and easy compared to the shelf.

Short and easy they may be, but you'll learn a whole bunch from the PreTest series. I certainly did.

Does anyone know of a source of practice questions that more closely resemble shelf exam questions?

As someone has already mentioned, MKSAP (Medical Knowledge Self-Assessment Program) for Students is in the same style of Shelf exams. The only thing is I believe they're really difficult compared to the real shelf and they're really poorly written. So poor in fact I had a difficult time figuring out what the hell it was they were asking.

This was your first shelf. I think the majority of us were caught off guard with the first shelf exam. Get used to it. Every exam from here on out will be as stupidly written. Wait until you take the Step 2. 🙄

Good luck.

 

[unregistered]

Best NBME type question books (from my opinion):

1. MKSAP for students "the green book" (some sections are great and reflective of the NBME, others would confound even an Internal medicine chief resident). Good explanations with citations.

2. Harrison's self-assessment and board review - I would have to say this is the best so far. Lots of pt management oriented questions w/ cases. Great explanations. Some Qs are too detailed but overall better than MKSAP.

3. Appleton and lange for IM. Ok. Too many small detail questions. Explanations suck.

4. PreTest for IM. Better than A&L. Nice pt-management oriented questions. But not as reflective of NBME as MKSAP and Harrison's.

5. NMS for Step 2. Haven't gotten through this yet. But based on my experiences with past clerkships, not that good for individual NBME exams.

6. The questions in the back of IM Blueprints. Very good. Just as good as Harrison's. Great explanations.

And, yes! I plan to go through all 4-5 question books for my upcoming IM shelf exam.

G'luck.

UNREGISTERED in TX.

 

[Jim Picotte]

Something else to consider is the Blueprints Clinical Case series for Medicine. I used a few of these books studying for Step III and they really explain a lot and have decent questions in the end. I only used the blueprints for medicine for my shelf when I took it a couple years ago and did very well. The key is to really know the details in that book. It's short and it seems like there isn't enough information but in reality it's just very condensed. The best prep of course is to read up on all your patients while in medicine. Nothing is better than figuring out what to do on real live patients...of course you can't see everything in medicine in just a couple short months so you do have to read.

 

[ortho2003]

Don't sweat it...I was pretty sure I failed my medicine shelf exam too. It was my first shelf and I came out thinking it was harder than step I. I ended up with an 84 scaled score, so don't get ready to drop out just yet.

If you do have to take it again, I would recommend MKSAP for students, pre-test, blue-prints, and FA for step II.

 

[mary]

I wouldn't assume you did so poorly before you get your score- you never know!
I agree that the Harrison's and MKSAP q's are some of the best preparation. NMS, Blueprints and Pre-test just barely helped me pass, but lots of others did great using Harrison's or MKSAP. Good luck!

 

[madcadaver]

StudentMD,

First, don't be too discouraged. The Medicine shelf exam is difficult, and certainly the most difficult exam to take at the beginning of your third year. Skills like picking out abnormal and important lab values from a long list will become much stronger as your third year progresses.

Sounds like your main problem is sorting through a question to figure out what the question is really answering. It's another acquired skill that you will get better at as the year moves on. Remember that you needed to do a lot of this on Step 1 - use the same approach!

For a study resource I would recommend First Aid for the Medicine Clerkship, and Pocket Medicine by Sabatine (to review how to think through a given clinical problem). Blueprints seems much too lightweight.

For question books I had only Pretest and Harrison's. I found Harrison's to be much too detail-oriented. Pretest was pretty good overall.

PS. A lot of people feel like they 'failed' the shelf as they walk out of the test. Few people do. And even if you did, you will get another shot to show that shelf who's boss.

 

[sperdoc]

I failed my medicine shelf as well,but my school only allows retakes at the end of third year (June 21st)...I'm not planning on going into medicine but I am worried about how the "marginally unsatisfactory" in medicine will look on my transcript for away rotations (since those apps have to be in by then)...does this mean that I won't be eligible? worried!

 

[McGillGrad]

7 year old thread, necromancer.

 

[xanthomondo]

Wow I was still in high school when this thread was created.