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Official Internal Medicine Shelf Exam Thread
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Hello everyone,
Thought I'd post my impression of the IM shelf and how I studied for it and throw in my proverbial 2 cents:
At our school, IM is a 12 week clerkship (2 months on the wards, including cardiology; 1 month of clinics). I studied about 2-3 hours a day when not in the hospital, considerably more (4-5 hours) closer to the shelf exam. I recommend that you keep your ears open and pay lots of attention to what happens around you when you're on wards or in the clinic - this experience is indispensable and though not directly applicable to doing well on the shelf, can really put your hours of studying in context of patient care!
What I used to study:
- Step-up to Medicine - I had read this book once during my family medicine clerkship. Read it x 2 during the clerkship. This was the "skeleton" into which I filled in extra information.
- IM essentials textbook - Read once, but in retrospect, was not helpful in addition to step-up to medicine
- UWorld - Did all 1400+ questions (random, tutor; random, timed). I made notes for almost every question I got wrong or questions that presented new concepts to me. I had about 60 pages of handwritten notes at the end and I'd review these periodically (1-2 x a week)
- MKSAP for students - Did all the questions and made notes similar to those described for UWorld. IMO, I liked the UWorld questions more.
- Pocket medicine - used ONLY as a reference while in clinic. Did not "study" from this book.
My impression of the test: (my breakdown is in %s)
I thought the test was fairly straightforward. Most questions reminded me of a UWorld question. The content was heavier on cardio, pulm, GI, and renal, and less on ambulatory care, skin/immune. Infectious disease was also a heavily tested topic.
There were of course a few (<5%) random questions that I still have no idea about.
Questions on screening for disease and vaccinations were very straightforward compared to family medicine.
Knowing how to quickly interpret EKGs (I had about 5), CXRs (~ 5), CTs (~ 5) was helpful
Knowing how to describe classic presentations in plain terms (how would you describe a "starry sky appearance" without using those words?) is very helpful too!
Bottom line: IM is difficult, and studying for it was hard! I think you can maximize your chances of success with step-up to medicine, Uworld and repetition (repeat to remember and remember to repeat).
Score: 99th %-ile
I hope that helps! Good luck everyone!
Thought I'd post my impression of the IM shelf and how I studied for it and throw in my proverbial 2 cents:
At our school, IM is a 12 week clerkship (2 months on the wards, including cardiology; 1 month of clinics). I studied about 2-3 hours a day when not in the hospital, considerably more (4-5 hours) closer to the shelf exam. I recommend that you keep your ears open and pay lots of attention to what happens around you when you're on wards or in the clinic - this experience is indispensable and though not directly applicable to doing well on the shelf, can really put your hours of studying in context of patient care!
What I used to study:
- Step-up to Medicine - I had read this book once during my family medicine clerkship. Read it x 2 during the clerkship. This was the "skeleton" into which I filled in extra information.
- IM essentials textbook - Read once, but in retrospect, was not helpful in addition to step-up to medicine
- UWorld - Did all 1400+ questions (random, tutor; random, timed). I made notes for almost every question I got wrong or questions that presented new concepts to me. I had about 60 pages of handwritten notes at the end and I'd review these periodically (1-2 x a week)
- MKSAP for students - Did all the questions and made notes similar to those described for UWorld. IMO, I liked the UWorld questions more.
- Pocket medicine - used ONLY as a reference while in clinic. Did not "study" from this book.
My impression of the test: (my breakdown is in %s)
I thought the test was fairly straightforward. Most questions reminded me of a UWorld question. The content was heavier on cardio, pulm, GI, and renal, and less on ambulatory care, skin/immune. Infectious disease was also a heavily tested topic.
There were of course a few (<5%) random questions that I still have no idea about.
Questions on screening for disease and vaccinations were very straightforward compared to family medicine.
Knowing how to quickly interpret EKGs (I had about 5), CXRs (~ 5), CTs (~ 5) was helpful
Knowing how to describe classic presentations in plain terms (how would you describe a "starry sky appearance" without using those words?) is very helpful too!
Bottom line: IM is difficult, and studying for it was hard! I think you can maximize your chances of success with step-up to medicine, Uworld and repetition (repeat to remember and remember to repeat).
Score: 99th %-ile
I hope that helps! Good luck everyone!
Awesome score. To everyone thinking "holy **** that's a lot of work to do" you may find my strategy/results comforting.
96th (or maybe 97th, can't remember) percentile for me. Medicine was my first clerkship of the year and I didn't read SUTM or IM Essentials at all. I did a few hundred MKSAP 5 questions and all of UWorld IM, but only reviewed ~700 of the UW questions. Most of the time I just read the explanations to the questions I got wrong and the ones I marked as "I have no idea what this is about". I watched that HY shelf lecture once throughout the clerkship and then again the day before my shelf. It's super quick and relatively useful. The only other resource I used was the NMS Casebook. I probably got through 10-20 cases and occasionally used it to supplement UW. Problem is there are many typos and a lot of the info is out of date. Upside is that presentations and general management is still accurate and much better than SUTM imo.
I wish I had studied more because I'd probably be in a better place for Step 2 CK, but don't feel like you have to kill yourself to do well on the shelf. It's difficult, but not impossible.
Also a disclaimer, my step 1 knowledge carried me throughout the clerkship on rounds and on the shelf. It's true that the medicine shelf is a lot of management and "next best step", but most of that is pretty obvious anyway.. I mean, if a patient has RUQ pain, but isn't toxic appearing then it makes sense to do a RUQ US first. Not rocket science.
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90 percentile. see above, Only did uworld
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Can anyone help out with V/Q mismatch vs shunt? UWorld is contradictory:
QID 4770 states that pneumonia causes a physiologic shunt due to lack of ventilation of perfused areas while QID 2303 states that shunting is when blood flow is diverted around a ventilated alveolus. So confused
QID 4770 states that pneumonia causes a physiologic shunt due to lack of ventilation of perfused areas while QID 2303 states that shunting is when blood flow is diverted around a ventilated alveolus. So confused
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I too know of 5-10 where I goofed, hoped I do as well as you did
Just to add another data point...
I ended up going through ~800 UWorld questions, 1/4 of Step Up To Medicine, and like 1/4 of MKSAP 5. The UT Health Science Center- San Antonio shelf review video was pretty money, too. (That girl is great, she makes review videos for almost every clerkship, and they're clutch) I finished UWorld with 70% overall cumulative. I only took NBME form 2 and scored an 85.
On the day of the test thought it was pretty straightforward to be honest. I don't know if I just prepared a lot more than my other shelf exams, or if some of my step 1 knowledge carried me as well but I didn't think it was nearly as difficult as the OBGYN shelf, for example. There were at least 10 "WTF, I have no clue type of questions" but many of them were similar to UWorld, if not a bit easier. It is also important to note, my feelings about this exam may not correlate at all to how I actually did so I may have actually scored terribly haha I guess we'll have to see.
I'll update when I get my score back in a few weeks. Best of luck to everyone else awaiting scores/ getting ready to take the exam soon. Merry Christmas and Happy Holidays to all.
I ended up going through ~800 UWorld questions, 1/4 of Step Up To Medicine, and like 1/4 of MKSAP 5. The UT Health Science Center- San Antonio shelf review video was pretty money, too. (That girl is great, she makes review videos for almost every clerkship, and they're clutch) I finished UWorld with 70% overall cumulative. I only took NBME form 2 and scored an 85.
On the day of the test thought it was pretty straightforward to be honest. I don't know if I just prepared a lot more than my other shelf exams, or if some of my step 1 knowledge carried me as well but I didn't think it was nearly as difficult as the OBGYN shelf, for example. There were at least 10 "WTF, I have no clue type of questions" but many of them were similar to UWorld, if not a bit easier. It is also important to note, my feelings about this exam may not correlate at all to how I actually did so I may have actually scored terribly haha I guess we'll have to see.
I'll update when I get my score back in a few weeks. Best of luck to everyone else awaiting scores/ getting ready to take the exam soon. Merry Christmas and Happy Holidays to all.
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Coming by to also add another data point:
IM was my 3rd cohort (had surgery and peds prior). I went through all of the UW IM except for about 200 or so neuro/biostats/ethics questions. I started using Step-Up to Medicine initially but ended up dropping it because it didn't fit with my style of learning. So I just stayed with UW, used UpToDate for my patients, and completed about 200 or so Pre-Test Medicine questions (which I surprisingly found helpful as a few of the questions I did actually appeared nearly word for word on my exam).
I also did both of the NBME practice IM exams and got in the mid-80s for both (one taken 4 weeks before and the second one taken 3 days before).
Raw score: 92 (99th percentile)
If you have any questions or need any more elaboration, feel free to shoot me a PM.
IM was my 3rd cohort (had surgery and peds prior). I went through all of the UW IM except for about 200 or so neuro/biostats/ethics questions. I started using Step-Up to Medicine initially but ended up dropping it because it didn't fit with my style of learning. So I just stayed with UW, used UpToDate for my patients, and completed about 200 or so Pre-Test Medicine questions (which I surprisingly found helpful as a few of the questions I did actually appeared nearly word for word on my exam).
I also did both of the NBME practice IM exams and got in the mid-80s for both (one taken 4 weeks before and the second one taken 3 days before).
Raw score: 92 (99th percentile)
If you have any questions or need any more elaboration, feel free to shoot me a PM.
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Answer in bold -- respiratory distress secondary to volume overload from an acute CHF exacerbation. The fluffy bilateral interstitial infiltrates = pulmonary edema. Also her PaO2 of 102 indicates that her A-A gradient is elevated given that she's on 40% FiO2
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It's an empyema -- pt is septic 2/2 left lower lobe pneumonia (bronchial BS is suggestive of a consolidation). Also there's a pleural effusion, which in this case is considered a complicated (vs uncomplicated) parapneumonic effusion given the low pH of pleural fluid plus some other criteria (high LDH, low glucse, high wbc etc)
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I just realized that "yellow colored" actually refers to frank pus. I guess I was thinking it was, well, yellow mountain dew colored - like "straw colored." LOL.
For other people who have a tough time with pulm, I found a great site where it says:
Parapneumonic effusions are due to infection, and are either complicated/uncomplicated:
Uncomplicated: If the pleural fluid pH is greater than 7.20, the pleural fluid glucose is greater than 60 mg/dL, and the pleural fluid LDH is less than 1000 IU/L, the parapneumonic effusion is in the exudative stage, and no further therapeutic intervention is required. Simply treat with antibiotics for now. However, if the pleural effusion increases in size or the patient remains or becomes febrile, repeat the thoracentesis.
Complicated: These have a poor response to antibiotics. Therefore, if the fluid is loculated, or the initial thoracentesis reveals pleural fluid with a pH less than 7.20, a glucose level less than 60 mg/dL, an LDH >1000 or a positive gram stain - then immediately perform tube thoracostomy.
Empyema: Frank Pus. This usually occurs when complicated parapneumonic effusions go untreated with antibiotics, or a chest tube is not placed. If you find this, then patient needs a (video-assisted thorascopic surgery) VATS
For other people who have a tough time with pulm, I found a great site where it says:
Parapneumonic effusions are due to infection, and are either complicated/uncomplicated:
Uncomplicated: If the pleural fluid pH is greater than 7.20, the pleural fluid glucose is greater than 60 mg/dL, and the pleural fluid LDH is less than 1000 IU/L, the parapneumonic effusion is in the exudative stage, and no further therapeutic intervention is required. Simply treat with antibiotics for now. However, if the pleural effusion increases in size or the patient remains or becomes febrile, repeat the thoracentesis.
Complicated: These have a poor response to antibiotics. Therefore, if the fluid is loculated, or the initial thoracentesis reveals pleural fluid with a pH less than 7.20, a glucose level less than 60 mg/dL, an LDH >1000 or a positive gram stain - then immediately perform tube thoracostomy.
Empyema: Frank Pus. This usually occurs when complicated parapneumonic effusions go untreated with antibiotics, or a chest tube is not placed. If you find this, then patient needs a (video-assisted thorascopic surgery) VATS
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Got an 86/95th percentile, enough for honors. Pretty darn, I worried about what my grade would be for like 3 weeks.
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When people say they used MSKAP, do they mean the content chapters or just the practice Q's or both? Also, for anyone who has MSKAP 5 (or any of the single-digit versions) how many pages is it? The MSKAP 15 is over 2k pages, which is a little overwhelming, (and someone said the double-digit MSKAPs are more geared torwards residents vs students anyways). :/
Took this thing last month. I felt good going into it after going through UW (~75% correct) and also half assed the MKSAP (IM essentials) questions at the end. I didn't do a text at all as I couldn't stomach SUTM but reviewed the high yield IM shelf ppt online a few days prior. Scored high 90's on both NBME's a week out.
Walked out of the exam dumbfounded...easily the most difficult exam I've ever taken and was unsure if I got enough for honors. NBME's were a joke compared to this. Definitely a level harder than step 1. Ended up getting 90 (99th percentile), so it worked out. The curve on this thing must have been massive.
So I would say if you studied hard for step 1 and have a decent base fund of knowledge, I'd say skip reading texts altogether. Just start hammering out questions from day 1. Review UW incorrect and re-read explanations. I'm not sure MKSAP helped at all. It will turn out okay in the end.
Walked out of the exam dumbfounded...easily the most difficult exam I've ever taken and was unsure if I got enough for honors. NBME's were a joke compared to this. Definitely a level harder than step 1. Ended up getting 90 (99th percentile), so it worked out. The curve on this thing must have been massive.
So I would say if you studied hard for step 1 and have a decent base fund of knowledge, I'd say skip reading texts altogether. Just start hammering out questions from day 1. Review UW incorrect and re-read explanations. I'm not sure MKSAP helped at all. It will turn out okay in the end.
Sorry for the late update, just started a new rotation and it's been hectic.
I have nicknamed this exam, "Step 1.5" haha that is kind of what it felt like. Anyway, I ended up scoring an 85 which was about the 93rd percentile. Interestingly, this is exactly what I scored on the NBME I took several days before the test. So I would argue the accuracy of the IM NBME is legit although of course this may have just been a freak coincidence in my case. Felt like UWorld was the best overall resource so if time is running out focus on UWorld.
Best of luck to everyone else who is going to tackle this beast soon.
It's IM essentials now. I only did the questions (didn't read a text at all). UW is much better than MKSAP/IME for the medicine shelf.
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The MKSAP/IME questions are an adjunct for uworld if you have the time, but you're not missing out on anything great if you don't do them. I wouldn't rely on them as my sole source of IM questions.
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Can somebody explain how they're calculating their percentiles for the shelf? I took it in December and ended up with a raw of 89. With an average of 73 and SD of 9 (reported by the NBME) ,that comes out to a 95-96th percentile, which seems to be at odds with what other people are calculating their scores to be. I realize this is a stupidly nitpicky point, but I am genuinely curious where the disconnect is?? Am i completely missing something?
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I replied to your post in the OB-Gyn thread with what my understanding is. I hope it helps. I wondered the same too in the past...
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Haha yeah thanks for the clarification
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I'd go with H. Nothing else seems to fit.
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Was wondering if anyone can help me with this question:
37 year old man comes to the physician because of an 8 week history of diarrhea ( 10 watery BM per day), and hair loss. four weeks ago, he had a rash on his elbos and knees. He has a 6 year history of regional enteritis treated with oral corticosteroids. Examination shows patchy alopecia on the scalp and hyperkeratotic lesions on the elbows and knees. This patient's condition is most likely the result of deficiency in which of the following?
Cobalt, Copper, Maganese, Selenium, or Zinc
Thanks !
37 year old man comes to the physician because of an 8 week history of diarrhea ( 10 watery BM per day), and hair loss. four weeks ago, he had a rash on his elbos and knees. He has a 6 year history of regional enteritis treated with oral corticosteroids. Examination shows patchy alopecia on the scalp and hyperkeratotic lesions on the elbows and knees. This patient's condition is most likely the result of deficiency in which of the following?
Cobalt, Copper, Maganese, Selenium, or Zinc
Thanks !
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Another data point
Resources:
Uworld 1x + incorrects
Onlinemeded 1x with repeats of some of the more important topics (Cards, neph, pulm)
3 pages of IM essentials or whatever it is they are calling it before I remembered textbooks suck
90+ raw. Stick to the basics
Resources:
Uworld 1x + incorrects
Onlinemeded 1x with repeats of some of the more important topics (Cards, neph, pulm)
3 pages of IM essentials or whatever it is they are calling it before I remembered textbooks suck
90+ raw. Stick to the basics
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Answer is E. Probably developed antibodies to factor VIII.
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It's H. I think he's eating his own hair and generating bezoars.
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Thanks IncognitoGuy..
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I have 4 week of mostly free time (2 weeks off + easy elective) before peds, primary care elective, and IM. Should I just barrel right into IM UW and Med Essentials questions during this time and supplement as needed with OMED and SUTM? How would you get started with that schedule?
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T-Minus 2 weeks until my shelf, I was I've gotten through about 75% of uWorld, I have about 300 questions left, but I've been averaging approximately 55%-60% on uWorld thus far (1st time through), is it enough to pass the shelf?
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Do some practice NBME exams and see for yourself. Nothing predicts shelf scores as they do.
What did you get on step 1?
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How many question is on this exam now? 110? 120?
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Are nbme 3 and 4 more representative of the exam? Are they recommended or just uworld?
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What is considered a good score to receive on the NBME Clinical Mastery Series practice exams? I have ~1.5 months until my IM shelf and I just scored a 79 on my first practice test (scaled score; 80% correct). I'm not sure how to interpret this, or where I currently stand. Would appreciate if someone offered some insight.
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As you may know the shelf scores are reported as an equated percent correct score - the percent of questions you'd get right in their pool of questions based on your performance on that particular test. I think this is roughly an estimate of your raw percentage on your shelf exam. My score sheet said that the average and SD for my test administration was 72 and 9, respectively. But there is no reason to believe that the distribution is 'completely' normal. My equated score was a 91 and percentile was a 99*.
Based on what my classmates have told me (and what I recall of them telling me), a raw of 80 correlated to about 70-80 percentile...
* Our score report only gives us the equated score; our clerkship admin gets a chart that correlates the raw scores with the percentiles
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Thanks for your response. Great score. 99th percentile among your school distribution? Or everyone who has taken that exam form? How were you doing on the Clinical Mastery Series exams? UWorld first pass? What did you do to prepare for the IM shelf?
Please let me know whenever you have time. I appreciate your insight.
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Thank you! I was very happy with the way the shelf turned out for me especially because it was pretty early in the year. Looking back, I think I could have done even better (if I only knew then what I know now...haha!). Guess that's why we have Step 2 to look forward to
The percentile is based on the population of first time internal medicine shelf exam takers from LCME accredited schools! I know schools can request percentiles that are from different test taking populations (their own school...)
I did not do any of the CMS exams during my clerkship, but as I've done some as I've been studying for my Step 2 CK to get some extra reps on the subject specific material (been missing between 1-4 on the medicine ones I've taken; would say they are pretty accurate representation of my shelf).
My uWORLD first pass on medicine was 85%, but I didn't do questions until I had read step up to medicine and part of IM essentials (MKSAP for students). I posted about my preparation a few posts above on this page (quoted here...)
Best of luck to you!
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You're the man, will read this soon.Thank you! I was very happy with the way the shelf turned out for me especially because it was pretty early in the year. Looking back, I think I could have done even better (if I only knew then what I know now...haha!). Guess that's why we have Step 2 to look forward to
The percentile is based on the population of first time internal medicine shelf exam takers from LCME accredited schools! I know schools can request percentiles that are from different test taking populations (their own school...)
I did not do any of the CMS exams during my clerkship, but as I've done some as I've been studying for my Step 2 CK to get some extra reps on the subject specific material (been missing between 1-4 on the ones I've taken; would say they are pretty accurate representation of my shelf).
My uWORLD first pass was 85%, but I didn't do questions until I had read step up to medicine and part of IM essentials (MKSAP for students). I posted about my preparation a few posts above on this page (quoted here...)
Best of luck to you!
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This is a reminder to refrain from posting NBME questions or any other copyrighted questions, either in full or partially abbreviated. Doing so is a copyright violation. You may paraphrase questions. Abbreviating words or removing fillers is not paraphrasing.
For those using UWorld and just a few other sources (or no other sources), what test mode are you using for your first pass through UWorld? Are you doing all sub divisions lumped together? If you are using another resource, do you go through it before doing UWorld questions?
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Tutor mode subject wise reading SUTM beforehand.
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Timed tutor mode. That's all I've ever done with Uworld. When I have a question I'm unsure about the underlying principles for I want to be able to immediately fix the right data in my head, and the timed part lets me keep a general-ish eye on my time. Obviously not nearly as well as timed mode would, but I've never had a problem with timing on tests so I don't stress about that too much.
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It depends on the resources you are using, for me I was using uWorld as my primary source with MTB as a supplement, most of my blocks (44 questions each, were organized via subject and were only un-timed tutor mode). I used uWorld and MTB as learning tools, essentially focusing on a subject per week, thankfully my rotation was light with hours and we had weekends off, so I focused on studying and pumping out blocks then. It's enough to pass with a decent score but not enough to solidify knowledge base, for that I would use SU2M (if you have the time).
As a gauge, I usually do an NBME approximately 3 weeks out, then 2 weeks out and then a week out. My scores were all over the place, so don't be discouraged if you aren't where you want to be on the 1st NBME you take. Don't stress about the questions, look up the reasons why you got it wrong in your resources and move on. Don't get bogged down with the score.
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I did around 1000 uworld questions (had like 300 left) mostly on timed mode, ~75-80% (mostly mid 80s by the end). Also read around half of step up (in topics I didn't feel too great about such as rheum and pull) and watched half of the online med ed. I watch the Emma holiday review 2 days before. I scored 96 (100th percentile per my schools report). So uworld really is tour friend here.
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Pretty much my days are 7am-7pm. I'm exhausted afterwards. How do you guys study after that? Tough it out or put more work during your days off?
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