Official Surgery Shelf Exam Discussion Thread

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Just got my score from Tuesday. I felt lost an confused while studying, but got an 86 putting me in 93rd percentile...this was my first rotation and shelf exam.
What I studied:
Blueprints Surgery
Casefiles Surgery
UWorld Surgery questions x2
Quickly read through the shorter 76 page Pestana document

I think blueprints was a waste of time and most of my learning was from CaseFiles. It walks you through step by step reaching the diagnosis which is crucial for this test since it is mostly pre-surgical and post-surgical management. It may seem an awful lot like Internal Medicine, but I think they are distinctly different.
 
I thought Pestana/Kaplan plus UWorld surgery was gold for this shelf. Many of the questions were eerily reminiscent. I also used Case files, NMS casebook, and pretest, which were fine for reinforcement. Not sure how I did as I took it on Friday, but I feel okay.

Edit - 95 raw.. I'll take it.
 
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Ilovewater said:
There was no anatomy question on my exam. Everything was about management or most likely diagnosis.



I was hoping for a little better because this one "big-name" attendings at the ophtho program I'm interested in kept telling me how important it was to get 90+ percentile on the shelf a few days before I took the exam. Probably should have avoided that conversation haha.
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Huh? How would he even know how you did on your Surgery shelf?
 
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ArcGurren said:
That's bizarre. My school transcripts only show my final grade for each clerkship.
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That's because our shelf grade and clinical grade are completely separate. The shelf doesn't affect the final grade for the rotation. We are only required to pass. Thus, it's on our transcript, so PDs can see everything. Maybe it doesn't show for you guys because the shelf is incorporated into the final grade?
 
Ilovewater said:
That's because our shelf grade and clinical grade are completely separate. The shelf doesn't affect the final grade for the rotation. We are only required to pass. Thus, it's on our transcript, so PDs can see everything. Maybe it doesn't show for you guys because the shelf is incorporated into the final grade?
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yep ours is all combined so dont think it's reported (but to honor a rotation you need a high score)
 
Raw - 90, scaled to 95th.

Pestana short notes 3x throughout the course, NMS casebook x2 (thoroughly the first time, quickly the second during the last week leading up to the test), and uworld (surgery x2, then as much GI as I could.)

The test was difficult; I expected more of the big hitters. Instead, there were quite a few peds questions and even a few OB/GYN throw in.
 
I am still waiting for my results but the test was horrible. I feel like I failed again. No graduation for me. Out of curiosity, what does your school require for you to pass the exam? Our school requires us to be in the 18th percentile. Most schools I have heard to 5th or 10th percentile.
 
Thought I'd throw a strategy into the mix that worked for me:
Pestana short notes once at the beginning, NMS casebook first pass, step up to medicine GI and electrolytes, NMS again, UW surgery questions and Pestana short notes again during last week. Last 2 days I did the surg questions I missed and as many medicine ones as I could stand. Hadn't had medicine yet.

EDIT: Because someone PMed me: Felt OK after the test. Seemed easier than some shelf exams but harder than others. Got a high score.
 
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Pestana 194 page document x 2
Pestana audio files x 3
USMLEWorld Surgery questions x 2
USMLEWorld Random assortment of various medicine, ob/gyn, etc. questions - a couple of hundred
Case Files: Surgery - read about half
Surgical Recall x 1
NMS Surgery Casebook x 1

Made an 89 (I think "raw", our school only gives us one number and we have no access to a score report, so I don't think this is a percentile)

Overall I was very dissatisfied with my score - I thought I would at least break 90. Surgical Recall was completely useless - if I could go back and do it again, I wouldn't have wasted time reading it. It wasn't even that helpful for pimping in the OR.

NMS Casebook is just OK - it's so dated and is full of extraneous information, but everyone seems to use it so it's at least worth one read through.

Pestana notes and audio files are excellent - there were a bunch of questions on the exam that I got right because of these notes.

UWorld is great - definitely worth doing. I had been out of school for well over a year because of research and surgery was my first rotation back after leaving. I had taken medicine and pedi a long time before but had trouble remembering some of that stuff. Would have done better otherwise I think.
 
Member12345674 said:
Pestana 194 page document x 2
Pestana audio files x 3
USMLEWorld Surgery questions x 2
USMLEWorld Random assortment of various medicine, ob/gyn, etc. questions - a couple of hundred
Case Files: Surgery - read about half
Surgical Recall x 1
NMS Surgery Casebook x 1

Made an 89 (I think "raw", our school only gives us one number and we have no access to a score report, so I don't think this is a percentile)

Overall I was very dissatisfied with my score - I thought I would at least break 90. Surgical Recall was completely useless - if I could go back and do it again, I wouldn't have wasted time reading it. It wasn't even that helpful for pimping in the OR.

NMS Casebook is just OK - it's so dated and is full of extraneous information, but everyone seems to use it so it's at least worth one read through.

Pestana notes and audio files are excellent - there were a bunch of questions on the exam that I got right because of these notes.

UWorld is great - definitely worth doing. I had been out of school for well over a year because of research and surgery was my first rotation back after leaving. I had taken medicine and pedi a long time before but had trouble remembering some of that stuff. Would have done better otherwise I think.
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If you scored 89% raw, you were probably in the 99th percentile.
 
tco said:
If you scored 89% raw, you were probably in the 99th percentile.
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If you only get one number, it's probably a scaled score and not a raw score. An 89 would be >2 standard deviations so yeah it would be a super-high percentile.
 
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Kaputt said:
If you only get one number, it's probably a scaled score and not a raw score. An 89 would be >2 standard deviations so yeah it would be a super-high percentile.
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I guess I should share just to bring a lil bit of diversity from the 99th percentile everyone apparently pulls.

I scored about 75 raw, which was 61% percentile. Not happy about it but what's done is done. The exam was really heavy on the internal medicine, I'd say it was 70% internal medicine, 30% surgery. So if I was to have changed anything it would have been to study the UWorld GI questions and to have started studying before rotation started. Don't bother w anatomy review beyond brachial plexus, and there were practically no ortho questions.

I did surgery recall x 0.75 ( only useful for clerkship)
Pestana x 1
UWorld x 0.75
Kaplan x 0.30
medical education online videos x 1
Kaplan diagnostic flashcards x 1 (helpful for the ophtha questions)

Prob would have been a good idea to have repeated uworld, quite a few questions were practically identical. Kaplan questions were useless.
 
Elle726 said:
I am still waiting for my results but the test was horrible. I feel like I failed again. No graduation for me. Out of curiosity, what does your school require for you to pass the exam? Our school requires us to be in the 18th percentile. Most schools I have heard to 5th or 10th percentile.
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My school also has an 18th percentile cutoff for passing. Are you sure other schools have 5 or 10 percentile? Seems really low. I've heard of schools with a 50thpercentile or 60th percentile cutoff for passing, but 5-10th percentile seems pretty low.

I dont exactly understand how to view the percentiles. Obviously being in the 90's is good, that's a no brainer. I talked to the director of my surgery clerkship because I was discouraged with my score, and he told me it was a fine score, and that anything above 50th percentile was good. Not sure how that can be.
 
Belleza156 said:
My school also has an 18th percentile cutoff for passing. Are you sure other schools have 5 or 10 percentile? Seems really low. I've heard of schools with a 50thpercentile or 60th percentile cutoff for passing, but 5-10th percentile seems pretty low.

I dont exactly understand how to view the percentiles. Obviously being in the 90's is good, that's a no brainer. I talked to the director of my surgery clerkship because I was discouraged with my score, and he told me it was a fine score, and that anything above 50th percentile was good. Not sure how that can be.
Click to expand...

I doubt that there are schools with 50th percentile as pass. That would mean a significant portion of their students would fail each year. That would look terrible for a school.

For the record, our school has the 10th percentile set as passing.
 
Kaputt said:
If you only get one number, it's probably a scaled score and not a raw score. An 89 would be >2 standard deviations so yeah it would be a super-high percentile.
Click to expand...

What is the difference between a scaled score and a raw score? My surgery director quoted my score as a raw score, but my score report lists it as my scaled score.
 
ijn said:
Thanks for the feedback for my previous questions. I just took the second Surgery NBME and had a few more questions. I'd appreciate any help.

B is wrong. I'm not sure what I'm missing here. I guess go w/ the less invasive MRI before sticking electrodes in her?

I'd go with MRI since it'll probably visualize the nerve compression, but I'm not 100% set on it.

E is wrong. I guess I should have started with medical management w/ laxatives and diet alteration before cutting?

Yeah, start with medical management first. The symptoms aren't too alarming.

D is wrong. Is the answer colonoscopy? I wanted to see CT angiography but it wasn't there. I figured you'd be afraid of perforating necrotic bowel if you stuck a scope up her butt, similar the contraindication in diverticulitis. In that case CT is the first choice.

You're gonna want some kind of surgery since the patient has signs of necrotic bowel with an acidosis. So I'd say celiotomy. If it said laparotomy, instead of laparoscopy, you could probably have picked that.

E is wrong. I guess pain causes hypertension. Since pedal pulses are present it doesn't seem like hypovolemia and you really need bilateral femoral fractures to cause significant blood loss within the leg compartments... is it a PE from prolonged immobility?

PE is possible since the patient is tachypneic and tachycardic, but I'm not so sure. I could also see hypovolemic shock if she hasn't been able to drink anything for 2 days, although I don't know if you'd go into shock that quickly. So.. hmm..

A is wrong. It sounded like a choledochal cyst to me. Apparently the treatment for those is Roux-en-Y cystojejunostomy, but it seems wrong to go straight to surgery without obtaining imaging of the biliary tree first.

Yeah, I don't know this one.

D is wrong. So she had an ovarian cyst... did it progress to an acute episode of ovarian torsion? And I should have done an exploratory operation? Do cysts predispose to torsion or is that just a red herring?

Generally the rule seems to be do surgery and ask questions later on anyone with peritoneal signs. So I would pick E.
Click to expand...

Hope that helps.
 
For the ischemic bowl question, the answer is Exploratory celiotomy....its another name for an EXLAP. Furthermore, someone who could be that potentially unstable is contraindicated to have laparoscopic surgery.
 
Just took this test Friday.

Did not feel as though it went well.

I've been usually doing very well on shelf exams and this one, I'm actually afraid I didn't pass.

I did: NMS casesx1, pestana x2, kaplan x2, uworld x2 + GI, lytes, hepato, GU and some cardio and endo.

There were so many questions out of left field, I couldn't have anticipated them. A few questions were directly from uworld. My thought is that pestana and kaplan give you the absolute bare minimum amount of information you need to make an educated guess. I don't know what I would have done differently. Everyone who took it with me felt this way. Will post score when I get it.

I will reiterate that i think the best thing one can do to prepare is to get on a M3 track where you do medicine prior to surgery!
 
Enolate said:
Just took this test Friday.

Did not feel as though it went well.

I've been usually doing very well on shelf exams and this one, I'm actually afraid I didn't pass.

I did: NMS casesx1, pestana x2, kaplan x2, uworld x2 + GI, lytes, hepato, GU and some cardio and endo.

There were so many questions out of left field, I couldn't have anticipated them. A few questions were directly from uworld. My thought is that pestana and kaplan give you the absolute bare minimum amount of information you need to make an educated guess. I don't know what I would have done differently. Everyone who took it with me felt this way. Will post score when I get it.

I will reiterate that i think the best thing one can do to prepare is to get on a M3 track where you do medicine prior to surgery!
Click to expand...

No doubt medicine helps, but I don't think it's essential to doing well. Yeah there's a lot of left-field stuff on the exam but I thought mine was about as fair as a shelf exam could get. You probably got >90th percentile like everyone else on these boards (still wonder how that happens). The resources you used are the same ones everyone uses to do well. Add in some test-taking skills and it gets the job done.
 
Hi all!

Two questions:

1.When people say Pestana, do you mean the short 73pg note set or a longer version?

2. How do people get access to Kaplan test prep materials?

Thank you so much for all your help!!
 
Starting surgery in a bit. Any recommendations for a text that's not just bullet points? I like a good thorough text. I've been eyeballing the NMS Surgery text (not the casebook).

Our recommended text is Lawrence's Essentials of Surgery, but I hear it's awful.
 
For the shelf? Probably Step Up to Medicine, but it's all bullet points. :laugh:

eMedicine and UpToDate articles were my primary text resource during my rotation. Although my real primary resources were the Step 2 CK surgery videos (along with rewatching the IM GI/neurology sections.)
 
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tco said:
I doubt that there are schools with 50th percentile as pass. That would mean a significant portion of their students would fail each year. That would look terrible for a school.

For the record, our school has the 10th percentile set as passing.
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yeah 5th percentile is passing here for all shelves, or 1.5 SD lower than the class average, whichever is lower.

Bbon said:
What is the difference between a scaled score and a raw score? My surgery director quoted my score as a raw score, but my score report lists it as my scaled score.
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raw score is often used interchangably with scaled score, which is unfortunate. everyone is talking about the same number. no one except the NBME knows what your actual "raw" score is (ie the percentage you got correct out of 100)
 
Just can't get the hang of this 3rd year shelf thing, but I've improved over FM and IM.

82nd percentile. Not used to being below 90...This is killin' me.

I did NMS casebook x 1.5, Uworld once then repeated incorrects, Pestana (small) x 2 and large x 1.
 
Well that didn't quite go as planned. That shelf was full of obscure things and questions about pee. Hope everyone else fared better.
 
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Enolate said:
Just took this test Friday.

Did not feel as though it went well.

I've been usually doing very well on shelf exams and this one, I'm actually afraid I didn't pass.

I did: NMS casesx1, pestana x2, kaplan x2, uworld x2 + GI, lytes, hepato, GU and some cardio and endo.

There were so many questions out of left field, I couldn't have anticipated them. A few questions were directly from uworld. My thought is that pestana and kaplan give you the absolute bare minimum amount of information you need to make an educated guess. I don't know what I would have done differently. Everyone who took it with me felt this way. Will post score when I get it.

I will reiterate that i think the best thing one can do to prepare is to get on a M3 track where you do medicine prior to surgery!
Click to expand...

Were the extra UWorld stuff you did (GI, lytes, hepato, GU and some cardio and endo) really helpful for this shelf? I feel like UWorld has really been nothing like the other shelf exams I took
 
Wondering--

Is the Pestana audio the same thing as the Kaplan surgery videos, only just the audio? Or is it totally different? Thanks 😳
 
And if u check YouTube someone had posted uploads if the pestana videos from waaayyy long ago (the same timeframe from which the online notes are based).

If you obtain the videos via the regular medical student route then just download an app and convert the video to mp3 or mp4 files. I did it all from my phone. There's no need to look at pestana anyways. ..you may risk falling asleep at the wheel 😛

Sent from my SPH-L710 using SDN Mobile
 
gravitywave said:
yeah 5th percentile is passing here for all shelves, or 1.5 SD lower than the class average, whichever is lower.



raw score is often used interchangably with scaled score, which is unfortunate. everyone is talking about the same number. no one except the NBME knows what your actual "raw" score is (ie the percentage you got correct out of 100)
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That's not true. I asked my last rotation prof to show me my results and they come in a class list from the nbme (names of those who took the shelf during same rotation) with everyone's raw score and the equivalent percentile. And nbme also provided preceding years results for the same rotation slot. You can ask your program director for these results. You have a right to see them.

Sent from my SPH-L710 using SDN Mobile
 
Belleza156 said:
That's not true. I asked my last rotation prof to show me my results and they come in a class list from the nbme (names of those who took the shelf during same rotation) with everyone's raw score and the equivalent percentile. And nbme also provided preceding years results for the same rotation slot. You can ask your program director for these results. You have a right to see them.

Sent from my SPH-L710 using SDN Mobile
Click to expand...

Right, so what you saw was your NBME scaled score. The NBME also provides the percentile relative to the entire cohort that took the exam, which at some schools (including mine) is used to determine whether or not the student passed.

From the NBME: "As a result, the vast majority of scores range from 45 to 95, and although the scores have the 'look and feel' of percent-correct scores, they are not."

People can call it a "raw" score if they want, I just feel that's confusing when it looks as though most people both here and IRL hear "raw" score and assume that it's their percent correct on the exam, when in fact the number you got has already been scaled by the NBME. You don't ever find out exactly how you did on the test, at least not in terms of "percent correct."
 
raw 84, percentile: unknown.
NMS surgery (the big book) except a few chapters, only reading procedures when I was interested or going to see them in the OR.
Pestana 1.5x'
Uworld surg 2x also did GI questions 1x,

Test was typical NBME pain in the arse, no magic bullet for them. Study hard and hope for the best.so,
Also I hadnt done medicine yet which would have been helpful.
 
To gravity wave.... So if they are not raw score as in #correct out of 100......what is their relevance? I haven't done the practice nbme shelf exams yet, but are the results provided also scaled scores as you say?
 
Belleza156 said:
To gravity wave.... So if they are not raw score as in #correct out of 100......what is their relevance? I haven't done the practice nbme shelf exams yet, but are the results provided also scaled scores as you say?
Click to expand...

I suspect the relevance lies in the ability to compare scores across separate test administrations when the particular items of each test form differ from each other. It's the same reason we get scaled scores for the USMLE, MCAT, SAT etc etc etc.... after all, when was the last time you got a score on a standardized exam that told you exactly what your actual percent correct was? That figure doesn't have any meaning in this context, it's how you did relative to the other people that took the test, or relative to the predetermined standard, that matters.

If you read back a couple pages in this thread, you'll also notice that the exams were scaled to a 70 average and a SD of 8 - but that standardization was done almost twenty years ago, and so few of the exams have an average of 70 any more as students' performance has improved.

I'm not familiar with any practice shelf exams, so can't comment on those.
 
Practice nbmes are on the nbme website. Same place as the step 1 nbmes. Cost about $20, there's 2 per clerkship. They started offering them this year.

Sent from my SPH-L710 using SDN Mobile
 
88th percentile

Crammed with 3 days Uworld Surgery Q's and NMS Surgery Casebook x 1.5 before shelf. Had to recall a lot of information from my internal medicine rotation 6 months ago on this exam.

I don't know how many of you guys were able to study so many sources for this shelf. I did four weeks of general surgery and four weeks of ortho. Was busy trying to memorize Netter's and parts of Miller.
 
ijn said:
I just took one of the surgery clinical mastery forms from the NBME. I had some questions about the questions I got wrong and would appreciate any help finding an answer.


I put C and got it wrong. Is the answer A? When you consent to an ectopic pregnancy removal do you give implicit consent for the surgeon to cure any other life threatening disease process that may be found once he cuts?

!
Click to expand...

This is actually a real court case: Barnett v Bacharach.

The answer is A. You wouldn't put her at risk to go find her husband, the appendix is useless, and she is pregnant.
 
No clue what my scaled score was, but it was 97th percentile. I absolutely loved the Kaplan surgery videos. I also rewatched select portions of the IM videos (GI, neuro, renal). I didn't touch Pretest. I thought Case Files was decent, but low yield. I did all of the USMLEWorld Surgery questions and the 2 new surgery practice NBMEs. I had family medicine and pediatrics before my surgery rotation.

Hell no, there's nothing like cancer staging on this exam. I'd focus on learning the best initial test, next step in management, and diagnosis of the common surgical disorders. I know there are some people who disagree but the exam really is for the most part a retread of your internal medicine or family medicine shelf exams.
 
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My surgery shelf is a 1/3 of my surgery grade, and I got a 99 (98th percentile).

However, my general surgery site director was a tough grader and gave a 3.5 out of 5 (a 70) and my month of surgical sub-specialty gave me and all their other rotators an 4 (an 80). Both had good comments to say about me in my evaluation. So in the end I did not get an honors, despite doing a slightly above average amount of work in both rotations and doing a good job when pimped by the attending.

Some of my classmates had more generous surgery site directors and were able to get honors, even with mediocre shelf scores.

Is this kind of tough and unfair grading system common in surgery? When I was in medicine almost all the attendings seemed to want to grade generously and it seemed like it was a lot easier for students to honor. If I am going into medicine, do you think residencies will care that I got a high pass in surgery?
 
smmypnts said:
My surgery shelf is a 1/3 of my surgery grade, and I got a 99 (98th percentile).

However, my general surgery site director was a tough grader and gave a 3.5 out of 5 (a 70) and my month of surgical sub-specialty gave me and all their other rotators an 4 (an 80). Both had good comments to say about me in my evaluation. So in the end I did not get an honors, despite doing a slightly above average amount of work in both rotations and doing a good job when pimped by the attending.

Some of my classmates had more generous surgery site directors and were able to get honors, even with mediocre shelf scores.

Is this kind of tough and unfair grading system common in surgery? When I was in medicine almost all the attendings seemed to want to grade generously and it seemed like it was a lot easier for students to honor. If I am going into medicine, do you think residencies will care that I got a high pass in surgery?
Click to expand...

unlikely. high pass is great.

what did you use to study?
 
JasonE said:
unlikely. high pass is great.

what did you use to study?
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I guarantee that poster didn't use any resource that hasn't been extolled already a billion times in this thread

The difference between a score in the 80s and a score in the 90s is simply your general body of knowledge up to this point, which cannot be dramatically altered in an 8 week rotation
 
Kaputt said:
I guarantee that poster didn't use any resource that hasn't been extolled already a billion times in this thread

The difference between a score in the 80s and a score in the 90s is simply your general body of knowledge up to this point, which cannot be dramatically altered in an 8 week rotation
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calm down. I just wanted to know, and theres nothing wrong with that. ive changed resources plenty of times becuase of what people say works and doesnt.

this thread is very, very, very long, and opinions are mixed. ive read hrough it all. unlike other rotations, surgery has a very mixed bag and not many strong opions of what works. im a big beleiver in using the best combo of resources, and its led to multiple perfect scores on shelf exams for me.
 
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