Official Surgery Shelf Exam Discussion Thread

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NMS casefiles was one of, if not the best resources I used for any shelf all year. I read it twice in the 2-3 weeks before the exam. It seemed to give the perfect amount of info on all of the high-yield surgery topics, and was also a great resource for our oral exam. Did a little bit of pretest and read some of recall. It was my last shelf of the year, which definitely added a couple points. Ended up with a fairly miraculous 99. Not going into surg, but still felt good doing well...
 
How did you guys estimate how you might do going into the shelf? What is a good UW score or with any other resource?
 
hi guys, just needed some advice -

i've read through NMS casebook, case files, and the notes section of Pestana once. I started doing USMLERx questions today and will bang them out by tommorrow hopefully. My plan was to do Kaplan questions, USMLE world questions, and the clinical vignettes in kaplan by the end of 4 weeks. Is this a good idea? I don't know what my "raw score" goal is but to just do the best I can so I can get an honors in the rotation. And if I exhaust these resources with time to spare, which ones should I repeat and go over again? or should I add in another source as well?

Thanks.
 
robosurgeon said:
hi guys, just needed some advice -

i've read through NMS casebook, case files, and the notes section of Pestana once. I started doing USMLERx questions today and will bang them out by tommorrow hopefully. My plan was to do Kaplan questions, USMLE world questions, and the clinical vignettes in kaplan by the end of 4 weeks. Is this a good idea? I don't know what my "raw score" goal is but to just do the best I can so I can get an honors in the rotation. And if I exhaust these resources with time to spare, which ones should I repeat and go over again? or should I add in another source as well?

Thanks.
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That's really thorough. If you can get through all that, you're doing great, well above average. I would read through the Pestana/Kaplan again and re-do the ones you miss in UWorld. But you're already doing a lot so I don't know how much time you'll have.
 
does anyone know if all those types of fractures and the names in the pestana notes under the orthopedic section are actually high yield? it seems like a ridiculous amount to stone cold memorize for the shelf?

if its worth it, i'll suck it up and do it
 
robosurgeon said:
does anyone know if all those types of fractures and the names in the pestana notes under the orthopedic section are actually high yield? it seems like a ridiculous amount to stone cold memorize for the shelf?

if its worth it, i'll suck it up and do it
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No.

Pestana Notes suck. At least I know that when I run out of toilet paper, I still have Pestana Notes in my pile of 3rd year junk somewhere.
 
robosurgeon said:
does anyone know if all those types of fractures and the names in the pestana notes under the orthopedic section are actually high yield? it seems like a ridiculous amount to stone cold memorize for the shelf?

if its worth it, i'll suck it up and do it
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I didn't have any of those but I did get an ortho question or two that I knew from Pestana (slipped capital femoral epiphysis).
 
Guile said:
I didn't have any of those but I did get an ortho question or two that I knew from Pestana (slipped capital femoral epiphysis).
Click to expand...

okay, maybe i will try to cram it in, thanks
 
Hey guys, I just got my surgery shelf back - 99th percentile, 90% adjusted

It was my first shelf so I did not have medicine, and I'm writing this for all the people who don't have medicine before their surgery rotation.

Things I used:

NMS Surgery casebook (read twice, once in the last two weeks)
Pestana Kaplan Notes (twice -- this is a very easy read especially after NMS, don't worry about the different kind of fractures, my second pass was the day before the test. It's very readable in 8 hours.)
UWorld Questions (1 pass through surgery)

I would say by far the NMS Surgery casebook is the best.
UWorld Questions and Pestana concentrated too much on ortho stuff which wasn't really hit on too much, but they are still very good resources. I would concentrate on GI stuff the most.

Like everyone else says, this is basically a medicine test.
 
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what did yo uguys think of pretest as a question source? I just did the first 2 chapters which were really long and got my ass kicked but reading the answer explanations help provided that what theyre asking about is relevant to the shelf.
 
killinsound said:
Hey guys, I just got my surgery shelf back - 99th percentile, 90% raw

It was my first shelf so I did not have medicine, and I'm writing this for all the people who don't have medicine before their surgery rotation.

Things I used:

NMS Surgery casebook (read twice, once in the last two weeks)
Pestana Kaplan Notes (twice -- this is a very easy read especially after NMS, don't worry about the different kind of fractures, my second pass was the day before the test. It's very readable in 8 hours.)
UWorld Questions (1 pass through surgery)

I would say by far the NMS Surgery casebook is the best.
UWorld Questions and Pestana concentrated too much on ortho stuff which wasn't really hit on too much, but they are still very good resources. I would concentrate on GI stuff the most.

Like everyone else says, this is basically a medicine test.
Click to expand...

Very impressive, congratulations also, how were you doing on UWorld btw (though I guess the balance of questions is not necessarily the same)? Did you do anything about the other subjects that were not well covered in NMS like uro besides doing uworld/pestana?
 
DocLan said:
Very impressive, congratulations also, how were you doing on UWorld btw (though I guess the balance of questions is not necessarily the same)? Did you do anything about the other subjects that were not well covered in NMS like uro besides doing uworld/pestana?
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on world i was hitting around 85% consistantly. For other subjects not really covered by NMS, i was kinda lucky in that I had a uro and ent rotation. To tell you the truth, a lot of the stuff is just going through the logic that NMS presents you with. There's a lot that isn't covered by NMS, but if you use teh nms framework as you're going on, i you can figure out the right answer.
 
I just read through kaplans notes really fast this morning and while im sure theres a lot more mistakes i found two I felt worth pointing out

1) its behind the ball on current recommendations for endocarditis prophylaxis (see uptodate or dynamed for latest guidelines) but basically, prophylaxis for dental procedures etc is much less than it used to be, only a couple conditions still require it.

2) says HIV is an absolute contraindication for transplant; which isnt entirely true, HIV donors can give to HIV recipients. Its done in my hospital.
 
Took the exam 8/27. Surgery was my first rotation. Just got my score back. 89 raw, 98%🙂. First, I am by no means a genius. I thought I failed the exam after I took it. I was sure of it. Our rotation requires you to get above the 15% nationally and I was just hoping to pass. I went home and looked up 10 questions I remembered, and got them all wrong. My advice is to put in the time and study consistently throughout the rotation. Don't worry about the test after you take it. Be confident in your preparation. I used the following resources and would recommend them to everyone I know.

1. NMS Casebook - read 2x - when reading this book, go slow throughout the first read, highlight, and really try to understand what you are reading. Review the second time during the last week of the rotation. It's a quick read. Has images as well which show up on the shelf.

2. Kaplan Surgery 2008-2009 Notes. 1x. Underground. Google it and you'll be able to find it. These include the highly sought "Pestana Vignettes". I felt they were good, but not as spectacular as everyone says.

3. Case Files Surgery. 1x. Easy read. High-yield. 2nd best resource after NMS

4. USMLE World - Surgery questions - go through the answers well as you do the questions - very helpful - use the internal medicine questions if you have additional time

General Tips:

1. Don't memorize procedures
- Diagnostic tools (CT, barium swallow, etc.) and treatment options (hyperkalemia, fluid management -causes of hyponatremia, etc.) are high yield so concentrate on these

2. Be prepared for some ethical situations

3. Questions- do more questions rather than adding another book resource

4. Be confident with your answers. Trust your gut.

Good luck to everyone. :luck:
 
anyone have any ideas on what to do about the ethical q's? i always feel a little unsure about these. in general, obv go with the patient's own choice in treatment plans but it can be hazy between a few choices sometimes. just curious if anyone has a good source - its only a few q's but still
 
I took the July administration of the Surg Shelf and my raw score was 65. I recently saw my evaluation from the clerkship, which said that I was in the 23rd percentile for the shelf. I am very confused:

I thought that NBME standardized the Shelf exams to a 70 with a standard dev of 8? So I am well within one standard deviation...and thinking about the normal distribution, if the exam is standardized to a 70, then shouldn't it be higher...? Something along the lines of 30th percentile, or so? Since It'd be 2.1+13.6+a little less than half of 34.1?

If I am going about thinking about this in totally the wrong way somebody please interject and explain how to figure this out because I'm genuinely confused. Thanks in advance!!

Image375.gif
 
tiburones said:
I took the July administration of the Surg Shelf and my raw score was 65. I recently saw my evaluation from the clerkship, which said that I was in the 23rd percentile for the shelf. I am very confused:

I thought that NBME standardized the Shelf exams to a 70 with a standard dev of 8? So I am well within one standard deviation...and thinking about the normal distribution, if the exam is standardized to a 70, then shouldn't it be higher...? Something along the lines of 30th percentile, or so? Since It'd be 2.1+13.6+a little less than half of 34.1?

If I am going about thinking about this in totally the wrong way somebody please interject and explain how to figure this out because I'm genuinely confused. Thanks in advance!!

Image375.gif
Click to expand...

That percentile makes sense. Remember that since it's an exponential curve that is pretty steep in places and always changing slope, you have to be really careful about saying things like "a little less than 1 SD." Your 65 is 5 less than the mean, or 5/8 = 0.625 SD. There is a table at http://www.acposb.on.ca/conversion.htm that you can use to find percentiles from other measures, and the Z-score is pretty convenient for this. Z-scores have a mean of 50 and 1 SD = 10, so you can do math with them more easily. Your score, mean - 0.625 SD, would be a Z-score of (50 - (0.625*10)) = 43.75, which from the table is a percentile between 25.8 and 27.4.

It's also possible that your school is reporting a percentile that is relative to people in your class, which could be way off from the national stats.

I wouldn't worry too much about a few percentile points. Just try to do your best and don't let the shelf scores determine your self worth.
 
While reading through NMS and Casefiles, it seems like there is a lot of information regarding tumor staging criteria and levels of invasion.

Do we need to know the different stages for different types of tumors for the shelf????
 
tiburones said:
I took the July administration of the Surg Shelf and my raw score was 65. I recently saw my evaluation from the clerkship, which said that I was in the 23rd percentile for the shelf. I am very confused:

I thought that NBME standardized the Shelf exams to a 70 with a standard dev of 8? So I am well within one standard deviation...and thinking about the normal distribution, if the exam is standardized to a 70, then shouldn't it be higher...? Something along the lines of 30th percentile, or so? Since It'd be 2.1+13.6+a little less than half of 34.1?

If I am going about thinking about this in totally the wrong way somebody please interject and explain how to figure this out because I'm genuinely confused. Thanks in advance!!
Click to expand...

The curve is based on a group that took the exam over 15 years ago. With that group, the average was scaled to be 70 with a standard deviation of 8. The average and median (50th percentile) have gone up since then and actually tend to be closer to 75 than 70. The current percentiles are based on the recent trends and are usually based on groups from the last 1-2 years. It's explained on the NBME site... I posted a link to it in the Medicine Shelf Exam thread a couple of weeks ago if you're interested in reading more about it.
 
No. I didn't have a single question about TNM staging for any type of cancer.
 
Adam638 said:
No. I didn't have a single question about TNM staging for any type of cancer.
Click to expand...

Took the exam yesterday and it was pretty tough. No straight TNM questions but there were 2 or 3 questions where you needed to know the stage b/c it affected tx options.

Very few (if any) questions about drugs or antimicrobials.

More OB then I expected and less medicine.

Overall it was a pretty fair test - very few things I hadn't seen before. The toughest questions were the ones where the answer I was accustomed to seeing was not there but instead two choices that were similar.

The question stems were not as long as I was expecting on average but I did need more time because of the amount of questions I wasn't sure on - probably 20-25.

The sources I used were Case Files x3, Pestana word doc x2, Step 2 secrets (found it very useful for GI stuff) UW -Surg and IM GI/hepato, Kaplan Q book, lange practice test. Did Lawrence questions online for in class exams - marginally helped for the shelf probably.
 
Could someone PM me the pestana review? Thanks so much!
 
our surgery shelf is pass/fail but we do have a tough departmental and oral exam. How do you think the following will be for prep (I have not had medicine yet!):

NMS Casebook x2
Case Files x1
UWorld Surgery questions
Blueprints Q&A, Kaplan Qbook
Kaplan Surgery/Pestana

Do you think it is worthwhile to read the first several chapters in Lawrence for a medicine background or does NMS cover it pretty well?

Thanks!
 
Hi. My goal is simply to pass. I'm fairly astute but haven't studied. Do I need to study for this test in order to pass? Thank you.
 
I felt the test was a challenge because it drew a lot of questions from medicine, peds and obgyn.. I felt the pestana and nms reviews along with pretest and uw was too focused on surgical patient care so I had to draw on outside knowledge to answer a ton of questions. Had I taken this test at the end of the year i'd probably say it was easy.. but since it was my first shelf it was definitely hard and I finished with only 7 minutes to spare.
 
GladifImakeit said:
Hi. My goal is simply to pass. I'm fairly astute but haven't studied. Do I need to study for this test in order to pass? Thank you.
Click to expand...

Yes you do need to study. If you have had medicine before surgery you may need to study less but the shelf was probably the hardest standardized test I've taken in med school.

Just doing the rotation is not enough because much of what is practiced in the real world isn't the exact way the question writers want it
 
2012mdc said:
Yes you do need to study. If you have had medicine before surgery you may need to study less but the shelf was probably the hardest standardized test I've taken in med school.

Just doing the rotation is not enough because much of what is practiced in the real world isn't the exact way the question writers want it
Click to expand...

This ^^^^

I never saw trauma, vascular, burns or a bunch of the crap that was included on the exam. Medicine is much different in that you pick up a lot just by working and going to the BS conferences on your rotation.

Surgery not so much. The first time I'd seen some of that stuff was in a book.
 
Folks, study your Pestana. BUT if you can get your hands on a copy of the Kaplan 2ck for Surgery, read that -- because it's the Pestana, but better, with more explanation so you really get your concepts down. Either is fine, but Kaplan is preferred.

I also looked at

  • NMS red book (decent, skim 1x, but don't spend too much time on this, it's too detailed and disorganized),
  • Case files (decent, go through 1x pretty fast is all you need, just use it like it's a resident trying to teach you during the down time, or you can read this before you start the rotation for some easy pimp points),
  • Surg Recall, Regular not Advanced (good for downtime, load onto your palm or iphone, Skyscape sells it, easy pimp points AND surprisingly I got a couple of shelf questions because I read this, but this should not be the focus of your shelf study)
  • Lange Qs (ok, but don't feel pressured to finish),
  • First Aid (horribly long and detailed, truly useless)
  • UW (computer questions are not completely helpful for practicing a paper exam, but doing questions early on is good to get into the groove of 2ck)
Seriously read Kaplan surg or Pestana (with understanding) will score you enough points to pass the silly surgery shelf. It's not easy but it's definitely silly for taking itself so seriously. I know this works because I have friends who did not pass the shelf, and then studied Kaplan/Pestana for 2 weeks, and then passed.

So Kaplan 2ck surg > Pestana >> other
 
i think i failed this shelf. i'm so nervous. i felt so lost during the entire exam. i read nms twice, and uworld and kaplan qs and still felt really unprepared. i'm screwed.
 
Jolie South said:
This ^^^^

I never saw trauma, vascular, burns or a bunch of the crap that was included on the exam. Medicine is much different in that you pick up a lot just by working and going to the BS conferences on your rotation.

Surgery not so much. The first time I'd seen some of that stuff was in a book.
Click to expand...

I saw tons of trauma - rotation was at a Level 1 trauma center and we had 24hr q4 trauma call for half of my surg rotation. Seeing it is not nearly enough because in reality many of the steps the books do are skipped IRL
 
2012mdc said:
I saw tons of trauma - rotation was at a Level 1 trauma center and we had 24hr q4 trauma call for half of my surg rotation. Seeing it is not nearly enough because in reality many of the steps the books do are skipped IRL
Click to expand...

My gen surg month was at a private hospital, and while I didn't see trauma, I was assigned an attending that really liked to teach and just scrubbed on his cases with one other resident.

At the county hospital that's level 1, students are glorified scut monkeys and don't get to go to the OR that much despite there being lots of cases, so I chose not to rotate there.
 
Jolie South said:
My gen surg month was at a private hospital, and while I didn't see trauma, I was assigned an attending that really liked to teach and just scrubbed on his cases with one other resident.

At the county hospital that's level 1, students are glorified scut monkeys and don't get to go to the OR that much despite there being lots of cases, so I chose not to rotate there.
Click to expand...

That's nice to have a choice of where to rotate. We have no choice - half the time on trauma, half on gen surg. All at the same hospital

Not only were we encouraged to scrub in, 1 student was required to be scrubbed in on every case so we got plenty of experience.

Now onto some advice (just got my score back)

I did Case Files 3x, Pestana x2, UW including Medicine GI&Hepato 2x, Kaplan Q book, and a Lange Test. In hindsight this may not have been the perfect method but it worked (84, 92nd percentile). Coming out of the test I felt really bad since it seemed like such a difficult test - either the curve was generous or I did better than I thought

Case Files was helpful but I think I should have read it twice and read NMS once.

Pestana was definitely helpful.

In terms of questions - UW was probably more similar in terms of vignette length but Kaplan was helpful as well. The Lange test was ok but I really only did it bc I wanted to do more questions.
 
How does everyone feel about First Aid for Surgery Clerkship? I'm 5 weeks away from the shelf and i'm nervous. Been going through FA and plan to supplement with Case Files and L&A for questions.

Is L&A one of the better sources for questions?

Any help is appreciated.
 
drcuma said:
How does everyone feel about First Aid for Surgery Clerkship? I'm 5 weeks away from the shelf and i'm nervous. Been going through FA and plan to supplement with Case Files and L&A for questions.

Is L&A one of the better sources for questions?

Any help is appreciated.
Click to expand...


im pretty sure the FA did not help me with a single question.. the vignettes are good though, skip the first part.
 
PokerDoc said:
im pretty sure the FA did not help me with a single question.. the vignettes are good though, skip the first part.
Click to expand...

Agree 👍👍

FA surg reeked of useless. I glanced at it in the book store. Saw that it was too detailed and disjointed -- why the hell did they put in 500+ pages worth of ****? Still didn't want to write off FA based on it's good will from Step 1. So Borrowed it from the library... and my nose was right 😱

Tossed that thing in the bin so fast ... the return bin though :laugh:

Still wasn't enough to contain my vitriol towards wasting precious surg rotation study time 👎thumbdown
 
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i hate to be the 100th person to request this but i can't seem to find the place on the forum where the links to pestana audio files were posted. anyways, when i extracted those files, it gave me audio for trauma, orthopedics, pre-op/post-op management and general surgery but not pediatrics and specialty surgery.

can anyone help me track those down? also, i'm happy to share what i've got. my e-mail is [email protected]

thanks.
 
icantlactate said:
i hate to be the 100th person to request this but i can't seem to find the place on the forum where the links to pestana audio files were posted. anyways, when i extracted those files, it gave me audio for trauma, orthopedics, pre-op/post-op management and general surgery but not pediatrics and specialty surgery.

can anyone help me track those down? also, i'm happy to share what i've got. my e-mail is [email protected]

thanks.
Click to expand...
That was me. The SDN police rained on the parade and deleted my post. I posted a few posts above this explaining this. I also said that under no circumstances would I ever consider sharing these files by PM because filesharing is wrong.

(So, check your PMs.)
 
drcuma said:
How does everyone feel about First Aid for Surgery Clerkship? I'm 5 weeks away from the shelf and i'm nervous. Been going through FA and plan to supplement with Case Files and L&A for questions.

Is L&A one of the better sources for questions?

Any help is appreciated.
Click to expand...

L&A questions were just too short IMO. I did the practice test because it was another source but I think Kaplan and UW are better sources. If you have time for 1100 extra questions do your thing though :laugh:, more questions can't hurt
 
I'm less than 24 hrs from the shelf. Here's what I've done so far:

Case Files: Made it up to Case 35 (I plan to read very quickly through the rest and only read the bold stuff and answer questions for the rest of the cases)
PreTest: All but about half of the GI and Transplant questions
Pestano Notes: Read completely yesterday (Also listening to audio)
L&A: Took practice test this am (~55% correct)


Am I in trouble for the shelf? What else should I do in my last remaining 24 hrs?

Thanks for any help!
 
Read Pestana notes at least once more, even if you don't get through Case Files.
 
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