Struggling with 3rd Year Shelves - Advice Needed

[2015Step1PhantomWorrier]

A little background:

I went to top undergrad university. I got 34 on the MCAT. Nontraditional student, 4 years off between undergrad and medical school, married with two small children (both in diapers), attend a top 20 medical school. Got a 204 on Step 1. I want to go into Psychiatry

I'm halfway through Third Year. Here are the rotations I've done in order and the corresponding shelf scores (in raw score percentages):

Psychiatry - 80
Neuro - 77
Pediatrics - 67
Ob/gyn (just got back score today) - 65

My school grades on percentiles and basically I went from 68th percentile on Psych down to 12th percentile on Ob/Gyn. Less than 5 percentile would be a fail. If I would have gotten 5 more questions wrong on Ob/Gyn, I'd have failed. That's scary. I'm 1) worried about failing either Surgery or Medicine shelves (I take them in that order) and 2) I feel like I study way too much to be doing so poorly.

I have two small kids in daycare and my wife works full time so obviously I have less time than the average medical student but I am pretty diligent in studying. I start studying/doing questions from day 1. For Pediatrics I did all of Pre-Test, all of the Uworld questions, 1/3 of Case Files and one of the NBME practice tests. For Ob/Gyn I did all of Case Files, all of Uworld questions, and like 300 questions in this UWise subscription the school got for us. For Ob/Gyn I didn't do the practice NBMEs (basically because since they don't give answers I wanted to spend time doing questions I could get feedback on) and my last two UWorld sets were 68% and 75%, so I was feeling fairly confident.

Long story short, I'm not sure the best way to study. Before coming to medical school I felt like a good test taker. Honestly, I've never had a 'strategy' when it comes to tests. I eliminate choices and pick the best answer. Step kicked my butt and I did a lot worse than I thought I would have given the schedule I laid out for myself. I can usually whittle down the answer to two or three choices but instead of having a 50% chance I feel like that somehow I'm more inclined to pick the wrong answer. Usually it's the small details that get me, like not realizing a description is saying 'strawberry cervix' in another way and therefore missing a buzzword that makes the diagnosis more clear. Or questions asking details at a higher level than I studied. For example, a question about managing a missed abortion patient. I know the risks with doing nothing but when it comes down to waiting a couple days due to patient's wishes.....I could see it going either way.

I plan to reach out to my school for tutoring/a learning consultant. I'm also wondering if anyone has any advice on how to effectively study with little time. I usually do a lot of questions and use Anki to make cards out of explanations, but obviously I'm doing something wrong.

Appreciate any insight.

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[mvenus929]

I think the tutor is a good idea. Do you read all the explanations carefully? Do you take notes on all the questions (there is always tidbits in the explanation that you don't know, even if you got the answer right)? Do you repeat the questions you got wrong?

How did you study for the MCAT? Were you more of a textbook studier, or a question person? Maybe you need more of a textbook foundation before you start testing your knowledge on questions.

Where do you study? Studying at home with two little ones is going to make it difficult to concentrate. Do you get enough sleep to actually remember things? Maybe having a family member come help out the week of the shelf would be helpful (if you could manage it, which I realize a lot of people can't).

 

[operaman]

Sorry to hear you're having some trouble. It's hard to really nail down the problem without watching you take a test, but I'll offer a few thoughts in case it helps. The issue is likely multifactorial and as such there is no easy quick fix, but you might be able to boost your scores with a few tweaks to your thought process. So here, in random order, are some thoughts:

1) "eliminate choices and pick the best answer." This mindset can get anyone into some deep trouble. There is no best answer. There is one correct answer and however many other totally and completely wrong answers. All of these questions are written and reviewed by committee before being refined as unscored items, so you can rest assured that the right answer is undeniably right and the wrong ones are wrong for very quantifiable reasons. Some of these are the seemingly unimportant details in the vignette.

2) For every question, determine your diagnosis. When the question asks for a diagnosis, this is the only step. For all other questions, you must answer this for yourself before selecting your answer. Sometimes it's easy to get caught up in the vignette and try to answer intuitively what your "next step" should be, but always be sure to clearly state your diagnosis before making the choice. For example, they may give you a patient with shortness of breath, cough, increased O2 requirement, etc., and ask for your next step. It's tempting to jump right to the answers and pick the intuitive answer (CXR perhaps?). That's great if you're working diagnosis is a pneumothorax, but the wrong answer if your working diagnosis is a PE. Maybe you think this is cancer and a CT scan is the way to go. Maybe it's a tension pneumo with hemodynamic instability and you need to act rather than image. The point is that you need to clarify your diagnosis and then act accordingly.

3) Avoid buzzwords in your study. You very wisely identify this as a weakness and it's something the NBME loves to do. They may not say "urge incontinence" and say "detrussor hyperactivity." Know the actual appearance and mechanism of things you study because they will not give you any layups. The beauty is that if you know the mechanisms, they can't really fool you.

4) Beware of ambiguity. The NBME and Step exams are incredibly good at making even the obvious questions a little bit ambiguous. The example I always give is they could give you the guy with a stroke and show you an ekg with no P-waves and irregularly irregular rhythm and ask the diagnosis. Sure, you're 99.9% sure it's a-fib, but then there's option E - "tako-tsubo cardiomyopathy." WTF is that?! Afib is too easy, they wouldn't possibly ask that, would they? Maybe it's that one I haven't heard of before....hmmm....and so on. Make your diagnosis and select your answer and don't get too caught up in the other answer choices. The tests are constructed to reward students who read the vignette, know the answer, and then find it. They are designed to penalize students who hope to cull through the choices and reason out the correct one. They'll ask a diagnosis question and all five choices are the top 5 on anyone's differential for that vignette. All the next step options are good next steps. It's easy to talk yourself into a wrong answer unless you've got your answer figured out as you finish the vignette.

5) Do whatever you can to take actual NBME tests. One of your biggest issues is learning how to manage their style of questions. They are markedly different from World or Pretest or any others. Taking the practice ones will alert you to terminology and subject areas you may not have realized were weaknesses.

 

[2015Step1PhantomWorrier]

I used the 90-day guide here for MCAT. The Berkeley books were a good combo of content and questions, like Case Files, which I felt good about for Ob/Gyn. Unfortunately, my wife was sick AND my youngest son was uncharacteristically fussy all the night before my last shelf (ob) so I had had a crappynight of sleep, but I'm not sure how much of a role that played.

One thing I've been wanting to do is make a flow chart for all diseases because I think a lot of times what's lacking is that, off the top of my head, I can't say, okay, here are the symptoms of this disease, here are the tests I'm going to use, in this order, to diagnose, here is the management based on different factors. I know it's a crucial component and a lot of times I can pick out the right answer in question form based on pattern recognition from doing a lot of questions, but if I could get all those flowcharts in my head, I feel I'd have an easier time. But I don't have time/I prioritize finishing the questions instead.

I try to go through the explanations as much as possible. Admittedly a lot of times I get fatigue and if an explanation is long/includes a lot of information on the broader topic, I might flag it to come back, but honestly I haven't had time to revisit flagged questions yet.

Honestly, during the test (and I felt this way with Step 1 as well), I have the thought that I don't even think studying longer would have helped me on certain questions. So I don't know if that's naiveté or just lacking strategy. Some of the problems are just simple things, like naming. For example, the answer to one question was ureto-vaginal fistula. I knew that from the vignette and there were about 12 answer choices, and I eliminated a lot but it was tough because the obvious answer wasn't there. I ended up picking vesicovaginal fistula but honestly didn't know if it was right and I was considering options like urethral diverticulum because I didn't remember studying that but...maybe it could lead to the same symptoms? Or lead to a fistula?

That's a main frustration I've had during the shelves, is that the answer I know from reading it isn't available in the options.

To answer some other things, I study at the library. We were loaned a textbook for ob/gyn but honestly it's hard to get through. If it's not more active, like doing questions, I'll unfortunately fall asleep after a few pages.

I haven't failed anything in med school yet and I hope I can continue to get through, just if I fail one it will be pretty bad for me, having to go back and retake, so a little nervous about going forward.

 

[2015Step1PhantomWorrier]

In response to the last (very helpful btw) I've gradually stopped taking the NBMEs. I took both for psych and both for neuro and 1 for Peds. For Peds my score ended up being the same as the practice I took a week before and I wasn't sure how much it was helping me, so I tried not taking any for Ob/Gyn. I felt like it was more of a peace of mind thing.

But great advice.

 

[charmiedermie]

A little background:

I went to top undergrad university. I got 34 on the MCAT. Nontraditional student, 4 years off between undergrad and medical school, married with two small children (both in diapers), attend a top 20 medical school. Got a 204 on Step 1. I want to go into Psychiatry

I'm halfway through Third Year. Here are the rotations I've done in order and the corresponding shelf scores (in raw score percentages):

Psychiatry - 80
Neuro - 77
Pediatrics - 67
Ob/gyn (just got back score today) - 65

My school grades on percentiles and basically I went from 68th percentile on Psych down to 12th percentile on Ob/Gyn. Less than 5 percentile would be a fail. If I would have gotten 5 more questions wrong on Ob/Gyn, I'd have failed. That's scary. I'm 1) worried about failing either Surgery or Medicine shelves (I take them in that order) and 2) I feel like I study way too much to be doing so poorly.

I have two small kids in daycare and my wife works full time so obviously I have less time than the average medical student but I am pretty diligent in studying. I start studying/doing questions from day 1. For Pediatrics I did all of Pre-Test, all of the Uworld questions, 1/3 of Case Files and one of the NBME practice tests. For Ob/Gyn I did all of Case Files, all of Uworld questions, and like 300 questions in this UWise subscription the school got for us. For Ob/Gyn I didn't do the practice NBMEs (basically because since they don't give answers I wanted to spend time doing questions I could get feedback on) and my last two UWorld sets were 68% and 75%, so I was feeling fairly confident.

Long story short, I'm not sure the best way to study. Before coming to medical school I felt like a good test taker. Honestly, I've never had a 'strategy' when it comes to tests. I eliminate choices and pick the best answer. Step kicked my butt and I did a lot worse than I thought I would have given the schedule I laid out for myself. I can usually whittle down the answer to two or three choices but instead of having a 50% chance I feel like that somehow I'm more inclined to pick the wrong answer. Usually it's the small details that get me, like not realizing a description is saying 'strawberry cervix' in another way and therefore missing a buzzword that makes the diagnosis more clear. Or questions asking details at a higher level than I studied. For example, a question about managing a missed abortion patient. I know the risks with doing nothing but when it comes down to waiting a couple days due to patient's wishes.....I could see it going either way.

I plan to reach out to my school for tutoring/a learning consultant. I'm also wondering if anyone has any advice on how to effectively study with little time. I usually do a lot of questions and use Anki to make cards out of explanations, but obviously I'm doing something wrong.

Appreciate any insight.

Have you tried www.medschooltutors.com? They're the only people I know who tutor students for shelf exams and they can do it thru Skype. I honestly don't know why you'd do it at this point really. You only have 2 shelves left, you're going for Psychiatry, and you're at a top 20 school. Why are you reading a textbook for the OB-Gyn shelf?

 

[2015Step1PhantomWorrier]

Have you tried www.medschooltutors.com? They're the only people I know who tutor students for shelf exams and they can do it thru Skype. I honestly don't know why you'd do it at this point really. You only have 2 shelves left, you're going for Psychiatry, and you're at a top 20 school. Why are you reading a textbook for the OB-Gyn shelf?

I just tried it once.

Mainly, my worry is failing. As the clerkships have gotten more demanding time-wise, my shelf scores have gone down. I've heard the surgery shelf is difficult, especially if you haven't had medicine yet (which I haven't). Also, with the family at home, I just feel like I'm metaphorically killing myself studying for these things with pretty piss-poor results.

 

[charmiedermie]

I just tried it once.

Mainly, my worry is failing. As the clerkships have gotten more demanding time-wise, my shelf scores have gone down. I've heard the surgery shelf is difficult, especially if you haven't had medicine yet (which I haven't). Also, with the family at home, I just feel like I'm metaphorically killing myself studying for these things with pretty piss-poor results.

Well you probably have to do it more than once. And if you're studying out of textbooks, you're way off. Please don't do this for Surgery or Medicine. I think you're not finishing the resources you do have, so you don't end up doing as well. Oh, and there weren't really any buzzwords that I can remember, and neither did Step 1 either. Did you do the uWISE questions for OB-Gyn?

 

[2015Step1PhantomWorrier]

Well you probably have to do it more than once. And if you're studying out of textbooks, you're way off. Please don't do this for Surgery or Medicine. I think you're not finishing the resources you do have, so you don't end up doing as well. Oh, and there weren't really any buzzwords that I can remember, and neither did Step 1 either. Did you do the uWISE questions for OB-Gyn?

I meant I tried the textbook once. It was loaned to us and I just couldn't get much out of it.

I did use UWise. I did them all except the practice tests. Did those first, then UWorld and Case Files the last two weeks (5 week clerkship)

 

[charmiedermie]

I meant I tried the textbook once. It was loaned to us and I just couldn't get much out of it.

I did use UWise. I did them all except the practice tests. Did those first, then UWorld and Case Files the last two weeks (5 week clerkship)

I mean don't read a textbook ever for any of the shelves, it takes way too much time, and you won't finish it in a reasonable time, and you won't finish going thru all the questions. You even said you flagged questions and never got to go back to read the explanations.

 

[operaman]

Sounds like terminology is a huge issue for you. The surgery shelf will have a lot of very similar appearing terms so make sure you get comfortable with the distinctions (i.e. Cholelithiasis vs cholecysitis vs choledocholithiasis vs biliary colic). Also know the mechanisms for each so they can't name it that way and trip you up.

 

[mvenus929]

How did you study for the MCAT? Were you more of a textbook studier, or a question person? Maybe you need more of a textbook foundation before you start testing your knowledge on questions.

Well you probably have to do it more than once. And if you're studying out of textbooks, you're way off. Please don't do this for Surgery or Medicine. I think you're not finishing the resources you do have, so you don't end up doing as well. Oh, and there weren't really any buzzwords that I can remember, and neither did Step 1 either. Did you do the uWISE questions for OB-Gyn?

Just to clarify in case someone gets confused over these seemingly dissonant pieces of advice... I do not recommend actually reading a textbook. However, some people do better reading through a review book made like a textbook (BRS, First Aid, etc), compared to case files or pretest. It's a matter of finding a study method that works well enough for you that you can remember the information.

 

[Gambler 101]

Based on your step 1 score, you may not have enough of a foundation to use questions alone during third year. Try adding something like blueprints on top of the questions. When you're doing questions, take notes on the answer choices.

 

[PL198]

compare your step 1 score percentile to your shelf performance. doesn't seem too off to me. the same people you were competing with on step 1 are the same ones taking the shelves.