MD Struggling with Shelf Exams, Worried About Step 2

[PathNeuroIMorFM]

TL;DR: How to study for shelf and how to retain info through 3rd year for Step 2?

Hey all,

Chugging along through 3rd year. Getting 90th percentile in clinical evals/subjective evals, 15th percentile in shelf scores. This is fine for now because evals make up the majority of my grade and I'm honoring, but I'm worried because I've heard shelf scores correlate with step performance. No point in honoring every rotation if I finish the year with a 220 Step 2 score. This problem is kind of two sided. On one hand, there are questions that I literally could never know after studying every material under the sun (and my peers say the same. There are many ridiculous and strange questions on the exam), on the other hand I'm studying just as hard/harder as others and doing the same methods. I do all the Anking, I listen to Dr. High Yield + Divine, I do all the relevant UWorld, I make cards for my incorrects, I do my incorrects, I do every single one of the practice NBMEs. If I have time (usually not), I try and throw in the Case Files. And somehow it's still not enough compared to the people who literally just do UWorld + 1 or 2 NBMEs.

I'm also worried that I will forget everything relevant from earlier rotations/subjects by the time I get to dedicated. How am I supposed to retain or revisit information from previous rotations when I'm constantly cramming down new info for new rotations? Anki is decent for this, but far from all encompassing.

I'm just tired of being the dumbest guy in the class.

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[Billiam95]

What are your grades like on the CMS forms? Would help differentiate if its a test-day performance issue versus content deficiency. Also, what were your grades like on S1 practice exams?

 

[Lifeblood_20]

Which rotations/shelves have you taken so far? They definitely vary in difficulty depending on the subject matter.

 

[PathNeuroIMorFM]

What are your grades like on the CMS forms? Would help differentiate if its a test-day performance issue versus content deficiency. Also, what were your grades like on S1 practice exams?

Which rotations/shelves have you taken so far? They definitely vary in difficulty depending on the subject matter.

Peds and then OB.

S1 is kind of irrelevant because I took a research year between S1 and clinical years. I think I was around 225 to 235 on those. S1 real deal was pretty easy, imo.

Peds definitely over predicted my score at like 78% to 85% using forms 1-4 and 6-7 (real deal 68%), OB was fairly accurate at about 65% to 75% on all 8 forms (real deal 71%).

I have absolutely no clue where I went wrong on peds. Since it was my first rotation, I over prepared, but a lot of the questions on the real deal were just so out of left field. OB made more sense as it was a difficult concept from start to finish. I just had a lot of problems differentiating things like management for PROM at 32 weeks vs 34 weeks.

 

[mistafab]

Peds and then OB.

S1 is kind of irrelevant because I took a research year between S1 and clinical years. I think I was around 225 to 235 on those. S1 real deal was pretty easy, imo.

Peds definitely over predicted my score at like 78% to 85% using forms 1-4 and 6-7 (real deal 68%), OB was fairly accurate at about 65% to 75% on all 8 forms (real deal 71%).

I have absolutely no clue where I went wrong on peds. Since it was my first rotation, I over prepared, but a lot of the questions on the real deal were just so out of left field. OB made more sense as it was a difficult concept from start to finish. I just had a lot of problems differentiating things like management for PROM at 32 weeks vs 34 weeks.

Good news! You have time to figure this out, you've only done 2 rotations. The fact that you are thinking about this is a good sign.

The questions are sometimes from left field, no question. However, your percentile compared to peers is valuable to know. See if you can cross above 30-40th percentile with some changes in your strategies for this next rotation. Maybe make it a goal to hit the 50th percentile in 2 rotations. See what some people who you think are 'similar' to you but are scoring better in your cohort are doing to achieve that. Emulate what works and abandon what doesn't. It sounds like you are doing a lot of things, which may be the core of the problem. It's better to do one or two things well, than to do 5 things not well.

For example, maybe the practice NBME is worthless and is just stealing your time. Or perhaps listening to something (dr. high yield) is doing nothing for you. Assume nothing (except Uworld) is truly essential.

Best way to retain information is to learn it really, really well the first time around. If you half learn it, you'll never remember it.

 

[PathNeuroIMorFM]

Good news! You have time to figure this out, you've only done 2 rotations. The fact that you are thinking about this is a good sign.

The questions are sometimes from left field, no question. However, your percentile compared to peers is valuable to know. See if you can cross above 30-40th percentile with some changes in your strategies for this next rotation. Maybe make it a goal to hit the 50th percentile in 2 rotations. See what some people who you think are 'similar' to you but are scoring better in your cohort are doing to achieve that. Emulate what works and abandon what doesn't. It sounds like you are doing a lot of things, which may be the core of the problem. It's better to do one or two things well, than to do 5 things not well.

For example, maybe the practice NBME is worthless and is just stealing your time. Or perhaps listening to something (dr. high yield) is doing nothing for you. Assume nothing (except Uworld) is truly essential.

Best way to retain information is to learn it really, really well the first time around. If you half learn it, you'll never remember it.

This is great advice. Thanks

 

[Anakinmemer]

I second the above advice on doing less things more thoroughly. I've found the people who blaze through the most material actually tend to score not great. You have to go slow and memorize EVERYTHING in uworld and it is more than enough. I slacked off clinical year and didn't even do uworld and ended up with low shelves. I took my first step 2 NBME at the start of dedicated and got a 212. I just got a 270 on the most recent NBME I took, and I still have around 1500 uworld questions left that I won't have time to finish. The difference is that I memorized everything for every question, doing only 80 per day max. I read through every answer choice which is very important as it allows you to learn critical features that distinguish diseases that they may not present in their little summary charts. I also read through questions I got right about "easy" diseases because they ALWAYS present new info that may show up, and mastering the core diseases is necessary as these are the ones the NBME presents in the weirdest way.

I also made an encyclopedia of uworld info in anki by legit copy and pasting everything so that I could search back diseases or algorithms to review, because you will forget things.

Your percentiles indicate it is not just left field questions and your knowledge is lacking in core concepts, which I believe can be solved by simply mastering uworld, its that good. The example you mentioned about PROM is a classic algorithm that shows up multiple times. Memorize all the flowcharts.

 

[ChordaEpiphany]

Peds and then OB.

S1 is kind of irrelevant because I took a research year between S1 and clinical years. I think I was around 225 to 235 on those. S1 real deal was pretty easy, imo.

Peds definitely over predicted my score at like 78% to 85% using forms 1-4 and 6-7 (real deal 68%), OB was fairly accurate at about 65% to 75% on all 8 forms (real deal 71%).

I have absolutely no clue where I went wrong on peds. Since it was my first rotation, I over prepared, but a lot of the questions on the real deal were just so out of left field. OB made more sense as it was a difficult concept from start to finish. I just had a lot of problems differentiating things like management for PROM at 32 weeks vs 34 weeks.

I'm also struggling heavily on peds. I'm a good test taker. I took psych first and scored a 94 (99th percentile). I took step 1 about 4 years ago and scored a 258. I'm failing practice exams for peds (just took form 6 and got a 15). I know part of this is that my base of knowledge is poor. However, I truly do not understand where these questions come from, what the test writers are trying to evaluate, or how UWorld/Amboss pull their questions for this shelf given the content of these practice exams. There seems to be little-to-no overlap.

I marked 31/50 questions on form 6, and my threshold for marking was truly having no clue what the diagnosis was. It's just SO VAGUE. The information you get has little rhyme or reason. Tons of details you'd get in any reasonable clinical scenario are left out, so studying sensibly (e.g., knowing that you can always differentiate X from Y with Z clinical presentation) is out the window, because they simply won't give you the Z presentation (even if Z would always be present in real life). There are no pictures, only obscure descriptions of rashes or murmurs with none of the usual vocabulary. Half the exam is just IM in teenagers. The stuff you would know from the usual study materials is described extremely vaguely and often the right answer is based solely on the "most likely" or "most appropriate" aspect of the question.

I just absolutely hate this. UWorld is genetic diseases, TORCH infections, milestones, etc... Clinic/wards is infectious diseases and falls in children aged 0-5 for >80% of all patients. NBME exams are vague nonsense and adult diseases presenting oddly in teenagers and examiners going way out of their way to describe common diseases with esoteric nomenclature.

At a certain point you just throw up your hands. Medical school and medical training are often absurdly stressful for no reason and with no benefit to the trainee. This is a prime example. My shelf is in 1.5 weeks and I have no idea what to do.

While I'm doing well clinically (~4.7/5 average eval), my school does not really allow honors without great shelf scores. They place the honors threshold at ~90%, which includes clinical evals. So your clinical evals must exceed 4.5/5 and your shelf can't bring you down too much. So you basically need to get lucky with evaluators and get no one who gives non-5/5 grades, then you have to survive the shelf.

 

[Augustoweiner]

If it makes anyone feel better, I was scoring 60s CONSISTENTLY on my Peds NBME practice exams and I felt really bad after I took the real thing. Got a 88th percentile on the actual shelf.

 

[operaman]

Been awhile since I was a third year so not sure about all the current resources. I’ll share a concept though that allowed me to honor everything pretty easily:

Try and get through ALL of two question bank resources. I my day that was PreTest and Lange Q&A. Plus I did World. But the other two were shorter questions and easy to bang out during down time. Not sure if they’re at all worthwhile anymore though. I’m sure there are better things.

But the idea is that getting through ALL of two comprehensive question bank sources will likely expose you to most of the possible left field questions. And it will help identify gaps in knowledge you can brush up using other sources. A common problem I see is when students use a lot of sources but never finish any of them. It just assures that you’re leaving large swaths of content unseen.

Not sure how much this applies to OP, but putting it here just in case it helps someone.