How can you prepare for the Internal Medicine Shelf Exam?
Although Step 1 and Step 2 CK tend to occupy the bulk of most medical students’ attention, there are also Shelf Exams to study for. These are given at the end of each rotation, and they often play a significant role in determining your grade for the clerkship.
The Shelf Exam can have a significant impact on your clerkship grade. If you know how to prepare for the exam, then you could improve not only your grade on this rotation, but also your performance on Step 2 CK. In fact, internal medicine is the most heavily emphasized specialty on Step 2 CK; given how important that exam is to your residency application, it makes sense to invest a significant amount of time in preparing for the Medicine Shelf.
At the same time, internal medicine is known for being a busy rotation, and you’ll be busy on the wards and in the clinic. How can you create the right study schedule, and stick to it even when you’re tired? What resources should you use, and what topics should you focus on?
What are the best resources to prepare for the Internal Medicine Shelf Exam?
Although the Medicine clerkship is generally the longest one (12 weeks at most med schools), the Medicine Shelf Exam is actually no longer than any of the other Shelf Exams – it’s 110 questions in 2 hours and 45 minutes. However, because of the breadth of information that this exam can cover, it’s often considered one of the more difficult Shelf Exams.
If you’re wondering what to focus on as you study for the Medicine Shelf Exam, the NBME content outlines can be helpful. This exam focuses most heavily on conditions of the cardiovascular and respiratory systems, with GI and renal coming next. Diagnosis is the most tested skill; decision trees can be useful (for example, the ones you’ll find in the OnlineMedEd notes).
The sheer number of possible resources out there for studying can easily be overwhelming. Having helped many students prepare for this exam and for Step 2, we’ve narrowed it down to the ones that are most helpful. Here are the resources that we’d recommend you focus on to prepare for your Internal Medicine Shelf Exam.
Remember that the Shelf Exams are essentially versions of the USMLE (actually, the questions on the Shelf Exams are “shelved,” or retired, questions from past USMLE exams), and so studying Step 2 CK questions is an excellent way to prepare. UWorld is hands down the go-to resource for preparing for the USMLE or your Shelf Exams. You can filter the questions to get just the relevant ones. The “Medicine” category is by far the largest one, with over 1100 questions, so you’ll need to be diligent to get through them all; fortunately, this is generally the longest rotation, which gives you enough time to do it. Ideally, aim to get through all of the medicine questions twice during your rotation.
We recommend using UWorld and other Qbanks as learning tool, rather than a diagnostic one. This means that you shouldn’t worry about your percentage of correct answers. Rather, focus on learning as much as you can from each question and its associated explanation, whether you got the answer right or wrong.
This is a very useful resource with multiple parts. It has a Qbank of USMLE-style questions, which can be filtered to just those for a particular clerkship (much like UWorld). The questions in AMBOSS have a tendency to be a little more detailed than in UWorld, which is why we recommend starting with UWorld first. Do your first pass through UWorld, then move on to AMBOSS. A week or two before your exam, go back to UWorld for your second pass through.
Besides the Qbank, AMBOSS can also be useful on the wards and in the clinic. It has a series of articles on a variety of clinical problems, which are evidence-based and updated regularly. You can use these to help you learn the most from each patient that you see, and also to help you impress your residents and attendings (which will help you to get a better clerkship grade).
This series of videos covers high-yield topics. They’re useful for review or for getting a high-level overview, and for tying various topics together. OME videos can be an excellent study resource; we often recommend starting with these in the first few weeks of your clerkship, then filling in with more detailed resources once your foundation is solid.
When you’re feeling tired or stressed after long hours on the wards, watching videos may feel easier than reading or doing questions. (Just make sure that you stay focused and don’t fall asleep!) Some students choose to watch the OME videos on the morning of their exam or the night before, targeting topics that they know they’re somewhat weaker in. There are also notes available for each video, which can serve as a very high-yield review before the exam. One of the most useful features of the notes is the decision trees; these help you to decide what to do next with a patient, given their clinical situation. They will serve you very well on the Internal Medicine Shelf Exam.
Step Up To Medicine
To supplement the Qbanks, a textbook is useful. For medicine, Step Up is a great one. Keep in mind that this book is very dense with information. If you’re cramming in the last few days before the exam, don’t even bother with Step Up – it will only make you feel stressed. However, if you start early and stay diligent about spending time with it daily, so that you get through the whole book before your exam, Step Up can be a great resource. (Step Up to Medicine is also very helpful for the Surgery Shelf Exam, so it’s definitely worth having around.)
How can you set up a study schedule for the Internal Medicine Shelf Exam?
Third year is incredibly busy, and the medicine rotation tends to be one of the busier ones. You’ll likely have relatively frequent call for much of the rotation, and you’ll be spending long hours on the wards. When you get home, you’ll be tired and you won’t necessarily be too interested in studying. The key to making sure that studying actually happens is to schedule it in advance.
Our advice is to set a daily goal for studying (for example, a number of questions in UWorld, or a number of pages in Step Up), and do your best to meet the goal. Be flexible; if you find yourself really busy on the wards one day, it’s okay not to get to all of your studying that day. Just make it up as soon as you get a chance. By having a daily goal, you know what it will take to be on track, and you can deal with the disruptions to your schedule that will inevitably arise.
We’d recommend beginning with UWorld and the OnlineMedEd videos. Once you get through these resources, then you can go to more detailed ones, like AMBOSS and Step Up. In the last week to two weeks of your rotation, go through the UWorld questions again and go through OnlineMedEd (either the notes or the videos) for the topics you’re weaker in.
The wards and the clinic can be unpredictable. Although you’ll be spending many long hours in these places, you never really know when you’re going to end up with some extra free time. Take advantage of it when it comes. You may want to consider having Step Up in your bag, so that if you have a bit of unexpected downtime during the day, you can get some studying done.
Seek help from others for your Internal Medicine Shelf Exam
Your colleagues who have taken the Medicine Shelf before you can be a great resource. The residents you interact with on your clerkship can also be of great help.
You may want to consider asking them for advice, and you could even trade books with a friend when you both move on to a new clerkship. (We do recommend using Step Up to Medicine for your Surgery Shelf Exam as well, so keep that in mind before you give it away!)
Professional tutoring can also benefit students who would like some extra help preparing, perhaps because they have failed or come close to failing past exams. I
t’s also great for those who are considering applying to a highly competitive residency program and would like to enhance their chances of getting in by honoring as many clerkships as possible and achieving a high Step 2 CK score.
Our online Internal Medicine Shelf Exam tutors have all scored 250+ on their USMLE exams, and have experience in helping med students to prepare for their NBME exams. If you’re thinking about choosing this option, you can try out a free Shelf Exam tutoring session to see whether it feels like the right fit for you.