As you progress through medical school and the structure of your educational curriculum evolves, how you learn will also change. The most dramatic transition happens when you start your clinical rotations. In the process, you move from classroom-based or online learning with content developed by your medical school (e.g., lectures, online modules, and labs) to more experiential learning immersed in patient care. This entails a year-long series of blocks, each comprehensively covering specific areas of healthcare to teach you how providers in these fields practice. Notably, exams remain built into the curriculum, but in contrast to preclinical tests developed by your school, these are often standardized “shelf exams” in most cases produced by the National Board of Medical Examiners (NBME). To make sure you’re as prepared as possible for your clerkships, read on to learn more about what shelf exams are and, even more importantly, how to study for and shine on these tests.

What are shelf exams and what is tested on shelf exams?

Most of your rotations for clerkship year will culminate in a shelf exam. As explained, most of these shelf exams are produced by the NBME and composed of 110 multiple choice questions which each have a single best answer and for which you have 165 minutes to answer. In contrast to the questions on the United States Medical Licensing Exam (USMLE) Step 1, these questions center much more so on the care of patients including how to diagnose and treat diseases. You should expect to be tested on the identification of the next steps in management, utilization of appropriate and cost-effective diagnostic tests, and selection of correct pharmacotherapy. In general, the questions are very reflective of the USMLE Step 2 CK. Many have likened Step 2 CK to a sampling of questions from all the shelf exams consolidated into one test.

Intuitively, the content of the exam will relate to the field of medicine or surgery through which you just rotated. For more specific details, the NBME publishes a content outline online that provides a breakdown of the different items tested on each exam. As an example, the outline for the internal medicine shelf exam can be found here. Notably, sometimes the material can overlap across multiple exams. An important example is the surgical shelf exam which tends to focus less on procedures or techniques and more on the medical management of surgical patients (e.g., diagnosing postoperative fever or recognizing peritonitis). Other examples include concepts at the intersection of neurology and psychiatry or internal medicine and pediatrics. This means that, while earlier shelf exams throughout the year may be inherently more challenging, they become easier as you see recurring concepts across specialties.

Which resources should I use to study for shelf exams?

The experiential learning you gain from the rotation itself will go far in your exam preparation. However, these exams are wide-ranging enough that you won’t be exposed to everything that might be tested, so you should supplement your “on-the-job” education with independent study. At the core of your approach to every shelf exam should be a good question bank like Rosh Review or UWorld. These banks are tailored to the NBME content outline and emphasize the high-yield content most likely to appear on the exam in a multiple-choice format that makes the learning active and effective. In particular, Rosh Review Shelf Qbanks stand out by how they categorize questions by shelf exam, so you can tailor the questions you do to the rotation you are on.

Put your knowledge to the test with this FREE shelf exam practice quiz of the most commonly missed shelf questions from the Rosh Review Shelf Exam Qbanks (one for each specialty)! Each question includes a detailed explanation and visuals to help you retain anything you may have missed. How many questions can you get?

Beyond questions, how you study will depend on the rotation, as different resources are effective for different shelf exams. Some of our best recommendations are summarized below.

1. – Internal Medicine: Step Up to Medicine, OnlineMedEd
2. – Surgery: Dr. Pestana’s Surgery Notes, Surgical Recall
3. – Pediatrics: Blueprints Pediatrics, Case Files Pediatrics
4. – Family Medicine: Case Files Family Medicine
5. – Obstetrics and Gynecology: Blueprints Obstetrics and Gynecology, APGO uWISE Program
6. – Psychiatry: First Aid for the Psychiatry Clerkship, Case Files Psychiatry
7. – Neurology: Blueprints Neurology

Remember: shelf exams are still standardized exams, so good test-taking skills will maximize your performance. You should use techniques such as reviewing the question before reading the vignette and using the process of elimination. As you study, you will pick up quick high-yield clinical pearls like avoiding a computed tomography scan for a hemodynamically unstable patient that will allow you to work through patient management questions quickly. Again, practice makes perfect, so make sure you’re building plenty of practice questions into your study plan.

How do I make a study schedule for shelf exams?

Another aspect of your clerkship year that is different from your preclinical experience is that you will have significantly less time for studying after a long workday in the hospital. To that end, you want to maximize efficiency in how you construct your study schedule. As with every plan, you should determine upfront how much you want to get done by exam day. First, consider which materials you will use; you can consult the list above for a starting point. You then simply divide how much time it will take to work through those resources by the number of days before the test to get a sense of what you need to finish daily.

Importantly, you must build in plenty of flexibility for catch-up days, practice exams, and days off. First off, you may spend longer in the hospital some days than you expected, and consequently not have much time to study once you get home. Furthermore, you should consider spending a day doing a practice NBME shelf exam or two; these provide an idea of what the exam format and questions will entail and can be purchased here for a small fee. Finally, it is most important that you schedule days off whenever possible to return to work in the clinic or hospital or to your studying feeling refreshed and recharged. A great resource that can help you keep track of everything is Blueprint’s Med School Study Planner. It takes all the guesswork out of how much time resources require and constructs a reasonable study plan leading up to your exam day in a user-friendly interface. And it’s free!

This recipe for success on shelf exams will pay off again when it’s time to study for and take Step 2 CK, an exam that borrows questions and concepts from each of the shelf exams and incorporates them into one test. Recall that Step 2 CK will still assign a three-digit score to your performance and know that score has been increasingly important in the residency application process now that Step 1 is a pass/fail exam. Your study plan for Step 2 CK will center again on a quality question bank in conjunction with the same ancillary resources listed above for each of the shelf exams. Therefore, heading into your clerkship year with a good plan of how you will prepare for shelf exams will pave the way for you to do well on almost all the standardized tests you will have in medical school thereafter including Step 2 CK.

Further Reading

• How to Honor Your Clerkships
• How to Introduce Yourself to Patients During Rotations
• Day in the Life of a Medical Student: Clinicals
• Don’t Fall off the Shelf: Balancing Shelf Exam Study with Third Year Rotations
• 4 Reasons Shelf Exams Matter