Know Thy Shelf: Internal Medicine

  • /Reviewed by: Amy Rontal, MD
  • It is the purest and most noble of all shelf exams. (According to the internists, that is.) The Internal Medicine shelf is likely the broadest, most comprehensive NBME shelf exam that you will encounter during your clerkship years.

    How does one begin to study for a test that might ask you the most common organism(s) in a diabetic foot infection, and then follow that up with pulmonary embolism management?

    Look no further, my brethren. In this post, we will tell you how to prepare for the ever-so-daunting Internal Medicine shelf exam.

    We won’t belabor that which we’ve been saying all along: the best “studying” can you do is not from a book or question bank. It is by being engaged in active learning and participation at your institution. But following just one patient, as the clerkship often requires, is not enough to learn what you need. Success comes from paying attention to the workup and management for Ms. Johnson’s hyperparathyroidism, even though she is not your patient and the attending isn’t pimping you on her. It comes from presenting that longer-than-expected UpToDate article on insulin formulations to the rest of your team. It is asking questions about the hyperkalemia review that the attending recommended looking over because Johnny Peakedteewaves missed his last 4 dialysis sessions. And, as important as test scores are, your job is to show up every day to provide patient care, and to learn how to do that in the most compassionate, efficient, and evidence-based way possible. If you focus on that, answers to the test questions will naturally present themselves in your everyday life.

    Ok. You get it. Learn from the patients. But, as you know, 10 weeks of hospital medicine might not afford you the chance to compare MRIs of patients with cerebral toxoplasmosis and B-cell CNS lymphoma. Furthermore, leprosy isn’t endemic to the cush suburbs of New Jersey. You will need outside resources to study. Your differential diagnosis for best IM shelf resources should look like this:

    1. UWorld Step 2 CK Internal Medicine section
    2. UWorld Step 2 CK Internal Medicine section
    3. UWorld Step 2 CK Internal Medicine section

    Just like Step 1 (and your impending Step 2) preparations, UWorld is your friend to cozy up to after dinner every night.

    Sure, s/he’s not cuddly, nor endearing, but s/he is quite frank in pointing out what you know and what you don’t. Just when you thought things were going great, UWorld will deliver you a bright red X, and then shame you by telling you picked the answer that only 3% of the fools out there went for. D’oh!

    In all seriousness, UWorld will cover the wide breadth of information that you must internalize, and will do so in the best possible format: questions. In a perfect (U)world, you should be able to get through all of the internal medicine questions once.

    As far as helpful tomes, StepUp to Medicine can be quite useful if employed correctly. This book is dense and does not cut corners.

    If you plan on using it to study, remember to do so early and often, with a pre-determined plan on how you will get through the book. It is not crammable, and will only make you feel underprepared if you try and jump into it too late.

    For lighter, pocket-sized reading, the old favorite Case Files Internal Medicine is a true ally.

    Many students and residents also appreciate Pocket Medicine. What it lacks in a readable font size, it makes up for with well-researched, dependable information. And speaking of lighter reading…

    Flashcards are one of the best ways to study on the go when you can’t have a book or a computer in front of you.

    Whether you’re creating your own flashcards or using a pre-made deck, flashcards can be one of the most effective ways to drill yourself and test your knowledge and retention for your upcoming exams (be they USMLEs or shelf exams). As such, a team of our expert tutors (who crushed their IM shelf exams) created Memorang’s Internal Medicine flashcards, so we can fully back its usefulness, accuracy and high-yield content.

    Finally, one of the primary goals of your medical education has been to try and get you to think like a doctor.

    More specifically, your job is to gather information, synthesize it into a differential diagnosis of what might be going on, and then figure out how to narrow that down to a working diagnosis (work-up). From there, treatment, management, prognosis, etc. are simple. Anyone, medically trained or not, can learn how to google “antibiotic choice for Legionella pneumonia.” Your true power comes from your ability to formulate an excellent differential, and use further details to narrow it down to a working diagnosis. Believe it or not, you should approach nearly every single question in this manner—form a differential and narrow it down. The rest is simple. (More on this in next post.)

    One final caveat:

    As a slap in the face, instead of getting set free after surviving a 100-question gauntlet, the IM Shelf will get you for 10 more. Don’t forget to answer these last 10 questions on this ONE HUNDRED TEN question test. Thanks a lot NBME…

    So… how are you feeling about the shelf? Ready to attack with confidence?

    Like these USMLE Step 2 CK flashcards? Get access to 8,000 more that cover all of UWorld and are authored by our experts at MST.