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Rebounding From a Low Shelf Exam Score

It happens all the time. You did really well during your first two years (or year and a half) of medical school and practically dominated Step 1. But now, you’re having trouble with your first few clinical rotations, and in particular, your first few NBME shelf exams.

“What do you mean, ‘What is the best next step in management?’ They all look like something I would do in real life!” 

Sound familiar?

You find yourself going from being tested on random factoids related to the basic sciences to answering more real life (albeit somewhat ideal) clinical scenarios. And then you get your first or even second score on your Shelf exam and it was not as good as you had hoped. But what about Step 2 CK? If you did this poorly, barely scraping by with a pass, you are bound to bomb Step 2 CK on your big test day… right??!?

This could not be further from the truth.

First of all, the first few rotations of anyone’s third year of medical school are a shock to the system.

You’re going from the books to the wards, and while you had up to 8 hours a day to study before, you now have to settle for an hour or two, but you are so SO tired after a long day of rounds or retracting in the OR.

It’s really tough to study for these Shelf exams when you’re unlikely to encounter all of the material you’re expected to know for your medical exams during your clinical rotations.

Plus, even when you’re fully caffeinated on your fifth latte of the day, you can barely find the energy to go through a single UWorld question. Still sounding familiar? Here’s the good news:

The Shelf Exam and how you do on it can point you in the direction of success in your medical education and career. 

How? If you did well, you know what you need to keep doing. If you did poorly, it’s time to troubleshoot and start some real learning. Each rotation has its own core curriculum and it’s up to you to figure out how to master its content within the timeframe of your rotation while trying to learn how to work clinically. Just like studying for Step 1, 2 CK or 3, a strategic schedule and plan is the way to go.

So you messed up on your first Shelf Exam. Hey, it happens to all of us (and sometimes more than once).

Let’s troubleshoot for the next rotation and Shelf. What did you do right? Wrong? UWorld as usual is still your friend here because within each clinical rotation you will find a rich list of questions that will prepare you well for the subsequent Shelf. Also, getting started early will get you in gear for Step 2 CK at the end of the year.

In addition to UWorld there are some other great resources that medical students have used to excel on Shelf Exams:

  1. MKSAP for Students – MKSAP for Students is a great resource for the dreaded Internal Medicine Shelf: It offers challenging clinical vignettes with great primary resources to supplement your reading. A benefit to this resource is that you can reset the question bank as many times as you want, and it comes in an app form as well so you can do questions anywhere anytime. 
  2. Step Up to Medicine – When it comes to choosing an actual book for Medicine you can’t go wrong with Step Up to Medicine. It serves as a great guide for what you should be studying both for your Shelf and for CK.
  3. The Case Files – The Case Files series of review books is a great way to ensure that you are maximizing on your reading time; pretty much every rotation has its own version. Since medicine already has you busy enough with UWorld, MKSAP and Step Up to Medicine, try saving Case Files for the rest of your rotations: Surgery, OBGYN, Psych, Family Medicine, and ER.

What about Pediatrics?

BRS (Board Review Series) is a great book for Peds. It reviews the content in bullet form but also adds another high yield source of over 400 board-style questions to your arsenal. 

How about flashcards?

Well, they work just like they do for Step 1. In fact, you can use those you toiled so hard to make each day while you were studying for Step 1; only now, just add the clinical correlation you need to hammer down as a third year med student. The great thing about this is you can save these flashcards for Step 2 CK and also Step 3 as that test is now forcing us all to recall more and more of basic science. 

On to scheduling: 

Plan Ahead For Your Shelf Exam Studying.

Make sure you have at least some dedicated study time each day in addition to your clinical work. These rotations go by fast and you want to make sure you cover everything you need to do well. 

Take all the questions you need to cover for a rotation and divide them by the total number of days you are going to do questions, ensuring you will take days off (and you need to!), but allowing some flexibility. For example, do some more when you have a day or on a weekend; do less right after a long school day.

The toughest rotation to do this with is Medicine since there are so many UWorld questions. For UWorld in Medicine, doing the questions by system allows you to manage them more easily and allows for tons of pattern recognition which will serve you well on Shelf day.

When it comes to reading, take your book of choice and divide the reading into small chunks per day ensuring you cover the book leaving you about a week pre-Shelf to just review. 

The content you need to master when studying for a Shelf is abundant, but it is not infinite.

UWorld and these other mentioned resources help you narrow down the NEED to know stuff. Do the questions, pace yourself with a solid study schedule of just a few questions a day and really internalize those concepts. Leave yourself about a week prior to your Shelf exam to review your notes and material, so have your questions done by then. 

Ultimately, you are practicing for the big day to come when you finally register for Step 2 CK. So consider each Shelf an opportunity to practice for the big day. Don’t be discouraged by a bad day—it happens to the best of us, and it’s part of learning. It’s how you respond to the new challenge that will get you to where you need to be. So pace yourself and good luck. 


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