I'm done with my internal medicine rotation!
At the end of every rotation, we take an exam from The National Board of Medical Examaminers (NBME) that we refer to as shelf exams. The internal medicine shelf is supposed to be one of the hardest, along with peds and surgery. And so, last Friday afternoon I took my first and possibly hardest shelf exam as a cumulative event of my medicine rotation.
It was 100 questions in 2.5 hours. Almost every question involves a clinical scenario, most with a lengthy paragraph or 2 and some lab values. Some questions revolve around asking what the diagnosis is, but many of them move beyond that and ask more difficult things like what is the next step in clinical management. The questions are long and hard, and there's a lot of them. I studied hard for it, and I'm glad I did.
Before I discuss how I studied, I do feel the need to explain why this test is important. At Baylor, the medicine shelf counts for 30% of your medicine grade. That might not sound like a lot, but it's enough that it can easily make the difference between a pass, high pass, or honors. Coming from a school that was pass/fail in the preclinical time, the grades on clinics are extra important. And since internal medicine is often viewed as the foundation for most fields of medicine, your grade in internal medicine is one of the most important grades on rotations. And so even though I've taken around 40 tests over the past 1.5 years, none of them mattered in comparison to this test. As long as I passed them, my transcript was none the wiser. The medicine shelf has a much more direct effect on my transcript, and has a much higher chance of affecting how competitive I will be for residency then all the previous tests I have ever taken. In sum, it's an important test that's worth studying for.
To prepare for this test, I spent the evenings of my first 6 weeks of medicine reading a 500 page book called Step Up to Medicine. It's a very solid book that overviews the background, diagnosis, and management of almost everything internal medicine docs have to deal with. It can be a bit hard to plow through, but it did actually help me with patients. Perhaps more importantly, I think it helped me do better on questions. When I started doing UWorld Qbank practice questions (which I'll discuss below), I often remembered the things that I read in Step Up To Medicine. Otherwise, I probably would have been lost. Furthermore, I reread about 250 pages of it right before the shelf, and it was an excellent refresher. I don't think there's a better way to concisely refresh your knowledge comprehensively on everything you need to know in internal medicine.
Upfront disclaimer -- I will get a few pennies if you buy the book through the above link.
One of the most widely acclaimed resources for studying for the medicine is
UWorld's Step 2 CK Qbank. Step 2 CK (Clinical knowledge) is like a combination of the medicine, pediatrics, OBGYN, surgery, and psychiatry shelf. Not all residency programs require it when you apply, but some do and it's starting to become more and more important of a board exam. The UWorld Qbank has about 2100 questions, and about 1250 of them are internal medicine questions. It's pretty pricey, but I went ahead and bought a year subscription for $400. I'll also use it for peds, psych, surgery, and OBGYN so I guess it's not a total rip off. But it was still too much money.
Some of the best features are that it has a mobile app that works well on tablets, and it also keeps track of the questions you miss. You can also flag any question you want for later review. I missed over 500 questions.... and I flagged about 200 questions that I got right but still didn't feel confident on. So, I did all 1250 medicine questions plus redid the 500 I missed plus redid the 200 I flagged. That's almost 2000 questions in the span of about 6 weeks!
It was a ton of work, but I think it helped. Lots of questions on the shelf were easy because they were similar to ones in UWorld. Of course, lots of them were hard and I probably still missed them. Nonetheless, doing practice questions and applying the things I learned in clinic and by reading Step Up To Medicine seemed like it worked well. I don't have my grade yet... so I don't know for sure. But hopefully I did well enough.
If I had to do it over again, however, I might go with the MKSAP book. It's a book of questions similar to what you find in UWorld Qbank, except there's only 450 of them. However, I think they are a little bit more broad and offer a wider review. I've heard of people just using MKSAP and doing very well. It seems like it doesn't matter what resource you use, just as long as you do lots of practice questions. I bet they are all probably pretty good. UWorld is just what has been touted the most by students at my school, and when you're at a school full of overachieving students that all test very well, sometimes it's easiest and safest to go with the flow.
Again, though, the MKSAP book is way cheaper, so in hind site I kind of wished I went with that. If I was a true overachiever I would have done both UWorld and MKSAP.... Sigh.
Upfront disclaimer -- I will get a few pennies if you buy the book through the above link.
I'll probably update this post with my score when it comes back.... hopefully it's not too embarrassing.
I am a medical student at BCM and all thoughts are my own. I am not a doctor at the time of writing this. I respect patient privacy and comply with HIPPA. Please read the disclaimer.
