Knowing how to study for shelf exams in medical school is a challenge for any student. Shelf exams are notoriously hard, and so being prepared to write them takes some effort. Fortunately, there are techniques and strategies med students can use to increase their chances of success in acing this exam. In this blog, we’ll cover some of the high yield study techniques for medical school and tough tests like the shelf exams, as well as why shelf exams are important, and how study guides can help students to prepare for it.

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Article Contents
6 min read

What exactly are medical school shelf exams? Are shelf exams mandatory? Study tips for your shelf exams Practice your physical exam maneuvers Study guides for shelf exams Conclusion FAQs

What exactly are medical school shelf exams?

The NBME medicine shelf exam, also called your clinical clerkship exams, are typically taken in the third year of medical school in the US. They take place after your clerkships, or clinical rotations, and are used to test a student’s practical application of medical knowledge.

Shelf exams are known for being notoriously difficult and stress-inducing. It’s recommended that students spend more time studying for these exams than others in medical school, because of the large amount of medical information covered in the questions.

Students are asked 110 multiple choice questions about various hypothetical cases, situations, and scenarios, where they must apply their learned knowledge so far and use your critical thinking skills. For example, on the surgical shelf exam, students can expect to be asked about diagnoses and post-op management. The shelf exam on internal medicine will include questions divided up between the different bodily systems and divide questions by patient age as well.

The test is introduced in the same format as the USMLE Step 1, Step 2 CK and Step 3 exams.

Shelf exams are subject-based, standardized exams that evaluate your knowledge and application of that knowledge in the seven core rotations: internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, and neurology. The shelf exams are broken up by the foundational subjects, so students may be tested on only one subject at a time, or two subjects at a time. For example, students might take an exam on internal medicine one week, and then surgery the next, followed by an exam on psychiatry, obstetrics and gynecology.

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Are shelf exams mandatory?

While the shelf exam is not required by all medical school programs, and it’s not a requirement of obtaining a US medical license, shelf exams remain a popular way to test medical students on the knowledge acquired during their clinical rotations. Depending on your medical school program, the results of your shelf exam may or may not determine whether you pass your clinical clerkships.

Shelf exam results are also not a required part of your residency application, and programs you’re applying for will not see your exam results. That being said, your exam results may be considered in grading your overall clinical clerkship results. In the case of failure of a shelf exam, you will be required to retake the exam, and a grade of ‘Conditional Pass’ or ‘Conditional High Pass’ will appear on your transcript. If you do fail one of your shelf exams, it could affect your MSPE at the end of your rotation. The final grade of your clinical clerkship is something residency programs will see and may determine whether you are accepted or not.

So, if your medical school program uses shelf exams, it’s best to get as high a grade on these exams as possible, so your final clinical clerkship grade is as high as possible. If you score well on your shelf exams, it can be a nice complement to your OSCE or NAC OSCE when readying your applications to residencies.

The exam is graded on a national average, curved to a mean of 70 with a standard deviation of 8, so it is not an easy task to ace this exam. However, the tips you learned for how to study in medical school and the knowledge you gained during your clinical rotations will help you tackle it.

Below we’ve outlined a comprehensive guide for how to study for shelf exams and how to prepare for them.

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Study tips for your shelf exams

You’ll likely be studying for your shelf exams alongside partaking in your clinical rotations, so studying for your shelf exams can be a challenge. Fortunately, there are some tips and strategies for how to study for your shelf exams while also keeping up with the rest of your busy schedule as a med student.

Practice your physical exam maneuvers

Although your shelf exam will likely be held online and will not include a physical examination evaluation, practicing your physical exam maneuvers can be helpful to your studies.

If you are in the middle of your clinical rotations, this is a prime time to practice examining patients in a supervised setting. Use the hands-on experience you’ll gain from your rotations and keep detailed notes about the maneuvers you practice. Writing them out will help you understand each step of the process and why it’s important. Connect each of these physical exam maneuvers to the concepts you’re studying.

As you’re taking the shelf exam, you’ll be able to approach each question as a real diagnostic situation. Take a practice test and pretend you are in the scenario you’re presented with. Which maneuvers are required? What information or concepts are guiding your process? How are you using these physical exam maneuvers to inform your diagnostic decisions?

Some of these maneuvers may be specific to a medical discipline, or it may be a “core” physical maneuver you’ll practice with every patient. Either way, it’s a good idea to connect the physical practice of patient treatment to the concepts you’re learning, forging yet another connection between the two in your mind. It’s proven that some students learn best through kinesthetic learning, and this can be used as a study method when preparing for your shelf exams.

Practicing your maneuvers can be as beneficial as a mental exercise as it can be when you’re actually learning through clinical rotations. Before your shelf exam, take a practice test and try working through different problems or scenarios in the questions as if you were treating a real patient. Or, get together with your study group and practice your maneuvers on each other to memorize the steps required and get feedback on your technique.

Study guides for shelf exams

A variety of online study guides exist for helping med students with their shelf exams. Some of these guides are broken down by subject matter—surgery, pediatrics, neurology etc.—and some are comprehensive. Some services have free resources or trials and others are paid, such as AMBOSS or UWorld. There are also many recommendations for textbooks to read, such as…

Students can also seek help from professional study services which help students create a study guide and strategize answer strategies for questions and subject matter that will be on the exam. 

Some of the most highly recommended online guides include resources like UWorld and OnlineMedEd, which provide in-depth help on studying and mastering the shelf exams in every subject. Study guides like these are broken down so students can prepare for each part of the shelf exam in pieces and includes advice on mastering each section of this comprehensive exam. However, using a study guide as the only study resource is not recommended. Taking your own notes and utilizing your own experiences will be more beneficial to your studying practices than reviewing as many study guides as possible, or one comprehensive study guide alone.

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If your medical school program is requiring you to take the shelf exam during your clinical clerkship, don’t be daunted. While it is a challenging exam to ace and requires intense study beforehand, it can be done. Using proven and effective study techniques, practicing maneuvers and making good use of study guides, any med student can walk into their shelf exams with confidence.


1. What are shelf exams?

Shelf exams are usually held in the third year of medical school, during a student’s clinical rotations. They are used to assess a student’s application of learned knowledge during rotations.

2. Are shelf exams important?

Some medical school programs take the scores of a student’s shelf exam into account when grading their clinical rotations. Since this grade may be a factor in acceptance to a residency program, acing the shelf exams is important for a student’s future career in medicine.

3. How difficult are shelf exams?

Shelf exams are largely considered to be very difficult exams, as they cover a broad range of topics in medicine and require memorizing a vast amount of knowledge and being able to apply it to hypothetical scenarios.

4. Are there study guides for shelf exams?

Yes. There is a wide variety of online study guides and professional help available for medical students. Some of the most highly recommended online study guides are UWorld and OnlineMedEd.

5. Do I need to score high on my shelf exam to pass my clinical clerkship?

Some medical school programs use shelf exams to test students on the knowledge gained during clinical rotations and may use the exam scores as a determinant in whether you pass or not. However, not all medical school programs use shelf exams.

6. When do I take shelf exams?

Shelf exams are usually taken during the third year of medical school during your clinical rotations.

7. What material can I expect will be covered in shelf exams?

Shelf exams have broad material coverage. You can expect the exam to include questions on internal medicine, family medicine, surgery, pediatrics, obstetrics, psychiatry, gynecology and neurology.

8. How many questions are on the shelf exam?

Shelf exams consist of 110 questions, to be answered in the allotted time of 165 minutes. Questions will be multiple choice, covering hypothetical clinical scenarios students must analyze.

To your success,

Your friends at BeMo

BeMo Academic Consulting

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