How to Study for Shelf Exams | BeMo®

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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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.

01
START STUDYING DAY 1

It’s important to start studying for your shelf exam as soon as you start medical school or your clinical rotations.
If you can, devote a little time to study every single day, such as reviewing your notes after each workday or summarizing the key aspects of cases you saw. Draw up an outline of all the patients you saw on your first day and the important information of their cases. Be sure to take thorough notes as you go through your first day.
Shelf exams cover a large amount of material in a variety of medicinal specialties, and cramming for these exams is not feasible. You’ll need to give yourself as much time as possible to learn, absorb and retain the knowledge you’ll be expected to know. Studying for your shelf exams should be a cumulative process. From your first day of medical school, you’ll begin studying for these exams. As you progress and begin preparing for your clinical rotations, you’ll only add to the study workload. Shelf exams will comprise all the knowledge you’ve learned so far in the first two years of medical school and the practical application of your clinical rotations.
02
TAKE GOOD NOTES

One of the keys to better studying is making sure you have superb study materials. Students can fall prey to passive note-taking and end up passively reviewing the subject material. Passive studying doesn’t cement the knowledge in our brains, however. Studying for the shelf exams require the same techniques as studying in medical school: actively learning the material and taking useful notes that help you learn, retain, memorize, and apply knowledge.
One of the best note-taking systems is the Cornell note-taking method, which requires students to divide their notebooks into three columns. On the right-hand side, students write key information and concepts, complete with diagrams, abbreviations, and short-hand form to help speed up the note-taking process. On the left-hand side, students write down “cues” or questions about the material they’re learning. At the bottom of the page, students summarize their learning.
03
USE STUDY GUIDES AND RESOURCES

When studying for the shelf exam, students can find several online study guides that focus specifically on this exam. You are not the first med student to feel anxious preparing for the shelf exam! There are many others who came before you, and many of them utilized online study guides.
04
TEST YOURSELF

There are plenty of resources online to help students to study in med school, including question banks, practice tests, and flashcards. It’s important to test yourself regularly on the material you’re learning to see how well you remember it. Review your notes, put them aside, and then test your recall of the information you’ve read using whatever system you prefer. Practice tests and quizzes might even give you a grade so you can gauge how well you’re answering the questions that might appear on the test.
Cover as many practice questions on as many different subjects as you can, since the material covered in the exam is so broad. Don’t focus just on neurology and psychiatry, even if that’s what you’re most interested in. Don’t just study the interesting cases or rare illnesses, but be sure to refresh your knowledge of the “mundane” medicine, too.
05
BREAK CONCEPTS DOWN

When confronted with so much information, it’s important to divide and conquer. Break your concepts down by subject, and then discipline. Separate your notes on internal medicine into cardiovascular, digestive, and respiratory. Categorizing and organizing your notes will reduce the chaos of memorization in your brain, and help you to better recall the information if it’s been ordered into neat mental boxes.
It’s also key to know which subjects to study and what will be on your exam. On your internal medicine shelf exam, more than half the questions are likely to cover cardiovascular, respiratory, digestive, and endocrine systems, so study these more heavily.
06
TIE YOUR EXPERIENCES IN

Your experiences during your clinical rotations will be essential to your success on the shelf exam. Not only will you have to demonstrate what you learned during rotations, you’ll need to prove that you’ve learned practices and behaviors from the clinical setting. Show that you learned how to care for patients and treat them appropriately. If you learned how to prepare for clinical rotations and kept excellent notes on the patients you saw, tie these into the subject material notes you have. If a patient during your psychiatric rotation had particular symptoms of a disorder, clip these notes together with the theoretical notes you have on the disorder.
Study both sets of notes together, creating a connection in your mind between the theory and the practice with the patient. You’ll be better able to remember the information and have a ready example of clinical practice. It will also prove that you know how to apply the knowledge you’re learned to actual cases with real patients, and that you understand the concepts.

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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Conclusion

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.

FAQs

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.

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