Entering third year, I was unsure of how to effectively study for the notorious shelf exams. Coming off my first two years of medical school, I did not establish efficient study habits during the didactic portion of the medical school curriculum. I would often spend hours aimlessly looking over PowerPoints with diminishing returns on my investment of time and effort. Furthermore, I struggled with time management. I knew that establishing structured, effective, and efficient methods of studying would be imperative for success moving forward in third year. In this article, I hope to detail how I altered my approach in studying to culminate in shelf exams scores that are dramatically better in comparison to my former years of medical school.

Shelf exams are multiple choice assessments that are taken at the conclusion of a clinical rotation. These are comprehensive exams in a particular discipline, with exams ranging from 100-110 over the course of approximately three hours. These tests are known for being particularly difficult due to the breadth and depth tested. This, along with the demands of a hectic clinical schedule and a variety of options for studying, make for a challenge. At the University of Kentucky College of Medicine, shelf exams are administered in the following disciplines: psychiatry, family medicine, obstetrics & gynecology, neurology, internal medicine, pediatrics, and surgery. Additionally, at UKCOM, there is an examination following completion of the emergency medicine clerkship; however, this is an exam that is not administered by the NBME and will not be further discussed in this article.

Questions, questions, and more questions! During the didactic portion of the curriculum, I was completely oblivious to the use of question banks as a means of studying. Once I began studying for USMLE Step 1, I picked up UWorld, and I had a reasonable amount of success with the resource for board studying. It struck me that this would be an effective means of studying moving forward. Thankfully, UKCOM bought a one year subscription for my class to use throughout our clerkships. I took full advantage of this generous gift and used it as a primary study resource. Question banks are an effective means of studying due to the use of active recall, which is similar to other study methods such as Anki (discussed elsewhere [e.g. 5.0.1] in this manual). Usage of UWorld was supplemented by one text per clinical rotation. Textbooks were consulted after looking at the performance tab of the question bank and identifying areas of weakness, which resulted in further reading to fill in remaining knowledge gaps. These books were not read in their entirety but rather served as a supplement to UWorld. Textbooks utilized are listed below with the corresponding rotation. • Psychiatry: First Aid for the Psychiatry Clerkship, Sixth Edition • Family Medicine: Case Files Family Medicine, Fourth Edition • Obstetrics & Gynecology: Blueprints Obstetrics & Gynecology, Seventh Edition • Neurology: Case Files Neurology, Third Edition • Internal Medicine: Harrison’s Principles of Internal Medicine, 20th Edition • Pediatrics: BRS Pediatrics, Second Edition • Surgery: Surgery, A Case Based Clinical Review, Second Edition

I found that answering approximately 40 questions per day to be manageable, with the goal to complete the question bank well before the end of the clerkship to allow for a week of review prior to the exam. Completing two 20 question blocks appeared to prevent the onset of fatigue while maximizing retention of material. Most question banks, including UWorld, offer extensive and often comprehensive explanations to both right and wrong answer choices. Reading the explanations for each answer choice, whether answered correctly or not, was integral to my approach to using a question bank as my primary study resource. I found that studying this way was comprehensive and covered all the common pathologies in addition to some of the more esoteric ones that have a propensity to be tested on shelf exams.

The final resource used for clinical rotations was NBME practice exams. These are 50 question exams available for purchase from the NBME website. I made a point to do ALL of the exams for each shelf exam and approached them with the same strategy as UWorld. I would take an exam on each Saturday of the rotation, beginning with the first week to establish a baseline score. I found this to be extremely useful as the shelf exams closely mirrored the content and structure of the available practice exams.