Third year rotations present unique challenges. While the first two years of medical school are certainly demanding, they are in some ways a more intensive extension of your undergraduate experience: go to class, take notes, study really hard, take exams, and then put it all together to ace USMLE Step 1.
Third year of medical school, though, brings a whole new dimension to the medical school experience.
Third-year rotations present unique challenges. While the first two years of medical school are certainly demanding, they are in some ways a more intensive extension of your undergraduate experience: go to class, take notes, study hard, take exams and then put it all together to ace United States Medical Licensing Examination (USMLE) Step 1.
Your third year of medical school brings a whole new dimension to the medical school experience.
Your core clerkship rotations demand intensive time commitment — 10- to 12-hour days that require you always to be “on” so you can succeed on the wards by showing attendings and residents your knowledge, preparedness and willingness to learn. By the time you get home, studying for your National Board of Medical Examiners (NBME) shelf exams is the last thing you want to do.
That’s why you need a plan in place to study for your third-year shelf exams. It will be much easier to stick to a schedule and follow a regime if you’ve already set out what you will do for each rotation and its shelf exam ahead of time.
Table of Contents
What Are Shelf Exams?
The NBME Shelf Exams are administered at the end of specific third-year rotations:
- Internal Medicine
- Family Medicine
- Neurology
- OB-GYN
- Pediatrics
- Psychiatry
- Surgery
Where Do Shelf Exam Questions Come From?
The questions on shelf exams consist of retired USMLE questions that have been “shelved,” meaning they are no longer used on USMLE Step 1 and Step 2 Clinical Knowledge (CK) exams. Many questions that you will see on the shelf exams will be VERY similar to what you saw on your Step 1 exam and what you will see on Step 2 CK.
How Are Shelf Exams Administered?
Each shelf exam has 110 multiple-choice questions and is 2 hours and 45 minutes long. Every shelf exam is computer-based and is administered using NBME’s portal. Depending on the shelf exam, you will either take it at your institution or a Prometric center.
Are Shelf Exams Mandatory?
Not all medical school programs require shelf exams, and you do not need them to obtain a United States medical license. Still, many schools use this testing method to evaluate knowledge gained during clinical rotations. In some medical school programs, the results may determine whether you pass or fail your medical clerkship.
Whether you must take shelf exams depends on the medical school program you choose. Different programs may also give more or less weight to your shelf exam scores. Some determine grades almost solely off your test scores, while others might weigh in your clinical performance a bit more.
When Do I Take My Shelf Exams?
Medical students take shelf exams during the third year of medical school during clinical rotations. Shelf exams often occur between USMLE Step 1, which students take after their second year of medical school, and USMLE Step 2, which students take in the fourth year of medical school.
The exams are broken up by foundational subjects, meaning you usually don’t take every exam in a day. Instead, you might take exams as you finish clinical rotations. One week you might take two subject exams, and the following week you might only take one. Usually, you will take shelf exams on the last day of the corresponding rotation.
Given that these tests take place during your rotations, the best way to study for shelf exams is to fit small study sessions into your other medical responsibilities to ensure you’re prepared when test day comes.
How Difficult Are Shelf Exams?
Many consider these exams quite demanding. They cover a broad range of topics across all seven medical school rotations. To pass them, you must memorize many topics you study during your rotations. Then, you must apply this knowledge to hypothetical scenarios. Since the shelf exams use the same questions as USMLE exams, you can assess the difficulty based on your success on USMLE Step 1.
Why Are Shelf Exams Important?
There are two main reasons why your shelf exams are important: (1) clerkship grades and (2) Step 2 CK Preparation.
Your shelf exam score is used to calculate your grade for each clerkship. Depending on how your medical school determines final grades for each clerkship, how well you do on the shelf exam can significantly impact your final grade.
For example, if your medical school does something like 60% clinical performance and 40% shelf exam score, then how well you do on the exam can have a notable impact on your final grade. Moreover, your shelf exam performance is the most objective control you have over your final clerkship grade since there are many subjective variables to how attendings and residents evaluate your clinical performance on each rotation.
Step 2 CK vs. Shelf Exams
The more diligently you study for shelf exams, the better off you’ll be when you sit down to prepare for Step 2 CK. The material covered during clinical rotations and shelf exam prep is the same material you must master for Step 2 CK. The studying you do for your shelf exams will pay off big time when you start to prep for Step 2 CK.
Shelf exam prep and Step 2 CK prep are so interconnected that we recommend you use UWorld’s Step 2 CK question bank throughout your clerkship year to prepare for each shelf exam.
(For tips on how to do well on Step 2 CK, check out our Comprehensive Step 2 CK Study Guide!).
At the end of the third year, reset UWorld’s question bank so you can use it to study for Step 2 CK.
Do I Need to Score High on My Shelf Exam to Pass My Clinical Clerkship?
While your shelf exams are not the only deciding factor in passing clinical clerkships, your third-year clerkship grades will hinge more on your shelf exam than your other clinical evaluations. Some schools don’t use shelf exams, so you won’t need those scores to pass your clerkship.
If your school uses shelf exams, you should aim for a high score, as your score can impact your grade. Your grade influences whether you pass and also shows up on your transcript. Residency programs might see a low clinical clerkship grade and decide not to accept you.
How to Study for Your Third-Year Shelf Exams
The two most important steps you can take to ensure you are studying effectively for your shelf exams are:
(1) create a study schedule and be diligent about studying during each rotation
(2) decide which resources you will use in your NBME shelf exam test preparation.
If you’re wondering how to study for shelf exams, your strategy should be daily reading and practice questions, plus 1-2 NBME practice exams about 1-2 weeks before the exam.
1. Create a Study Schedule
Make a study schedule that will help you stay on track, despite the ups and downs that come with rotations. It is understandable (and expected) that you will be exhausted after spending long hours in the wards. When you finally make it home after a long day, you will be tempted to just change out of your scrubs, eat food and watch Netflix. But you need to avoid falling into this pattern. It will leave you scrambling during the last week of your rotation.
Get a calendar and count up how many days you have until the shelf exam. At the start of each rotation, identify the resources you want to use to study. Then, divide the number of pages to read and the number of questions by the days available for studying. This method gives you a structured schedule and a daily goal. It spaces out the material to cover and the practice questions you must complete and review. When the time comes for you to take your shelf exam at the end of each rotation, you will be fully prepared!
When you sit down to map out your study schedule for each shelf exam, be honest in acknowledging the days you won’t be able to study. If you plan to attend a family get-together or a friend’s birthday celebration, build that into your schedule. Your honesty will help you create a schedule you can actually keep.
Set aside a few days before the shelf exam for dedicated studying. Try to leave the 2-3 days immediately before the shelf exam for dedicated studying. Use this time to review the material and practice questions you’ve covered over the past few weeks.
Take at least one NBME for each rotation. We recommend that you take an NBME practice test 1-2 weeks before you take the shelf exam — this will help to put you in test-taking mode, give you more material to review and identify your topic-area weaknesses.
Make studying a daily habit. Creating a schedule and sticking to a plan will help you avoid last-minute cramming and alleviate unnecessary stress and anxiety. Be diligent — make it a goal to study every day for a set amount of time. Even if you don’t have time to hit your plan on a particular day, you should still sit down to study and chip away at your goal as much as possible. Even one solid hour of studying is better than no studying at all. Cultivate a daily study habit and solidify a routine throughout your clerkship year.
Your consistency will add up in the long run. Not only will you avoid last-minute cramming, but you will achieve deeper content mastery because you are giving your brain the space and time to process information throughout your rotation. Your diligence will pay off big time in your shelf exam performance and Step 2 CK score.
2. Decide Which Resources to Use
We recommend using UWorld and OnlineMedEd as a resource for every rotation. UWorld’s Step 2 CK question bank is the best resource for shelf exam practice questions. Use UWorld for every rotation, and at the end of your third year, reset the question bank and use it for Step 2 CK. Review answer explanations thoroughly — that’s where much of the learning happens!
OnlineMedEd videos do an excellent job of breaking down complex concepts, and you can easily access rotation-specific material by searching the library. Many students find OnlineMedEd videos helpful as a primer before they begin their rotation and as a resource for high-yield review 1-2 weeks before the shelf exam.
AMBOSS is an excellent tool for use on the wards and for studying for shelf exams. It includes a vast database of evidence-based guidelines and a question bank containing thousands of exam-like practice questions. What makes AMBOSS a go-to study resource is that everything is connected across the platform, helping to unify and solidify your knowledge base and prepare you for exams.
Another great resource is the Divine Intervention podcast. This podcast is an ongoing series of reviews on high-yield topics, which can help you on your shelf exams and USMLE Step 1 and Step 2 CK. You can look through 250+ episodes to find the ones relevant to your current clerkship. The podcast format is handy for those extra spaces of time that would otherwise be hard to use for studying, such as your commute or workout time.
For each rotation, you will need a text-based resource as your go-to reference. A text resource can supplement practice questions and help you strengthen any subject area weaknesses.
Resource Recommendations for Each Rotation
Here are the best resources for shelf exams categorized by rotation.
Medicine
Compared to the family medicine shelf, the medicine shelf places more emphasis on understanding the pathophysiology of conditions that affect different organ systems. The Medicine Shelf will require you to establish a diagnosis and recommend appropriate diagnostic or treatment options.
UWorld Medicine is the best resource to study for the Medicine Shelf Exam. Although it will take several weeks to complete, it’s worth it! There are currently over 1400 medicine questions — if you have a typical medicine rotation (8-12 weeks), you should aim to finish all the questions by week 6.
UWorld Medicine is the gold standard resource here — the amount of content it covers and its answer explanations provide a fantastic resource for the Medicine Shelf Exam.
- Step Up to Medicine is the best text-based resource for medicine, in our opinion. It is a comprehensive and excellent resource to supplement your UWorld Medicine practice questions. Some students might find it a little longer than they’d like, but the depth of information it provides is second to none, especially if you consider medicine to be one of your weaker subject areas.
- Case Files Internal Medicine is a great resource, too — it provides 60 clinical cases, each with shelf exam-style questions designed to illustrate fundamental medicine concepts. It’s also much shorter than Step Up to Medicine and focuses more on high-yield material.
- UpToDate is excellent in general and especially for medicine.
- Many students also like to use Pocket Medicine, especially during the wards (when access to electronics is limited).
Family Medicine
It can be a little challenging to know how to use UWorld to prepare for the Family Medicine Shelf Exam since Family Medicine covers a broad scope of material. Regarding content, many things are fair game for the Family Medicine Shelf — questions can range from pregnancy to child developmental milestones and puberty to age-related diseases.
Compared to the Medicine Shelf Exam, the Family Medicine Shelf Exam places more emphasis on a person’s development, from childhood to adulthood to old age.
- Case Files Family Medicine does a great job covering the basics.
- Blueprints FM is also a great study resource. It’s concise and has a well-organized format; it’s best used as a high-level/overview text.
- Step Up to Medicine is an excellent in-depth resource for your Family Medicine Shelf Exam. It’s more commonly used for Step 2 CK prep and focuses on internal medicine, family medicine, neurology, ambulatory medicine and surgery.
As a clerkship scheduling tip, we recommend taking Family Medicine later in the year — especially after medicine. This way, you will have already seen and studied the range that family medicine can test you on, such as pediatrics and OB-GYN.
Neurology
The neurology shelf exam tests your knowledge of diseases of the nervous system. The content covered on the exam is narrow. It often tests topics such as nerve injuries, head trauma, central nervous system infections, neuromuscular disorders and degenerative neurologic disorders.
- Case Files Neurology and PreTest is a popular combination — these resources work well together. Case Files provides its on-brand 60 clinical case scenarios that illustrate essential concepts for the neurology clerkship and shelf exam. Each clinical case includes review questions and an extended discussion. PreTest provides 500 neurology-focused USMLE-style questions and answers, with detailed explanations for right and wrong answers.
- Blueprints Neurology is also a popular resource. It is well-organized and provides a helpful framework for understanding neurology. It’s comprehensive and can be used as a standalone resource. It teaches students through clinical vignettes and by working through a diagnosis. It provides 100 USMLE/shelf exam-style questions with complete answer explanations.
- Moreover, the neurology section of Step Up to Medicine is a great resource to consult, especially if you already purchased it for your medicine or family medicine shelf exam!
OB-GYN
The OB-GYN shelf exam tests you on conditions and diseases that affect the female reproductive system across all ages (from childhood to puberty to old age). Questions will cover content such as pregnancy: prenatal management, physiologic changes of pregnancy and disorders of pregnancy (pre-eclampsia, placenta previa, placental abruption, gestational diabetes); routine health maintenance: annuals, pap smears and breast exams, STIs; and breast, ovarian, vaginal, uterine and cervical conditions.
- Case Files Ob/Gyn is an excellent foundational resource for your rotation. It’s a quick read and covers all the high-yield material. We recommend you read it at the start of your rotation because it’s comprehensive and will set you up for answering pimping questions in the wards and what to expect on the OB-GYN shelf exam.
- Blueprints Ob/Gyn is also a great resource. However, we recommend using it cautiously because it’s rather lengthy and many students have trouble getting through all of it. It’s better to use a shorter resource like Case Files Ob/Gyn and ensure that you get a comprehensive overview of the whole subject area. That being said, Blueprints Ob/Gyn provides an excellent resource for in-depth learning — and if you can get through it with time to spare, you’ll be set for success on your OB-GYN shelf exam.
- UWorld isn’t ideal for practice questions here because it doesn’t provide many OB-GYN questions. PreTest is a great resource for OB-GYN questions — it includes 500 USMLE-style questions and answers with detailed explanations.
- We also recommend using the uWISE (ACOG/APGO) question bank as an additional question-based resource for OB-GYN. Some medical schools pay for their students to have access to this bank, so double-check this with a school administrator.
Pediatrics
The pediatrics shelf exam tests you on infant, child and adolescent development. You should expect to see questions on normal infant/child development, developmental milestones, vaccine schedules, puberty, and diseases and conditions unique to the infant, child and adolescent populations — for example, asthma, meningitis, abnormal puberty congenital infections and heart defects.
- Case Files Pediatrics and Blueprints Pediatrics is a popular combination. BRS Pediatrics is also a great resource, and we find it to be extremely comprehensive. If you’re able to get two texts, then we recommend Case Files Pediatrics as the foundational quick-read text, with your choice of Blueprints Pediatrics or BRS Pediatrics. (Blueprints Pediatrics is more popular, but as mentioned, BRS Pediatrics is a great, thorough resource if you have more time.)
- Pediatrics PreTest is a great resource for questions, especially if you’ve exhausted UWorld for Pediatrics. It has 500 USMLE/shelf exam-style questions with thorough and clear explanations for correct and incorrect answer choices.
Psychiatry
The psychiatry shelf exam tests your knowledge of the pathophysiology, diagnosis, and treatment of mental and neurologic disorders. You should expect to see questions on personality disorders, mood disorders (depression, mania), anxiety disorders, somatoform disorders, substance-related mental disorders, schizophrenia and other psychoses. The Psychiatry Shelf Exam also focuses on the adverse effects of its medications — you should know the common side effects of every important/commonly prescribed psychiatric drug.
- First Aid for the Psychiatry Clerkship is a must-read for the psychiatry shelf exam and clerkship. It’s short, easy to read and comprehensive (it covers everything you’d need to know).
- Case Files Psychiatry is a great additional resource that will help you prep effectively for the psychiatry shelf exam, as it does a great job of distinguishing between various disorders (especially adjustment disorders like PTSD vs. acute stress disorder) that have significant overlap and can be difficult to distinguish.
- If you use UWorld along with First Aid and Case Files, you’ll be set for success on this exam.
Surgery
The surgery shelf exam is one of the more difficult shelf exams. Importantly, the surgery shelf is more medicine-heavy — details about actual surgeries and surgical techniques are not on the exam. The focus of the exam is more on diagnosis, the decision-making that goes into offering surgery, post-op management, and the risks/complications of various surgeries. Trauma management is heavily tested. You should know the ABCs and be able to apply them properly.
- Dr. Pestana’s Surgery Notes is a must-have — it’s extremely high-yield and quick to read (only about 140 pages). It has excellent content and 180 practice questions. It is hands down one of the best texts available to help prep for your surgery shelf.
- You should read Case Files Surgery early on in your surgery rotation so that you can get the fundamentals down, understand what’s expected of you, and answer pimping questions on the wards more quickly and confidently.
- After reading Case Files, read the NMS Surgery Casebook — it’s comprehensive, well-organized and has great diagrams. Particularly with your surgery rotation, it’s helpful to do some foundational reading before going into practice questions.
- Pretest Surgery is the go-to resource if you need more practice questions along with or after completing UWorld.
- deVirgilio Surgery is also a decent resource. However, it’s lengthy (700+ pages) and pretty dense. It can be a lot to get through in an 8-week rotation.
- We highly recommend using Pestana, Case Files, NMS Casebook and Pretest/UWorld.
- Moreover, there are four NBME Surgery tests available. You should work your schedule so that you can take at least two of them before you sit down to take the surgery shelf.
3. Be Diligent During Clerkship Year, but Also Be Flexible
No matter how well you plan out your schedule, there are some things that are just beyond your control. You might need to take care of personal obligations or decide to take the evening off to exercise self-care after a particularly overwhelming day.
There will be days when it won’t be possible to meet the daily goals you’ve set out for yourself. When that happens, re-tweak and recalibrate! Try to make up the missed work over the next two days or so. You might even have larger study disruptions, but stay firm and put in the time to rework your study schedule. Don’t fall into a pattern of deviating from your schedule. Instead, build a habit of sticking to your schedule and be flexible in reworking it however necessary to meet your study goals for each rotation.
Would You Like Some Help Planning for Your Third-Year Shelf Exams and Beyond?
Best of luck during clerkship year! Don’t hesitate to reach out to the Medlearnity team if you have any questions or need guidance on how to prepare for shelf exams or Step 2 CK. Our tutors are exceptional educators who can help you honor your shelf exams and boost your Step 2 CK score.
