How to get a 90th percentile score in your Pediatrics shelf

The pediatrics shelf exam is one of the more challenging examinations given its breadth of topics, covering everything from neonatology to adolescent medicine. To achieve a 90th percentile score, you will need a targeted study strategy that leverages high-yield topics, effective study methods, and the best available resources. This guide breaks down what you need to know to help you crush the exam!

General Study Strategies and Advice for the Pediatrics Shelf Exam

1. Master the Core Pediatrics Topics

The pediatrics shelf exam is heavily weighted toward growth and development, infectious diseases and vaccine schedules, and congenital conditions and conditions predominantly seen in childhood/early adolescence. Prioritize these areas and ensure you understand key milestones, disease presentations, and management plans.

2. Use UWorld/AMBOSS as Your Primary Question Bank

UWorld/AMBOSS are the gold standards for all shelf exams. Our general recommendation is to complete all of the pediatrics questions 1-2 weeks prior to your shelf exam. While you are studying, you should also be taking notes when you come across topics you do not know or find difficult. If you have time, re-do incorrect questions and flag any concepts you struggle with. It is important to note that Pediatrics is one of the largest sections in UWorld or AMBOSS, so it is important to start early and stick to your study schedule.

3. Supplement with NBME Practice Exams

NBME self-assessments closely mimic the style and difficulty of the real exam. It is crucial for you to take as many NBME examinations as possible. We recommend you start taking these examinations one to two weeks prior to your shelf examination as this will prepare you for test day, and allow you to identify any weaknesses you want to refine at the last minute.

4. Learn High-Yield Algorithms, Vaccine Schedules, and Developmental Milestones

The pediatrics shelf exam often tests management pathways (e.g., neonatal resuscitation, approach to fever, asthma exacerbations), vaccines schedules, and developmental milestones. Understanding these three concepts will help you quickly identify the correct answer. Often, these topics are purely memorization based, so resources that allow for spaced repetition (like Anki or flashcards) are of great utility here!

High-Yield Pediatrics Shelf Exam Topics and Resources

1. Growth and Development

• Developmental milestones (gross motor, fine motor, language, social/cognitive)
• Developmental delay
• Interpreting growth charts and normal vital signs per age group
• Failure to thrive (organic vs. non-organic causes) – there are many etiologies!
• Puberty and normal vs. precocious/delayed development

2. Neonatology

• APGAR scoring and neonatal resuscitation steps
• Newborn screening tests and metabolic disorders
• Neonatal jaundice (physiologic vs. pathologic) and how/when to treat
• Prematurity and associated problems (RDS, BPD, NEC, ROP, IVH)
• Birth trauma

3. Infectious Diseases

• Pediatric vaccination schedule and contraindications (EXTREMELY HIGH YIELD)
• Presentations for measles, mumps, rubella, varicella, pertussis, polio, hepatitis B, diphtheria, tetanus, HiB, RSV, and TB
• Meningitis workup and empiric antibiotic treatment by age group
• Perinatal Infections (GBS, E. coli, Listeria, HSV, HIV, Chlamydia, Syphilis)
• Rashes (viral exanthems, Coxsackievirus, RMSF, Lyme, Toxic Shock Syndrome)

4. Respiratory Disorders

• Asthma – diagnosis, management, and classification
• Foreign body aspiration
• Croup vs. epiglottitis vs. tracheitis (often challenging for students to differentiate these conditions but look for subtle differences provided in the question stem)
• Pharyngitis and when to treat for GAS
• Cystic Fibrosis (high yield! Many different ways this can present and multiple pulmonary or GI symptoms)

5. Gastrointestinal Disorders

• Newborn feeding (normal amount of wet diapers and bowel movements per day)
• Breast milk vs. formula feeding 
• Pyloric stenosis vs. malrotation vs. intussusception vs. volvulus vs. Hirschsprung disease (all can present with obstruction-like symptoms, learn how to differentiate them!)
• Appendicitis (high yield as it is very common!)
• Inflammatory bowel disease (Crohn’s vs. ulcerative colitis)

6. Cardiology

• Congenital heart defects (there are many, so start by categorizing as cyanotic vs. acyanotic diseases)
• Innocent vs. pathologic murmurs (always ask yourself: where on the chest is it? Systolic or diastolic?)
• Kawasaki disease and Rheumatic Fever and their cardiac complications
• Understand the basics of reading an EKG (will be very important on Internal Medicine as well)

7. Endocrinology

• Type 1 diabetes mellitus: diagnosis and management (understand DKA!)
• Congenital hypothyroidism screening and treatment
• Adrenal disorders (CAH, Adrenal Insufficiency, Pheochromocytoma)
• Disorders of sexual development

8. Hematology, Oncology, and Immunology

• Allergies (environmental and medication) and Anaphylaxis
• SCID, CVID, Wiskott-Aldrich, CGD, IgA Deficiency, Bruton’s, Chédiak-Higashi
• Anemia (commonly tested on iron deficiency, thalassemia, folate/B12 deficiency, and lead poisoning)
• Sickle cell disease (High yield!)
• Leukemias and lymphomas in children
• Hemophilia and von Willebrand disease

9. Neurology and Psychiatry

• Seizures: Febrile seizures vs. epilepsy
  • Know how to determine from physical exam if something is truly a seizure or not!
• Meningitis/Encephalitis
• Cerebral palsy and other learning disabilities
• Pediatrics brain tumors
• ADHD, OCD, Depression, Anxiety, Tic Disorders, Eating Disorders

10. Miscellaneous High-Yield Topics

• Pediatric dermatology (viral exanthems, atopic dermatitis, impetigo)
• Child abuse, neglect, and trauma (red flags, mandatory reporting laws)
• Common genetic syndromes (Down syndrome, DiGeorge Turner syndrome, Fragile X, PKU, A1AT, Wilson’s)

Best Resources for the Pediatrics Shelf Exam

1. UWorld/AMBOSS Pediatrics Section

• As mentioned above, these are the single best resources for question-based learning – having a question bank is a must

2. BRS Pediatrics

• This is a relatively concise but comprehensive review book for all things pediatrics
• We do not recommend reading this cover to cover; however, use this as a good reference guide for specific topics.
• Great for future pediatricians

3. First Aid for the Pediatrics Clerkship

• This is similar to BRS Pediatrics in that we do not recommend reading this cover to cover; however, it is written in a much more concise manner than BRS
• This is an easy-to-read format for quick review – great for people who only want to know the high yield points of pediatrics

4. OnlineMedEd

• Video-based learning for visual learners
• Great supplement to reinforce difficult topics

5. NBME Pediatrics Self-Assessments

• As mentioned above, these assessments are a must. Take these close to the actual exam date as it will mimic your test day in terms of timing, question style, and difficulty
• These tests will help predict your score and identify weak areas that you can refine in the final days before your test

6. Cheat Sheets

• We at EMP have created concise two page cheat sheets for all core clerkships.
• Check them out here to review them!

Final Tips to Score in the 90th Percentile

• Start studying early!: Don’t wait until the last few weeks to begin dedicated shelf prep. Try and finish UWorld or AMBOSS with 1 to 2 weeks remaining so you can focus on practice tests.
• Take notes on missed questions: Keep a study log of incorrect concepts and use textbooks like BRS or First Aid for targeted review
• Prioritize NBME practice exams: These are the best predictors of your final score.

By following this structured approach, we believe you can maximize your chances of achieving a 90th percentile score on the pediatrics shelf exam. If you would like personalized guidance to stay on track and boost your score, get in touch with our team to learn more about one-on-one tutoring.Good luck!