7 Ways to Ace Your Psychiatry Shelf Exam

After surviving a notoriously more rigorous clinical rotations like Internal Medicine and Surgery, many students find some relief in knowing that they are able to take a little breather on their Psychiatry service. The hours are more regular and your psychiatry shelf exam seems a bit less daunting and easier to ace. With only 369 questions on UWORLD, preparing for the Psychiatry shelf exam generally requires less study time overall. However, doing well on this exam is important both for your residency application and success on your Step 2CK exam. The Psychiatry shelf exam is 110 questions long and you are given 165 minutes to complete it.

Inherit Difficulties of the Psychiatry Shelf Exam

It is worth noting that acing the Psychiatry shelf exam is also difficult in many ways. For one, the average score for this exam is much higher than other clinical shelf exams, making it harder to achieve an Honors score on your psychiatry shelf. However, the criteria for Honors may vary depending on your medical school. Currently, the mean score is 84, with a standard deviation of 6. For reference, the average and standard deviation for the Internal Medicine and Surgery shelf exams are 75 ± 9 and 75 ± 8, respectively.

In addition, the material covered on the Psychiatry shelf exam can propose a challenge to many students. You must demonstrate a mastery of the DSM-5 diagnostic criteria, which requires memorization of specific timelines and presentations. In order to answer a question correctly, you must understand the nuanced differences between two very similar disorders. This involves great test-taking skills and making sure that you are reading the question stems thoroughly.

Lastly, a large component of this exam consists of knowing which medications to use and their side effects. Not only do you need to recognize scenarios in which a certain medication isn’t suitable for the patient due to its side effects, but you must also be able to quickly choose another medication that is suitable. If you struggle with pharmacology, then this may be a challenge for you. As a tutor, I have seen many students request help specifically for this reason.

If you’re reading this blog post, then you are well on your way to tackling the Psychiatry shelf exam! Hopefully, you will gain some insight into how you can knock the ball out of the park on this exam.

1. Do ALL the UWorld Psychiatry Questions x2

The bottom line is that you must do practice questions to ace your psychiatry shelf. It is without a doubt that UWorld QBank questions are the gold standard for all shelf exams. I recommend cracking open UWorld and doing questions starting day 1. While recognizing “buzz words” can be helpful on other shelf exams, this is not the case for the Psychiatry shelf exam.

The question stems can be very long and filled with details left for you to tease out. I encourage you to build a picture of the patient as you are reading the clinical vignette and highlight key information along the way. Particular attention should be paid to the timeline. For example, if the vignette clearly paints a picture of psychosis, the duration of symptoms helps you differentiate schizophreniform disorder from schizophrenia. Similarly, recognizing the temporal relationship between mood disturbances and psychosis allows you to differentiate schizoaffective disorder from major depressive disorder with psychotic features. These are just some of the many examples in which identifying these nuances is critical for this exam. 

With these long and descriptive question stems, you can imagine that many people struggle with time management on this exam. The only way to overcome this is to do these questions in the timed mode and practice pacing yourself. The good news is that since there are only 369 questions in the UWorld QBank for Psychiatry, you can easily do a second pass. While not necessarily feasible for other clinical shelf exams, I do encourage you to do so for this exam. Practice makes perfect!

Working Through UWorld Questions Effectively

Even more importantly, you should aim to review the answer explanations in depth. Your goal should be to understand the content and develop a deeper appreciation for how test writers frame clinical vignettes to test certain high-yield topics. On average, you should be spending at least twice the time it takes you to complete the question blocks to review the answer explanations. Of course, this may vary depending on your baseline level of knowledge. 

If you find that you are starting with lower score percentages on your practice question blocks, do not let your scores discourage you! Keep in mind that UWorld is a learning tool and you should be treating it as such. You will find that most of the learning comes from getting a question wrong. Again, my biggest advice is to hit the ground running with UWorld at the beginning of your Psychiatry service. 

2. Do NBME Exams to Ace Your Psychiatry Shelf Exam

I would also add NBME practice exams to your must-do list in preparation to ace your Psychiatry shelf exam. NBME exams are 50 questions long and reflect the format of your real shelf exam. The consensus is that NBME exams are typically rated to be of greater difficulty than UWorld practice questions. For this reason, many students hold off on doing these exams until the last minute. You should think of these NBME exams as a learning tool as well as a tool to test how prepared you are. Remember that the only thing that matters is your performance on your real test day and that everything else is just to prepare you for that.  

NBME exams receive a gold star rating from us because it offers a unique experience that UWorld practice questions cannot achieve. The people that write these NBME practice exams are the ones who write the USMLE exams as well as the clinical shelf exams. From this perspective, you can gain some insight into the high-yield topics that they will test you on. After completing all the NBME exams, you will notice that certain topics are repeated across the different examination forms. Some of these high-yield questions will even show up on your real shelf exam! Definitely do not sleep on this very valuable resource available to you.

Incorporating Practice Exams Into Your Psychiatry Shelf Study Schedule

At a minimum, you should be looking to complete at least one NBME exam per week. When creating a study schedule, make space for these exams. When doing the NBME exams, it helps to approach it with a mindset that best simulates the actual test day. Let’s say that you know that your shelf exam is going to be taking place from home at 7AM. Then you want to make sure that you are well-rested the night before, wake up early to get through your morning routine and be settled into your undistracted space ready to start the exam at 7AM. It is best to do these exams timed. This is a great opportunity for you to develop good habits and ease any test-taking anxiety. By establishing this routine, you will know what to expect during your real test day and be more confident going into the exam.

3. Use First Aid for the Psychiatry Clerkship

To supplement content learning, First Aid for the Psychiatry Clerkship is a fantastic book. If you must choose one other resource other than UWorld and NBME practice questions, then this is it. Similar to the First Aid for USMLE Step 1 book, the format is largely the same with high-yield information presented in bullet-point format. This 200-page book is well-structured and the text is easy to read. On the margins, you can find “tips for the ward”, which consists of high-yield content you will encounter both during test day and during your Psychiatry service. 

Bring this book with you to your rotations and read it when you have downtime. You can also reference this book and correlate it with the patient presentations you see on your clinical rotation. Keep this book open on your desk when reviewing your practice questions to further solidify your understanding. This book will serve as your best friend for this rotation.

4. OnlineMedEd

If you are in your clinical years of medical school, then you have probably heard of OnlineMedEd, which is a series of lectures where the founder Dr. Dustyn Williams walks you through key concepts on a whiteboard. Specifically for the Psychiatry section, there are 20 lessons for a total video time of 5.4 hours. They are well-organized and you can easily pick a topic to review. It is a great combination of visual and auditory learning, which can help the information stick better. In terms of content covered, the Psychiatry section of OnlineMedEd is essentially the First Aid for the Psychiatry Clerkship book in lecture format.

5. Utilize Resources for When You’re On The Go

If you are looking to absolutely ace your Psychiatry shelf exam, there are many other resources you can use to learn passively. If you have a long commute to your clinical rotations, you can take advantage of audio resources like Youtube videos and podcasts to supplement your learning. Many people find Dr. High Yield’s Youtube videos and Divine Intervention’s podcasts to be very helpful. These types of resources generally provide a quick review of high-yield facts and are short enough for you to sprinkle into your study schedule. They are not recommended as a primary content resource but are a great way to supplement and make use of your time on the go. This is especially great for auditory learners!

6. Create a Psychiatry Shelf Exam Study Schedule and Stick to It

The key to your success on the Psychiatry shelf exam is to create a study schedule and stick to it. Form good habits early on in your clerkship so that you are not playing catch up towards the end. You may utilize some or all the resources I mentioned above, but be honest with yourself and find what works for you.

The goal is not to create a strict hour-by-hour schedule, but instead aim to create a flexible schedule that you can adhere to. Consider using Google Calendar to map out your Psychiatry clerkship month to keep yourself accountable. Take into account your extracurricular activities and block out time for when you know that you will be stepping away from studying. If you are a morning person, then perhaps you will consider doing your practice questions first thing in the morning. Reassess your progress every week and implement changes if you need to. 

And lastly, make some time for yourself to do the things you love. Spend some time with your family and friends! After all, this is one of the less demanding clerkships so don’t feel guilty to take a breather.

7. Don’t Be Afraid to Ask For Help to Ace Your Psychiatry Shelf

During your Psychiatry clerkship, you have direct access to your preceptor, other medical students, and various healthcare professionals that can help you. Don’t be afraid to ask your preceptor for clarification on certain topics that puzzle you. Allow them to teach you and share their clinical expertise. Your peers may surprise you with excellent notes and high-yield concepts that you weren’t aware of. If you find yourself struggling, be proactive to turn the situation around. 

If you have previously failed the Psychiatry shelf exam or are at risk for failing, consider seeking professional guidance from an expert tutor. Your one-on-one tutor can help you with targeted content review, test-taking strategies, study schedule creation, keep you accountable, and be your cheerleader! If you would like to learn more about how our dedicated tutors at Elite Medical Prep can help with your shelf exams, please contact us to schedule a free consultation. As always, good luck with studying!