How to Study for the Internal Medicine Shelf Exam: A Practical Study Plan

If you’re preparing for the Internal Medicine (IM) Shelf Exam, don’t stress! While shelf exams can feel overwhelming—especially when balancing them with USMLE Step 2 CK—having a solid internal medicine study plan can make all the difference. We’ve gathered insights from experienced tutors to help you succeed. And if you need extra support, you can always schedule a free consultation to explore how tutoring might help.

How to Study for the Internal Medicine Shelf Exam During Your Rotation

Stick to a Consistent Study Routine

The internal medicine rotation can be long (up to 12 weeks at some schools), so don’t wait until the last few weeks to start studying. Instead, dedicate time each day to:

• 20-30 UWorld questions
• 2-3 Online MedEd videos
• 50-100 Anki flashcards

This structured approach requires about 2 hours per day and is one of the best ways to prepare for the IM Shelf Exam.

Use a Structured Study Plan

Not sure where to start? Our free Internal Medicine Shelf Study Planner provides a structured daily plan to guide your preparation. Fill out the form below to get it delivered straight to your inbox!

Fill out the form below to receive your free IM Shelf Study Planner via email!

Maximize UWorld from Day One

• Select the Medicine subject and cover all systems.
• Consider using the UWorld Shelf Exam QBank add-on for additional practice.
• Try to complete as many questions as possible, but at a minimum, do 20-30 new questions per day.
• One week before the exam, switch to reviewing marked/incorrect questions.
• Read all answer explanations carefully—even for questions you answered correctly!

Leverage Anki for Spaced Repetition

• Choose a deck like Zanki for Step 2 or Anking and stay consistent.
• Aim for at least 50 new cards and 200 reviews per day.
• Keep the deck synced on your phone to review during downtime on the wards.

Watch Online MedEd for High-Yield Review

• Cover all major Internal Medicine Shelf Exam topics: cardiology, pulmonology, gastroenterology, nephrology, hematology/oncology, infectious disease, endocrinology, rheumatology, dermatology (about 90 videos total).
• Watch 2-3 videos per day to finish at least a week before the exam.

Supplement with a Reference Book

• Step Up to Medicine is the most high-yield internal medicine study resource.
• Use it selectively to clarify UWorld questions or clinical cases—don’t read it cover to cover.

Take NBME Practice Shelf Exams

• Two weeks before the exam: Take your first two NBME practice tests back-to-back.
• One week before the exam: Take the remaining two practice tests.
• Thoroughly review all missed questions.

Learn from Patients (But Stay Efficient!)

• When assigned to research a pathology, read the Step Up to Medicine section and watch the Online MedEd video on that topic.
• Keep this to 30 minutes max per day—don’t let it replace your core study plan!

Study Adjustments for Students with Lower Scores

If you’ve struggled with exams in the past or need to retake the IM Shelf Exam, refine your approach:

Stick to a Structured Daily Plan

• Track your study goals with a spreadsheet.
• Assign daily tasks for UWorld, Anki, and videos.
• Begin on Day 1 of your rotation—don’t wait!

Prioritize UWorld Over Books

• The UWorld explanations should be your primary learning tool.
• Only supplement with Step Up to Medicine if an explanation is unclear.

Take NBME Practice Tests Early & Regularly

• Every 2 weeks throughout the rotation.
• Early exposure to NBME-style questions builds familiarity.

Use Smart Test-Taking Strategies

• Read the last line of the question first to orient yourself.
• Glance at the answer choices before reading the full question.
• This helps identify the organ system and avoid distractions.

Consider Studying by Organ System

For students with weaker foundations, an organ-system-based approach can help:

• Assign specific UWorld questions, videos, and Anki cards to each system.
• Complete organ-based studying 1-2 weeks before the exam.
• Use the last few weeks for mixed review.

Know Which Topics Matter Most

The most heavily tested subjects on the Internal Medicine Shelf Exam are:

• Cardiology
• Pulmonology
• Gastroenterology

Spend a full week on each of these before moving to other topics.

Consider Additional Video Resources

• Boards & Beyond for Step 2-3 covers IM topics in detail.
• If using Online MedEd, note that it provides a broader overview but less depth.
• Focus on UWorld questions, not Board & Beyond quizzes.

Don’t Get Lost in Minutiae

• Focus on high-yield topics that appear frequently on NBME practice exams.

Final Thoughts

By following this internal medicine study plan, you’ll be well-prepared for the IM Shelf Exam. And if you find yourself drawn to internal medicine, check out our blog post on matching into IM for residency!

Need extra help? Schedule a free consultation to see if 1-on-1 tutoring can support your success!