How to Study for the Internal Medicine Shelf Exam

Pro Tips on Studying for the IM Shelf Exam

So you’ve got the internal medicine shelf exam ahead of you huh? Well, don’t stress! While shelf exams (family medicine, internal medicine, surgery, neurology, pediatrics, OB/GYN, and psychiatry) may seem stressful or intimidating at first, (Especially while trying to study for them along with USMLE Step 2 CK!) with proper preparation and planning, you’ll do just fine. In order to help students who are feeling a bit lost in terms of how to prepare for the IM shelf exam, we’ve surveyed some of our Shelf Exam tutors and put together this helpful guide. So, enjoy! And don’t forget that if you need extra shelf exam help, you can always contact us for a free consultation call to see if a few 1-on-1 tutoring sessions could be beneficial.

How most students should prepare for the Internal Medicine Shelf Exam while on their rotation:

• Keep a consistent schedule for studying throughout the entire medicine rotation. This can be a long rotation (up to 12 weeks at some schools) and you shouldn’t save your shelf study for the end. Each day, aim to do at least 20-30 UWorld questions, watch 2-3 Online MedEd videos, and at least 50-100 Anki flash cards. This adds up to only about 2 hours per day if you are consistent throughout the rotation.

• • Use UWorld early – start day one of the rotation! You should click Subject “Medicine” and all systems. You can also use the new UWorld Shelf Exam qbank add-on specifically for shelf exams. Try and complete as many questions as possible. Medicine is the most dense section of UWorld so it is possible that you won’t get through 100% of the questions (>1600 total and new questions added daily). That’s okay, as long as you keep up with at least 20-30 new questions per day. The week before the shelf, switch from new questions to marked or incorrect medicine questions to ensure that you have learned from things missed previously. It’s very important to read the explanations thoroughly for ALL questions, even those you answer correctly. This is where the bank of information will be most dense!
• • Choose an Anki deck at the start of the rotation and be consistent with it. Zanki for Step 2 and Anking are the most commonly used. Try and do all medicine cards (at least 50 new + maximum 200 review per day). Keep the deck synced on your phone because this is a great thing to do during some downtime on the floors!
• • Watch Online MedEd videos for a broad overview of each topic. There are many medicine topics and you should try and get to them all: cardiology, pulmonology, gastroenterology, nephrology, hematology oncology, infectious disease, endocrinology, rheumatology and dermatology (about 90 videos in total). Depending on the length of your rotation, you should aim to watch 2-3 videos per day in order to finish the videos at least one week prior to the NBME shelf exam.
• • You can supplement your studying with a book. The most high yield is Step Up To Medicine. I don’t recommend reading this cover to cover, but rather referring to it if you get a UWorld question wrong and want more detail beyond the explanation. You can also use this book to learn about patients you’re following in the floors.

• Two weeks prior to the exam, take the first 2 NBME practice shelf exams. Try taking them back to back to simulate the length of the true exam. Review the questions thoroughly. One week prior to the exam, take the second 2 NBME practice shelf exams, again back to back. Make sure you review this as well! The score on the final exam will be most predictive of the score on the true exam.

• Learn about your patients but don’t spend too much of your study time there. If you are asked to learn about a pathology that your patient has, read the few pages about it in Step Up To Medicine and watch the Online MedEd video on that topic. Do not let this influence your UWorld or Anki habits. This should take no longer than 30 minutes per day.

How students who have a history poor exam performance should adjust their approach, especially if they are required to retake the shelf because they scored below the 5th percentile (passing cut off)

• Stick to a schedule! Consistency is key for improvement. Create a spreadsheet in which you assign yourself a certain # of Anki cards, UWorld questions, and videos each day. Holding yourself accountable will be crucial. Do not wait until a few weeks before the exam to start studying – you must start on Day 1 of the rotation!

• Rely more heavily on UWorld explanations than books/video resources. Because Internal Medicine is the most vast content base, students often find themselves overwhelmed with resources. UWorld should be the primary source for information (the question explanations). Only if you feel the explanation is not sufficient should you read Step Up To Medicine or another book to supplement your learning.  

• Take the practice NBME shelf exams early, and spread out. I recommend taking one every 2 weeks throughout the rotation. Getting to see these questions earlier prepares your mind for more shelf-style descriptions, which is helpful to recognize as you continue through UWorld.

• Rely on test taking strategies as you do for the USMLE Step exams. The most important strategy is: read the question first (last line of a stem) and glance at the answer choices to orient yourself to the sub-topic within medicine before reading the stem. Then read the top of the question/entire stem. Since medicine is so broad, it’s often daunting not to know what organ system a question will be about; you can combat this by following the strategy!

• Consider studying by organ system throughout the block. While we recommend studying in a mixed fashion (not by organ system) for most students, those who do not feel they have a solid knowledge base may want to consider breaking their studying into smaller chunks by organ system. In the schedule, assign specific organ-system questions, videos, and flashcards on each day. You should plan to complete organ specific studying 1-2 weeks before the exam and dedicate the last few weeks to mixed review of all topics. Make sure to allot time for all of the organ systems included on the medicine shelf exam. On UWorld these subtopics are: allergy & immunology, cardiovascular system, endocrine, female & male reproductive, GI & nutrition, hematology & oncology, infectious diseases, pulmonary & critical care, renal and rheumatology. You should not dedicate specific days to the following topics but should do these questions the last 1-2 weeks before the test during mixed review days: dermatology, ENT, nervous system, ophthalmology, poison, psychiatric & social sciences.

• • The most highly represented organ systems on the Internal Medicine Shelf exam are cardiology, pulmonology and gastroenterology. Consider allowing yourself a full week for each of these topics, while only a few days for some of the others.
• • If using a video series to accompany your topic learning, consider Boards & Beyond for Step 2-3 clinical knowledge. There are in depth explorations of each topic via video. Don’t worry about doing the Boards & Beyond quizzes/questions. Focus on UWorld as your question bank. You can also consider using Online MedEd videos, but these will not go into as much detail.

• Do not worry about minutiae! Since medicine is such a broad topic, it is more important to understand the high yield topics that come up on every practice test, rather than focus on small details.

That’s all! Best of luck and if while you are studying for your internal medicine shelf exams you decide that IM is your passion and you want to apply to an internal medicine residency program, check out our blog post on matching into IM for residency!