The third year of medical school will be one of the most memorable years of your medical training: you are learning how to function on the wards, balancing call schedules, working with residents, fellows, and attendings, and somehow finding time to study for your very important shelf exams. Each shelf exam is designed to test both the breadth and depth of your clinical knowledge within each rotation. At most schools, they are standardized, clinically focused, and often weighted heavily in your clerkship grades — which in turn matter for residency applications.

As tutors, we have worked with hundreds of students who have felt overwhelmed trying to balance patient care with test prep. The good news: with the right strategies, you can consistently score at the top of your class and get an “honors” on all of your rotations. In this guide, we will walk you through rotation-specific shelf strategies, highlight the most high-yield resources, and share tutor-tested tips that can help you maximize your scores without burning out.

General Principles for Shelf Exams

Before diving into each rotation, let’s establish some universal rules:

1. Questions are the top priority. NBME exams consist of multiple choice, clinically focused questions. Doing thousands of high-quality practice questions (UWorld, AMBOSS, NBME self-assessments) is the single best way to prepare.
2. Integrate studying within the rotation. Shelf prep is not just for dedicated study time. Use cases you see on wards as springboards to review relevant topics that night. Also, start early!
3. Timing matters. Shelf exams for each clerkship will build off one another. Additionally, concepts from Step 1 carry forward and can show up on shelf exams. Start with foundational resources and then refine with shelf-specific ones.
4. Practice pacing. The shelves are fast. You’ll need to answer ~1 question per one minute and fifteen to thirty seconds. Building stamina is part of studying.

Internal Medicine Shelf Exam

 The internal medicine (IM) shelf is often considered the hardest shelf exam out there. It is extremely broad, covering everything from cardiology to infectious disease, and it rewards both depth and clinical reasoning.

High-Yield Strategies

• Start early. We cannot emphasize this enough. IM has the most practice questions out of any clerkship and it is often challenging for students to get through all of them prior to your shelf exam. Take initiative and start working through IM questions BEFORE your clerkship starts. Aim to complete all of the IM questions ~1-2 weeks before your shelf exam.
• Prioritize breadth over depth. You do not need to know every detail of nephrology, for example, but you must recognize the most common inpatient problems.
• Think in algorithms. The NBME loves “next best step” questions. Practice decision-making for chest pain, shortness of breath, GI bleeding, altered mental status, etc. Develop frameworks for the most common chief complaints so you know how to work them up. After determining the diagnosis, you now need to know how to treat the patient which is a whole other skill you must develop.
• Do not underestimate outpatient medicine. Hypertension, diabetes, hyperlipidemia, and screening guidelines appear often. These are low hanging fruit but often overlooked – so make sure you are up to date on the guidelines!

Top Resources

• UWorld Step 2 CK (Internal Medicine section): The gold standard and backbone of prep. As we mentioned before, get through all of the questions early.
• AMBOSS: A great alternative to UWorld if you are looking for a different question bank, or a supplemental bank if you run out of UWorld questions. This is a great for extra practice and quick resources when you encounter an unfamiliar case on wards. Beware – the style in which questions are asked between UWorld and AMBOSS is quite difference and the transition from one question bank to the other can be challenging at first.
• NBME Self-Assessments: Essential for gauging readiness – we recommend completing all of these examinations near the end of your rotation to get you prepared for test day.
• Step-Up to Medicine: This textbook is the best reference book, in our opinion. It is by no means comprehensive; however, it provides a great framework and outline for the most common and highest yield conditions you will experience on your shelf examination. It is not necessary to read this book, but it will not hurt! Otherwise, use it as a reference to look up specific topics/concepts you encounter on the wards or with your question bank.

Tutor Tip

During your IM rotation, learn from your patients! It is much easier to remember a patient you treated rather than a UWorld/AMBOSS question. For every patient you encounter, think of all of the different topics that come to mind regarding their care. For example, if your patient has pneumonia, review the criteria for inpatient vs. outpatient therapy that night, the difference between community acquired and hospital acquired pneumonia, testing, follow up, etc. This practice will reinforce recall through real life experiences!

Surgery Shelf Exam

 The funny thing about the surgery shelf exam, is that it really is not a “surgery exam.” About 75–80% of the questions are internal medicine-related — perioperative care, trauma resuscitation, fluids and electrolytes, and surgical complications. Therefore, it is often very challenging for students to balance studying with clinical care. You may stay up late learning the steps for a laparoscopic cholecystectomy; however, this is not going to be tested on the shelf examination. Rather, the indications and complications for a lap chole will. As you can see, there is A LOT of time and effort you will need to put into preparing for your surgery shelf, on top of balancing one of the busiest and most time consuming clinical rotations.

High-Yield Strategies

• Know acute management of surgical emergencies cold. Trauma (ABCDE approach), burns, shock, and post-op complications dominate. These are unique to the surgery shelf and will come up often.
• Fluids and electrolytes. You will often be asked to choose the right IV fluid (amount and type), or correct sodium/potassium abnormalities.
• Do not over-focus on anatomy or specific surgical procedures. NBME rarely asks direct surgical anatomy; it’s almost always clinical application. Often, if there are classic anatomical complications of surgeries (i.e. what is the most common structure incidentally damaged during this procedure), those are the structures to know.

Top Resources

• UWorld Step 2 CK or AMBOSS (Surgery + IM + Emergency Medicine): If possible, try and complete all of Surgery and Emergency Medicine (EM) during your actual surgery shelf (unless your school has a dedicated block for EM). If you are able to, complete as many IM questions as you can as well. It often helps if you have IM BEFORE your surgery rotation as this will make the shelf exam MUCH easier for you.
• Dr. Pestana’s Surgery Notes: A must use resource. This book consists of very short, high-yield, and shelf-oriented questions and vignettes. Many questions from the shelf are traced right back to this resource
• NBME Surgery Self-Assessments: A must for use for the same reasons as IM.
• Surgical Recall: This book is similar to Pestana; however, it presents the material in bullet point format and it is much more practical for the OR than Pestana (think Pestana = Shelf while Surgical Recall = OR). We recommend using this resource to help prepare you for common questions you will be asked in the OR.

Tutor Tip

As mentioned before, surgery overlaps heavily with IM, so reviewing Step-Up to Medicine chapters on GI and Cardiology can also boost your score as these two organ systems are tested heavily on Surgery.

Pediatrics Shelf Exam

Pediatrics, similar to IM, can feel overwhelming because it covers everything from neonatology to adolescent medicine. The scope of practice is extremely wide, and it takes place in a highly specific patient population (infants, children, and adolescents). Therefore, there is an added challenge of remembering normal developmental milestones and age-specific presentations. As most pediatricians say, “kids and not just little adults!” This is very, very true and simply applying your IM knowledge to pediatrics will not suffice. Dive headfirst into learning about this specialty and treat it as its own, not just “IM in small adults”.

High-Yield Strategies

• Memorize developmental milestones. Make sure to know what is expected at each time frame as an infant grows up (verbal, gross motor, and fine motor). You can almost guarantee that you will get a few questions about this on your shelf examination.
• Know vaccine schedules and screening guidelines. This information is extremely high yield. We recommend going to the CDC website to look for the most up to date vaccine schedule for children. Screening guidelines, like in IM, are also critical and play an important role in outpatient pediatric care.
• Master congenital disorders. There are a variety of congenital and genetic conditions that present at birth or early in life like cyanotic heart disease, metabolic diseases, and inborn errors of metabolism. These are only tested on pediatrics, even though they may persist into adulthood, as this is when the diseases will often first present.

Top Resources

• UWorld Step 2 CK/AMBOSS (Peds section): Like every rotation, these questions should serve as the core foundation of your shelf preparation.
• NBME Self-Assessments (Peds): Similar to other shelf exams, these will provide a great snapshot of what test day will look like
• BRS Pediatrics: This is a concise but comprehensive review book for all things pediatrics. Do not read this cover to cover; rather, use this as a reference guide for specific pediatric topics you want to learn more about
• PreTest Pediatrics: This is an excellent supplement if you finish UWorld/AMBOSS early but are looking for more practice questions.

Tutor Tip

Keep a milestone chart and vaccine schedule on your desk or in your Anki deck. Review it daily — it’s one of the highest yield memorization tasks you can do for this shelf and will get your easy points on test day! Also, make sure to get normal range for vital signs down early as this will make you move through practice questions faster.

Obstetrics & Gynecology Shelf Exam

The OB-GYN shelf is tricky because it combines two disciplines. It is also a blend of both medicine and surgery. The key is mastering management algorithms — prenatal care, labor, postpartum complications, gynecologic malignancies, and contraception. Fortunately, the scope of practice is narrower than IM or pediatrics; however, the questions often will go a bit more in depth into each specific diagnosis.

High-Yield Strategies

• Labor management is central. Recognize fetal heart rate tracings, stages of labor, induction, and complications (shoulder dystocia, uterine atony). You will have many questions related to both normal and abnormal labor, so spend a significant amount of time familiarizing yourself with this part of the exam.
• Pregnancy. Make sure to understand both normal and abnormal pregnancy, including the normal screening at different parts of the pregnancy, as well as what to do when a screening test comes back abnormal.
• Gynecologic oncology. Understand screening guidelines (Pap smears, breast cancer, HPV), as well as presentation, diagnosis, and management of cervical, ovarian, and endometrial cancers.
• Contraception and ethics. Do not underestimate counseling, informed consent, and contraindications to contraceptives.

Top Resources

• UWorld Step 2 CK/AMBOSS (OB-GYN section): Essential – we do not need to reiterate ourselves. Questions, questions, questions!
• OnlineMedEd OB-GYN lectures: This is a great video resource for specific areas of OB-GYN (as well as all other rotations), where you can go for targeted review. Some students will watch all of the lectures, but this often is time consuming.
• Association of Professors of Gynecology and Obstetrics (APGO)) uWISE questions: This is a question bank that comes from a national association of OB-GYN. Many schools will provide this as a resource to supplement your learning, and if so, we highly recommend using this if you run out of UWorld/AMBOSS questions
• NBME Self-Assessments (OB-GYN): Final calibration – non-negotiable!

Tutor Tip

Flashcards can be extremely helpful for prenatal care labs, fetal monitoring, and gynecologic screening – this can save you enormous time. These details are easy points if memorized in advance and will make it easier and faster to read through questions.

Psychiatry Shelf Exam

 Psychiatry tends to feel easier than others, but do not underestimate it. Many students lose points on subtle differentiations between specific conditions (e.g., schizoaffective vs. bipolar with psychotic features). The scope/depth of the psychiatry shelf is one of the most narrow you will encounter during your clinical year which does make preparing for this shelf exam easier than others. However, some students will put off studying until the end which ultimately is asking for trouble – like all shelf exams, start early and be thorough.

High-Yield Strategies

• DSM-5 criteria. NBME expects you to differentiate disorders based on timeline and symptom clusters. Saying that something “sounds like” schizophrenia is not sufficient; the practice questions will always give you enough information to rule in/out a diagnosis, so you must know what the criteria are for each psychiatric condition.
• First-line treatments. Know the drug of choice for each condition, plus contraindications. Pharmacology is extremely high yield for this examination.
• Side effects matter. Clozapine agranulocytosis, lithium nephrotoxicity, SSRI sexual dysfunction — these are classic questions and there are many side effects to psychiatric medication. Flashcards can help you if this is not your strong suit.

Top Resources

• UWorld Step 2 CK/AMBOSS (Psych section): Again, this should serve as your primary source. Given the limited scope of this shelf exam, many students can get through the question bank quite quickly, so feel free to redo the questions, or use more than one question bank.
• NBME Psych Self-Assessments: As always, essential.
• OnlineMedEd (Psych videos): This is especially helpful for visually structuring the DSM-5 criteria for tricky diagnoses. Again, it is not necessary to watch all of the videos; rather, pick the videos based on the specific diagnoses that you are struggling with.
• First Aid for Psychiatry (Clerkship book): If you are looking for a textbook, this book is concise and focuses on the high-yield material. However, the problem with this (and many) books is it does NOT present the psychiatric conditions in the form of a clinical vignette, which is often the most challenging part of the psychiatry exam. Only use this for specific questions, but do not rely on this as a primary resource.

Tutor Tip

Timeline flashcards (acute stress disorder vs. PTSD, brief psychotic disorder vs. schizophrenia) are low-effort, high-yield. Make flashcards that highlight the differences between seemingly similar conditions or pharmacology questions.

Family Medicine Shelf Exam

 Family medicine is a unique challenge because it is extremely broad and often overlaps/integrates components of every other clerkship, just in the outpatient setting. It integrates content from internal medicine, pediatrics, OB-GYN, and psych. Many students feel unprepared because it does not go deep into one specialty. Additionally, there is A LOT to memorize, specifically the screening guidelines and vaccination schedules.

High-Yield Strategies

• Screening guidelines are critical. Colon, breast, cervical cancer, cholesterol, diabetes – there is a lot to keep track of so start early to really commit these guidelines to memory.
• Outpatient management of the most common conditions. This includes hypertension, diabetes, asthma, COPD, thyroid disease — bread-and-butter conditions. You should be able to recognize, diagnose, treat, and follow up on each of these conditions.
• Preventive medicine. Vaccines and lifestyle counseling questions are frequent and, although they are easy, there are MANY of them and it can be challenging to keep track of them all.

Top Resources

• UWorld Step 2 CK/AMBOSS (Family Medicine and Ambulatory Medicine): Again, Core material – the bulk of your time will be spent here
• United States Preventative Services Task Force (USPSTF): Your resource for all things guidelines.
• American Academy of Family Physicians (AAFP) Questions: Similar to the UWise questions for OB-GYN, this is a great source for more questions if you complete AMBOSS/UWorld; however, these can be above the level for a medical student and may be more appropriate for residents/fellows.
• Case Files Family Medicine: If you want more practice with questions presented in a clinica cases, this is a great resource that highlights the highest yield concepts of FM.
• NBME Family Medicine Self-Assessments: Again, these are key for readiness.

Tutor Tip

Think “primary care” mindset. If you are debating between ordering a test or offering counseling, the latter is often the NBME answer unless there is a red flag in the history or physical exam.

Neurology Shelf Exam

Not all schools require a neurology shelf, but where offered, it is one of the most challenging exams. It emphasizes localization of neurologic lesions, vascular syndromes, and acute management. Neurology rotations tend to be short (~4 weeks), so there is a lot to cram in in a short amount of time!

High-Yield Strategies

• Neuroanatomy matters. This is one of the highest yield but most challenging components of the neurology shelf. A significant majority of your questions will be related to localization of neurologic lesions. You should learn how to recognize stroke syndromes, spinal cord lesions, and cranial nerve deficits.
• Acute management. There are many neurologic conditions that are emergencies like status epilepticus, stroke thrombolysis windows, and increased ICP – learn how to diagnose and manage these situations
• Chronic management. Similarly, a significant amount of neurology deals with chronic conditions like Parkinson’s, dementia, and multiple sclerosis. Again, recognition, diagnosis, and management are key for these conditions.

Top Resources

• UWorld Step 2 CK/AMBOSS (Neuro section): Self explanatory
• NBME Neuro Self-Assessments: Again, Crucial before the real exam.
• Clinical Neuroanatomy Made Ridiculously Simple: A great resource for anyone who is struggling with neuroanatomy – this book is very short and teaches the highest yield neuroanatomy and how it will present clinically. A must use for anyone struggling with this topic.
• Case Files Neurology and PreTest Neurology: Both are very useful books if you are looking for more practice questions/scenarios.

Tutor Tip

In addition to localizing the lesion, there are some specific neurologic conditions that have pathognomonic presentations. Make a “neurologic syndromes” one-pager that highlights the classic presentations and lesion locations, and review it daily during the rotation. These questions show up often and are quite challenging.

High-Yield Cross-Rotation Resources

• UWorld Step 2 CK/AMBOSS QBank: The single most important resource for every shelf – you should aim to complete ALL questions before your shelf exam. This is non-negotioable for anyone who wants to “honors” a rotation.
• NBME Self-Assessments: Predictive and NBME-style. Always take at least one, but we recommend taking them all.
• OnlineMedEd: Best for those who like videos and are looking for a more comprehensive and clinically oriented presentation of the material
• Textbooks (First Aid, Case Files Series, Pretest): These are supplemental resources that can provide written reviews of the highest yield material (again, not comprehensive), or more practice questions if you finish UWorld or AMBOSS.

Timing and Scheduling Advice

During Each Rotation

• Aim for 10–15 UWorld/AMBOSS questions daily in the relevant subject (use the weekends to catch up if you are busy)
• Aim to finish all practice questions one to two weeks before your shelf exam
• Watch OnlineMedEd videos for upcoming patient encounters.
• Focus on patient care! Even though you need to ace your shelf, you went to medical school to become a doctor. The only way to learn how to do this is to do it in real life! Not through some written test.

Final 2 Weeks Before the Shelf

• Focus on NBME self-assessments – use these as tools to assess your preparedness and also to discover your weakareas
• Memorize charts and high-yield material (milestones, vaccines, screening guidelines).
• Drill weak spots with Anki or flashcards.

Common Mistakes to Avoid

1. Leaving questions until the end. Shelf prep is cumulative. Daily questions beat cramming. Use your weekends to catch up if needed.
2. Ignoring ambulatory/outpatient medicine. Shelf exams test preventive care heavily – although most of your clinical year will be inpatient, most health care in this country is delivered in the outpatient setting.
3. Over-focusing on rare diseases. Bread-and-butter conditions will be tested more commonly on shelf exams and Step 2 CK.
4. Neglecting practice pacing. Many students run out of time. Simulate test conditions on a regular basis (especially when taking your practice exams the week leading up to your actual shelf exam).

Final Thoughts

Shelf exams can feel like a never-ending gauntlet, but they are also an incredible learning opportunity. With a strategic approach — grounded in UWorld/AMBOSS, NBME practice tests, high-yield clerkship resources, and active integration with patient care — you can consistently score at the top of your class. Remember: the goal is not just to ace the shelves. It’s to build the knowledge and reasoning skills that will carry you through Step 2 CK, residency, and beyond.