Why Getting a High Percentile Score on Your Shelf Exams is More Important Than Ever

Many medical students take NBME Clinical Science Subject Exams, or “shelf” exams after completing core clinical rotations in Internal Medicine, Psychiatry, Emergency Medicine, Surgery, OBGYN, Family Medicine, Neurology, and Pediatrics. While passing and honors scores for these exams differ between medical schools, it is important to do your best on these exams and aim for a high percentile shelf score in 2025 for several reasons. 

Before we discuss why it is important to aim for a high (90th) percentile score on your shelf exams, it is important to note that percentiles correlate to a different estimated percent correct (EPC) depending on the exam. For example, according to the Texas Tech School of Medicine, a 90th percentile score on the surgery shelf exam is about 84-85 EPC, compared to psychiatry, where a 90th percentile score is about 91-92 EPC. This can be interpreted to mean that more students find it difficult to get a high EPC on the surgery shelf compared to the psychiatry shelf. 

Honor Your Rotations

The first reason it is important to aim for a high percentile score on your shelf exams in 2025 is that it will likely help you achieve honors for that rotation at your medical school. Many schools roughly use clinical evaluations to determine 80% of the rotation grade and shelf scores to determine the other 20%. This is dependent on your medical school’s grading system (look into this before your rotation). However, the honoring guidelines for most medical schools will be met with a 90th percentile score. In addition to scoring high on the exam, consistent studying will support your clinical skills, a significant component of getting honors on a rotation. 

Score High on Step 2

Second, scoring high on your shelf exams will set you up well to score high on Step 2. After the change of Step 1 from numerical to pass/fail scoring, there was a shift in importance to Step 2 to help determine residency selection and competitiveness. Step 2 covers all subjects on the shelf exams that students take during their clinical rotations, so learning the material well to perform well on the shelf exam is beneficial to mastering Step 2 content.

All shelf exams are made up of important-to-learn content for Step 2. However, the medicine and surgery shelfs represent the largest percentage of exam material (up to 90% combined). Practice of medicine and surgery can involve many different concepts and these exams test a broad range of material. They are considered some of the most difficult shelf exams. Mastering these exams will set you up well to perform well on Step 2. 

Impress Residency Programs

Finally, some schools report shelf score performance to residency programs. While this is dependent on the institution, it benefits students at these institutions to know that their scores will be reported and for students to do as well as possible on these exams. 

Prior to Step 1 becoming pass/fail, some residency program directors used shelf scores to evaluate applicants if the information was available. In advising for my own residency applications, some residency advisors told me that certain specialties look at specific rotations or shelf exams to evaluate applicants (ex: dermatology programs looking at internal medicine, pediatrics, and surgery). More information is needed to evaluate how different specialties use rotation grades and shelf scores. Additionally, it is possible that shelf exam scores (specifically medicine and surgery) may serve as a proxy for Step 1 scores now that the exam is pass/fail. 

Largely due to the transition of Step 1 to pass/fail, doing well on shelf exams is more important than ever before. Set yourself up for success and if you’re struggling, contact EMP to set up a consultation, or purchase a trial session with a tutor.