Third year is a long road of challenges, including Shelf exams, ever-changing rotations, and preparation for the USMLE Step 2 CK. The Cram Fighter team is always looking for ways to pass on great advice to medical students. To that end, we asked medical student Barrett H. how he approached MS3 and how he organized his study schedule.

Barrett H. is an MD/MBA student at the University of North Carolina School of Medicine & Kenan-Flagler Business School.

1. How does studying for Shelf exams differ from Step 1?

One major difference between Step 1 and the Shelf exams is that Step 1 requires you to draw from your knowledge of basic science to connect the vignette to the correct answer. Or at least eliminate incorrect answers. This is true of the USMLE Step 2 CK as well. In contrast, Shelf exam questions rely on clinical reasoning to arrive at the correct diagnosis or treatment. The end result is that clinical experience become invaluable assets on test day.

2. What textbooks, qbanks, and video series did you find to be the most helpful for each Shelf?

I used UWorld and OnlineMedEd videos for every rotation. OME was useful as a primer or high-yield review. I treated UWorld as an interactive text and tried not to pay attention to percent correct or incorrect. I also took at least one NBME for most rotations to get a feel for how clinical concepts in each field might be tested. I did not find NBMEs to be useful predictors of Shelf scores.

3. Did your prep vary a lot from shelf to shelf?

For all rotations, I tried to pick one “bread and butter” text and one text that focused on finer points, details, and nuances. These were most often Case Files and PreTest, respectively. My prep for each Shelf was pretty consistent: daily reading and questions with one or two NBME practice exams one to two weeks before the shelf. For longer rotations, like medicine, I took two NBMEs. Our shelf exams were always in the afternoon, so I would watch OME videos the morning of the test to target my weakest areas for each subject.

Here were my main resources for each rotation:

Family/Outpatient Medicine
Case Files and PreTest

Neurology
Case Files and PreTest. In this particular rotation, these two resources really shined.

Psychiatry
I used First Aid for the Psychiatry Clerkship exclusively and found it sufficient for the boards and the wards. Whatever you end up using for this rotation, make sure it’s been updated to reflect changes in the DSM-5.

Pediatrics
Case Files and PreTest. This shelf is broad and difficult, but I found that reading up on patients was especially helpful for this shelf.

Ob/Gyn
Case Files, PreTest, and First Aid for the Obstetrics and Gynecology Clerkship. I found the First Aid for this clerkship to be useful as a quick reference while working through the other two texts.

Internal Medicine
Step-Up to Medicine and UWorld. Because this is the broadest shelf exam, I chose a more comprehensive text. Medicine is the largest category on UWorld, so there are plenty of practice questions to work through.

Surgery
DiVirgilio’s Surgery: A Case Based Clinical Review was the only text I studied for the shelf. What makes this one of the best shelf-prep texts for any rotation is a case-based structure that not only explains the reasoning for the most likely diagnosis and treatment but also why other diagnoses and treatments are less likely or appropriate. It will feel like reading a medicine text, but remember – the Surgery Shelf is about knowing which treatment options to exhaust before choosing surgery, as well as pre- and post-op care. For learning about specific operations and the questions you might be asked in the OR, read Surgical Recall.

4. Did you have a set study schedule that you followed for Shelf prep?

How did you work this into your rotation schedule? At the beginning of each rotation, I identified the resources I wanted to use and tried to divide the number of pages to read or the number of questions to work through by the number of days available for studying. I had a daily goal to work towards, which was really helpful because it gave me a sense of whether I was covering enough material daily. I always tried to leave a couple of days right before the shelf for dedicated studying, and I tried to work in an NBME practice test 1 to 2 weeks before the shelf. I made studying a daily habit, even if I knew I didn’t have time to hit my goal on a particular day. Any progress is better than no progress!

Don’t underestimate the value of clinical duties as a learning experience. I was amazed at how many times I used my clinical experience to answer questions on shelf exams and Step 2 CK.

5. How did you manage reorganizing it when things didn’t go as planned?

Despite the best planning and strongest commitment to a study schedule, there were many days where it was just not possible to meet my daily goals. There were a few where I couldn’t study at all between clinical duties, other obligations, and sleeping. When I missed a day, I tried to make up the missed work over the next day or two. Bigger schedule disruptions required a more thoughtful evaluation of my progress and goals before reworking my study plan. In some cases I could increase my daily goals for the rest of the rotation, but there were a couple of times where I had to completely rework my study plan for the time I had left before the shelf. These were times where I had to think about which resources were highest yield for me personally and then focus on those for the rest of the rotation. For example, I might focus on more detail-oriented resources in a rotation where I felt comfortable with the fundamentals, or I might choose to abandon a nitty-gritty, nuanced resource in order to make sure I had a grasp on the core concepts in a rotation where I was having trouble learning the material. Flexibility is key.

There is no shame in reworking your study plan as you go!

6. How do you recommend students prepare their own study schedules in light of busy rotations and other commitments?

Even though 3rd year schedules are busy and unpredictable, I recommend setting specific daily study goals. Work hard to meet your goals daily, and use days off from clinical duties or free time to catch up or work ahead. To use these daily goals effectively, you have to make peace with the fact that you will frequently miss your daily goals due to factors beyond your control. That’s a lot to ask of med students, who are typically planners and goal-oriented to a fault! But the advantage of having running daily goals is that it gives you a concrete sense of how far ahead or behind you are in your studying. Above all else, don’t be afraid to change the plan if your timetable won’t permit you to get through all the texts, question banks, and videos you wanted to cover. In that case, decide what resources serve you best, and make those your focus. Ask yourself: Do you learn more doing questions or reading text? Can you afford to focus on more advanced material or do you really need to master the fundamentals in your remaining time?

I made studying a daily habit, even if I knew I didn’t have time to hit my goal on a particular day. Any progress is better than no progress!

7. How should people use practice tests to prepare for Shelf exams?

Practice tests and questions are just that: practice! Resist the temptation to use them diagnostically. All of my NBME practice scores fell within two points of each other, but my raw and percentile shelf scores were much more widely distributed. UWorld and other questions banks are created with an educational objective in mind for each question. They are incredibly useful learning materials. The NBME practice exams are made up of retired test questions from actual shelf exams, so they are your best glimpse into what your shelf exam will be like. Try to take at least one practice exam a week or two before the shelf exam. No matter what your score, remember that you still have one to two weeks of studying. If you can’t fit one in that far in advance, try not to take a practice exam in the last few days before the real deal. Bombing a practice exam right before test day can get you trapped in a very bad headspace!

8. How can students stay motivated throughout MS3?

To stay motivated, remember a few things: you’re human, plans change, and experience teaches. As a human being, you need to sleep and fight stress. Sometimes there’s more benefit to an extra hour of sleep or a little time enjoying a hobby or the company of loved ones than banging out a few more practice questions. Realize that when you first create your study plan, there is no way for you to know exactly how feasible it will be to get through it all while balancing everything else in your life. There is no shame in reworking your study plan as you go! Finally, don’t underestimate the value of clinical duties as a learning experience. I was amazed at how many times I used my clinical experience to answer questions on shelf exams and Step 2 CK. Read up on your patients, pay close attention on rounds, and ask questions about diagnostic and treatment processes.

Third year is tough, but it’s a once in a lifetime learning experience. Good luck out there!

  • Barrett H.

Final Thoughts from Cram Fighter

Barrett’s approach involves sticking to a study plan, but acknowledging that changes and interruptions are bound to happen. At Cram Fighter, we strongly agree and recommend thinking of your study schedule as fluid. That’s why we invented the ability to rebalance your schedule so you can get back on track automatically when you fall behind. We find that students rebalance 10 times on average over the course of their study plan, so be prepared for the unexpected!

In agreement with Barrett, we find that Case Files and PreTest are some of the most popular resources to use when studying for the Shelf exams. To see a complete list of stats, visit cramfighter.com/stats.