You’ve made it through your first couple of years in medical school and the USMLE Step 1, and your next set of hurdles are tests you’ll take after each clinical rotation, called Shelf exams. As with most of medical school, the Shelf exams can be challenging if you aren’t aware that they’re coming and don’t know how to prepare correctly for success. We’ve put together a set of FAQs to get you on the right track for assembling an effective Shelf exam strategy.

1. What is a Shelf exam?

Simply put, a Shelf exam is a standardized exam covering material on one of a range of subjects and assembled by the National Board of Medical Examiners (NBME). The material covered by these exams primarily include basic sciences and clinical sciences.

2. What does “Shelf exam” stand for?

The “Shelf” in the name Shelf exam isn’t some sort of clever acronym abbreviating a longer name but is actually a reference to one source of questions that appear on the exams. The NBME subject exams sometimes include retired, or ‘shelved,’ questions from the USMLE Step 1 and Step 2 CK, hence the colloquial term “Shelf exam.”

3. How important are Shelf exams?

Shelf exams are a crucial step to overcome during medical school. As a standardized set of examinations from the National Board of Medical Examiners, the Shelf exams are arguably the most objective metric for assessing a student’s problem-solving and clinical skills. However, the way in which Shelf exams are used is left up to each medical school and therefore can differ from one institution to another.

The NBME Shelf exams in and of themselves are not required for licensing—unlike the USMLE Step exams—but medical schools frequently use the Shelf exams for assessing clinical proficiency from clinical rotations, or medical clerkships, and successful completion of these rotations are a licensing requirement. Similarly, the Shelf exams covering basic sciences may be incorporated into lecture or laboratory courses on related material.

A typical way that Shelf exams are used is to assign some portion of the overall clinical rotation or lecture course grade (usually 20-30%) to the corresponding NBME subject (Shelf) exam. In other words, the Shelf exams are certainly important, but just how important is determined by your specific medical school.

4. What happens if you fail a Shelf exam?

Because medical schools often use the Shelf exams to measure their students’ proficiency from clinical rotations, failure of a Shelf exam can risk failure of the rotation for the corresponding clinical subject. For the basic science (non-clinical) NBME Shelf exams, a failing grade may result in failure of a lecture or laboratory course. It should be noted, though, that because of the variable way that Shelf exams are employed in different institutions, failing a Shelf exam does not necessarily translate into not passing that rotation or course. Additionally, institutions have the option to allow students to retake Shelf exams. If your medical school allows retakes, if you fail a Shelf exam, it is advisable to retake it within 90 days of your first attempt. This is because initial Shelf scores can be completely expunged and replaced with the retake score if the retake occurs within 90 days after the original exam.

5. How do you study for Shelf exams?

Studying for the Shelf exams will require a fair amount of planning and incorporation of knowledge gained from your clinical rotations. Given the large range of material that might be on a given exam, you will want to work in a form of studying—whether reading, note-taking, flashcards, or doing Qbank questions—at some point every day. A carefully planned study schedule, like those you can create with Cram Fighter, will help you make sure that you’ve sufficiently covered the right material. It can be especially difficult to sort through the full range of study resources on your own, so take advantage of our customers’ most popular Shelf exam resources and see what other students used for their Shelf exam prep. In addition, explore these blog posts in which we interviewed two med students who share their advice on how they prepped for their Shelf exams and Step 2 CK during rotations.

6. How are Shelf exams graded?

According to the NBME Clinical Science score interpretation guide, the clinical Shelf exam grading format will report your score as an equated percent score from 0% to 100%. The equated percent score indicates what fraction of subject matter questions you would answer correctly at your level of proficiency, and this is adjusted depending upon question difficulty. Currently, the mean score ± one standard deviation for US and Canadian medical schools is approximately 75 ± 9. Your score report, or performance profile, will provide not only your equated percent score, but also a graphical breakdown of your exam performance by subtopics covered on the exam.

Getting ready to take Shelf exams this year? Try Cram Fighter free for 7 days and create your own schedule today.