Official Internal Medicine Shelf Exam Thread

[pommes]

I ran out of time on the last question on the practice NBME I took. I didn’t take the shelf yet. Have about 16 more days until I have to. Any last minute tips?

Can you pump through more UWorld on timed? And watch Emma Holliday before the test!

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[ciestar]

did any of you have issues with running out of time?

I was cutting it close but was able to answer every question on the exam

 

[Giovanotto]

Is this thread for COMATs or NBMEs? I'm a bit confused reading through this. IM COMAT coming up in a week.

 

[Giovanotto]

Dunno. Who cares. We're merging residencies, let's merge threads .

Same exam, same time frame. What are you doing this last week? And what have you done up to this point? Not sure if I should do a DO specific bank or not (only done uworld so far). Thoughts?

I guess so. I've had this week off :O, so I just started studying for it by doing USMLERx questions (school got it for us) and Zanki Step 2. I will say though, I'm not sure if Zanki is better than Visitor's deck for step 2, I'm finding the Visitor's to be far better aligned with USMLERx at least. Don't really want to pay for the 1-year UWorld subscription, so I'm waiting for another couple months before going that route. How screwed am I? Don't think I'll get much studying after this week, so I may very well be in the "winging it" territory.

 

[ciestar]

I guess so. I've had this week off :O, so I just started studying for it by doing USMLERx questions (school got it for us) and Zanki Step 2. I will say though, I'm not sure if Zanki is better than Visitor's deck for step 2, I'm finding the Visitor's to be far better aligned with USMLERx at least. Don't really want to pay for the 1-year UWorld subscription, so I'm waiting for another couple months before going that route. How screwed am I? Don't think I'll get much studying after this week, so I may very well be in the "winging it" territory.

Zanki is based off UWorld, I love it.

 

[ciestar]

Were you a Anki user the first two years? I couldn’t never get into it but am trying to find new ways to study for third year as time seems to be more finite now

I wasnt and wish i was. My pre-clinical grades were awful.

 

[nebuchadnezzarII]

Lol what are you guys averaging on UW? I'm getting an average of 56-57% (27th percentile). Anyone else around the same area?

 

[nebuchadnezzarII]

In case anyone cares - and for future reference for test takers:
UWorld - 58% correct; 240 Qs left
NBME Form 3 - 68% three weeks out
NBME Form 4 - 69% one week out (lol)
Shelf - 71%

 

[pommes]

Thanks for following up! Form 3 and 4 are under the “Clinical Science Mastery Series”, ya? Sorry for the dumb question, never taken a nbme for 3rd year yet!

Yes! Don't be sorry. Hopefully the new site design will make it more intuitive haha

 

[19pieces19]

Dumb question, just starting the rotation. What are the NMBE's and where do you get those? Have just been doing UWorld.

 

[nebuchadnezzarII]

Dumb question, just starting the rotation. What are the NMBE's and where do you get those? Have just been doing UWorld.

Not a dumb question. Same place where you got the practice NBMEs for STEP 1. https://nsas.nbme.org
I think they shelf NBMEs are under clinical mastery series?

 

[TheIllusionist]

U world- 73% did in first 3 weeks

Next 2 weeks just anotated STEPup2 medicine with answers. Read rapid review path for systems along with it. Goljan is god, even 3rd year.

Then Zanki and Bros entire last month. Listened to Goljan STEP1 and STEP2 on car rides. Listened to kaplan high yield lectures. Also did NBMEs. Scores were: 80, 96, 82, 94. Average= 88

Score: 90

Finished with 5min left. Every single resource gave me answers. But they are also testing algorithms and mechanisms not in common resources. Read uptodate throughout the day on your phone or tablet when stuff comes up, even common stuff. Those were types of things I got wrong. My background going in was also very strong because I honored everything else and had done stuff like read divirgilios twice and listen to pestana 3x in surgery.

All Hail Papi

 

[Reperfused]

U world- 73% did in first 3 weeks

Next 2 weeks just anotated STEPup2 medicine with answers. Read rapid review path for systems along with it. Goljan is god, even 3rd year.

Then Zanki and Bros entire last month. Listened to Goljan STEP1 and STEP2 on car rides. Listened to kaplan high yield lectures. Also did NBMEs. Scores were: 80, 96, 82, 94. Average= 88

Score: 90

Finished with 5min left. Every single resource gave me answers. But they are also testing algorithms and mechanisms not in common resources. Read uptodate throughout the day on your phone or tablet when stuff comes up, even common stuff. Those were types of things I got wrong. My background going in was also very strong because I honored everything else and had done stuff like read divirgilios twice and listen to pestana 3x in surgery.

All Hail Papi

Listen to pestana? I thought pestana was only a book?

 

[TheIllusionist]

Listen to pestana? I thought pestana was only a book?

free audio book w/ trial on audible

and he also has his own lectures like Goljan. they are really good. they follow his book. try to find them on the interwebz. worth it

 

[MerYangBey]

Took it last week
Score 93
Resources-
Uworld medicine question (minus a couple sections I had done earlier in the year)
Used AMBOSS library to look up stuff I got wrong
(I had surgery and family medicine already which helped)
Overall I think Uworld is sufficient to do well especially if you have internal med later on in the year.
Good luck!

 

[AMB94]

U world- 73% did in first 3 weeks

Next 2 weeks just anotated STEPup2 medicine with answers. Read rapid review path for systems along with it. Goljan is god, even 3rd year.

Then Zanki and Bros entire last month. Listened to Goljan STEP1 and STEP2 on car rides. Listened to kaplan high yield lectures. Also did NBMEs. Scores were: 80, 96, 82, 94. Average= 88

Score: 90

Finished with 5min left. Every single resource gave me answers. But they are also testing algorithms and mechanisms not in common resources. Read uptodate throughout the day on your phone or tablet when stuff comes up, even common stuff. Those were types of things I got wrong. My background going in was also very strong because I honored everything else and had done stuff like read divirgilios twice and listen to pestana 3x in surgery.

All Hail Papi

Goljan has STEP 2 audio lectures?

 

[AlteredScale]

For DO students:

I did SU2M early on and read it as much as possible. Personally I thought it read quite well and the pearls on the side are great.

I did COMQUEST on my second month and created a word doc of short 1 sentence pearls id learn from reading the answers. If I got questions wrong I would go to the topic in SU2M, read it and try and mentally go through the pathology, dx, and tx. I ALWAYS made sure I understood the difference between “next best step” which can be inferred as the quickest and most efficient thing to do now vs gold standard which is what other diagnostic modalities are tested against.

I ended up honoring this one at >115 (NBOME COMAT scores)

 

[thecomeback2019]

took the shelf last week, had 2 fill in the blank questions where i had to type in the answer and also was not allowed to highlight in these 2 questions. are these experimental or would the nbme be moving towards theses in the future curious.

 

[ciestar]

took the shelf last week, had 2 fill in the blank questions where i had to type in the answer and also was not allowed to highlight in these 2 questions. are these experimental or would the nbme be moving towards theses in the future curious.

They released a bulletin about a year ago that they were adding a max of three of these style questions to the IM shelf.

 

[mistafab]

Got an 87 on this beastly exam. I think that’s around 90th percentile.

Resources were just zanki and uworld. Matured the whole IM deck and then got through about 60% of uworld (saved some for my FM rotation and step 2.
Took an average of 2 hours a day to study 6 days a week for 2 mo. Not too much work but it was definitely tough at some points on the wards.

 

[shinsoochoo]

Got an 87 on this beastly exam. I think that’s around 90th percentile.

Resources were just zanki and uworld. Matured the whole IM deck and then got through about 60% of uworld (saved some for my FM rotation and step 2.
Took an average of 2 hours a day to study 6 days a week for 2 mo. Not too much work but it was definitely tough at some points on the wards.

How many cards were you doing per day over an 8 week period?

 

[mistafab]

I think I stuck to around 40 new cards per day and all reviews.

How many cards were you doing per day over an 8 week period?

 

[shinsoochoo]

I just took it and feel empty right now lol. Did any of you feel a correlation between the practice exams and the shelf? I got 72, 79, 79, and 79 on 3-6. I ran out of time on the actual exam. Did others feel the same?

 

[Epicurusall]

Would someone mind posting the percentile chart given with this year's shelf exams? Really wanna see how the raw score matches up to percentiles and how we'll be graded

 

[Shirafune]

Would someone mind posting the percentile chart given with this year's shelf exams? Really wanna see how the raw score matches up to percentiles and how we'll be graded

https://www.ttuhsc.edu/medicine/documents/policies/SOMOP30.01.A.pdf

I've been using this for my clerkships, and it has been pretty close to the actual percentiles I've received.

 

[ace_inhibitor111]

Is step up to medicine really that great? They’re recommending cardioversion or transcutaneous pacing for asystole and I’m wondering if there’s other crazy stuff in there.

 

[Epicurusall]

Is step up to medicine really that great? They’re recommending cardioversion or transcutaneous pacing for asystole and I’m wondering if there’s other crazy stuff in there.

All you need to honor the shelf is UWorld. If you've got the time to read a textbook probably Cecil's or if you want shorter do Kaplan notes

 

[thehopefuldoctor23]

I just took it and feel empty right now lol. Did any of you feel a correlation between the practice exams and the shelf? I got 72, 79, 79, and 79 on 3-6. I ran out of time on the actual exam. Did others feel the same?

Can I ask how you ended up doing?

 

[justheretodownloadstuff]

7 week clerkship - 2 weeks general medicine, 2 weeks specialty #1, 3 weeks specialty #2

Resources used: UWorld IM, WiWa (anki), NBME CMS forms 1-6, Emma Holliday

Advice: UW and Anki is all you need to build your foundation. Suspend all cards prior to the rotation, do ~20 UW questions/day, un-suspend/create relevant cards as you progress through UW, review your cards as consistently as possible. No textbooks, no OME, no [insert other MS3 recommendations].

If you space out your studying and use Anki even moderately consistently you should easily knock this shelf out of the park. By the time I took the IM shelf I still had 150 IM questions left to complete, I hadn't seen the ~200 renal & GI questions since I did them during my July/August surgery rotation, and I still had 1/3rd of the WiWa IM deck left unseen. Oh, and I'm not some gifted student; I bottom quartiled every block of M1-M2 and scored dead average on Step 1. If my half-assed attempt at studying doesn't convince you that UW + Anki is the best and most efficient study method to do well on shelf exams then idk what else to tell you.

Emma and the CMS forms fit into the equation as resources to use at the end of your rotation to get you into shelf mode. Emma is pound-for-pound the most high yield resource to use for the shelf; probably 20ish questions from her PPT popped up on the shelf (watch the video with it). It's significantly more useful when you already have a solid foundation from UW + Anki so you can pinpoint info that isn't covered by those resources because you can be sure that the NBME will test it. There was a particular infectious disease concept that popped up multiple times on the shelf that Emma covered but UW didn't.

Verbatim from my surgery shelf review because it still applies: do the ****ing practice shelf exams (CMS forms). It doesn't matter if you're trying to just pass or if you're trying to honor; if you walk into that shelf without taking all of the CMS forms you're leaving lots of free points on the table. The style of NBME questions is nothing like UW. The CMS forms prepare you for that unique style of questioning, they allow you to practice your test-taking skills, and they give you free points on the real deal through direct repeats and repeat concepts.

Impression: felt like the easiest shelf of the year by a long shot (have already taken surgery, OBGYN, psych, and neurology), which surprised me since everyone and their mother says this shelf is insane. The scope of information that can be tested on this shelf is so broad that they only go surface deep with each respective topic. The questions don't come near the level of depth or difficulty of UW IM questions so it should feel like a walk in the park if you've been using UW + Anki consistently. Soooo many repeat concepts popped up from the CMS forms that I was able to answer tons of questions within seconds of reading the last sentence of the stem because I had essentially already seen the question before. The only surprise to me was that I had 6 biostats questions, which is the max allowed per shelf based on their content outline. Back on the surgery shelf I had to pull out all my test-taking strategies to answer questions, but only a handful of questions required that level of effort on this shelf. Idk what else to say really. If you do what I outlined above and don't panic on test day I think you can easily demolish this shelf.

Scores:

• UWorld IM: 74%
• NBME CMS Form 1: did not score, used for extra practice questions
• NBME CMS Form 2: did not score, used for extra practice questions
• NBME CMS Form 3: 22 (79)
• NBME CMS Form 4: 26 (90)
• NBME CMS Form 5: 24 (85)
• NBME CMS Form 6: 25 (87)
• IM Shelf: 93 raw - 100th %ile

 

[Taxonomy]

U world- 73% did in first 3 weeks

I sometimes think only top 1% of gunners post here on sdn - I just can't do all 1400 IM questions from UW in 3 weeks of IM rotation - that's just God level of skills needed to do so many UW questions in whatever time is left after IM shifts in 3 weeks.

 

[TheIllusionist]

I sometimes think only top 1% of gunners post here on sdn - I just can't do all 1400 IM questions from UW in 3 weeks of IM rotation - that's just God level of skills needed to do so many UW questions in whatever time is left after IM shifts in 3 weeks.

I didn't read explanations much. I just blazed through and read explanations slowly with anki when reviewing rest of the time. works for me but not everyone

 

[ASGD1983]

Can anyone clarify what does my 73% raw score means please? I was also given adjusted score of 89%, but I'm confused how to interpret them? Did I hit a national average for IM for this year or not? Thank you
Exam was doable, but a bit more harder than I expected.

 

[recycledpaper]

I think it is pretty self explanatory that you got 73% right without a curve (73 questions right out of 100 total, as an example), and when adjusted for the curve, you scored 89%. So yes, you got higher than the national average, which would be an adjusted score of 50%.

 

[ASGD1983]

I think it is pretty self explanatory that you got 73% right without a curve (73 questions right out of 100 total, as an example), and when adjusted for the curve, you scored 89%. So yes, you got higher than the national average, which would be an adjusted score of 50%.

Thank you! I think I got confused when I saw in attached pdf file (someone posted this file in this thread earlier) on page 5 - it shows that 73 raw was roughly about 45% to 56% percentile depending on which quarter is current. Figuring out percentile correlations is harder than exam itself lol.

 

[FlowRate]

Scaled scores are not any sort of percentage unless they've changed shelf exams in the years since I was taking them. That they're on a 100 point scale just makes it confusing, but thing of a shelf score the same way you think of a step score, except you don't know what the scaled score compares to in terms of percentile. (Some schools use percentile for your school, percentile for competitor schools, percentile nationally, etc.)

 

[CyrusHabs7695]

Anybody have/know where to get Step up to medicine 5E pdf?

 

[lj_99]

How do raw percentages for the NBME CMS practice exams compare to the real IM shelf exam? I've been hitting the raw percentages (on offline forms 1, 2, and 3) I need for the real thing, and am hoping I'm not getting lulled into a false sense of security!

 

[Noemata]

IM Shelf Write-up

Ah, the IM Shelf, aka Step 1.5

Score: >90th percentile

Rotation Breakdown: 2-month elective space followed by 4 weeks wards, 2 weeks subspecialty, 2 weeks ICU.

Resources: Zanki Step 2, UWorld, NMS Medicine Casebook, Emma Holliday, Divine Intervention Podcast, NBME practice forms, OnlineMedEd IM videos, thehymedicine.com NBME form explanations, NBME "Sample Assessment Items" for Subject Exams.

This shelf can technically ask you any question from your first three years of medical school. I had my IM rotation last in third year, so I feel that really helped. I will attempt to detail how I studied for this shelf. Reading about other people's experiences helped me tremendously, so I'm hoping this would help clerkship students preparing for this exam.

I had a two month elective space before my IM rotation, during which I read NMS Medicine Casebook completely (yes, I skipped SU2M and other recommended textbooks). I highly recommend this book. The details are way beyond what the shelf could ask for, but this book covers everything you should know. I also did about 10-15 UW Qs a day, which left me with a manageable 500 or so UW Qs by the time my clerkship started. I also finished the Zanki deck (500 or so cards) before my clerkship started.

And once the clerkship started, I finished the UWorld Qs and did all the incorrect Qs, managed to get through a second pass of the NMS Medicine Casebook, and did my flagged Zanki cards (140 or so). For shelf exams, I usually do 20 UW Qs a day in tutor mode for an hour, with another half-hour or so for review. I also supplemented this with Emma Holliday's IM shelf review and the Divine Intervention IM podcasts (4 parts). These five videos cover the most high-yield stuff that you just have to know. You have to make sure you can remember the details and knowledge contained in all these resources — skimming over a resource is not useful if you want to do well. Not as high yield but as a strong foundation, I watched and reviewed any remaining IM OnlineMedEd videos during the rotation (50 or so).

I also did the NBME forms 3-6 and my scores on those forms were consistent yet the newer ones (Forms 5 and 6) seemed tougher. Forms 5 and 6 under predicted my actual score by about 4-5 points. The order I would recommend is Form 3, then Form 5, then Form 4, then Form 6.

The week of my shelf, I reviewed all the NBME forms and quickly skimmed through thehymedicine.com IM NBME form explanations, mentally noting down what concepts are tested frequently. I also did the NBME "Sample Assessment Items" for Subject Exams two days prior to the Shelf.

I know this is a lot, and people have obtained higher scores with less studying so you probably don't need to do this much to get a good score, but I'm someone who had real trouble breaking past the 50th percentile on some of my previous shelf exams, so I really went all in for this one, and it was enjoyable to actually learn medicine along the way! The 2 month elective space and IM being my last third year clerkship played a big role. All this studying also helped me with my clinical score and boosted my confidence on the rotation, which was a double bonus. For specific questions, feel free to PM me.

Good luck with your rotation!

 

[Dr. USMLE]

IM Shelf Write-up

Ah, the IM Shelf, aka Step 1.5

Score: >90th percentile

Congrats!

 

[FalconSlice]

I had recently gotten much interest on my Step 2CK write-up and was requested my individual shelf prep/experiences, so I'll do a mini-series of listing the pertinent resources I used, how and what I did, and other things. Here goes for IM:

IM Shelf: >99th percentile

Resources: UWorld, SU2M

Approach: Having had an extremely solid foundation from Step 1 (that I took about 5 years prior) was very helpful and, for me, compulsory to do well on this shelf. That being said, I prioritized flying through UWorld as fast as I could. Before the rotation started, I had already read SU2M (actually I wished I did this immediately prior to third-year) and did the questions in the back of this book. Furthermore, I had already finished over half of the UWorld questions before this rotation started. This allowed me to do two things: 1. I wasn't rushed to finish the UW section, and 2. I was able to integrate and review material in a more holistic way with my day-to-day clinical duties (i.e. rounding, presenting, etc.). The key is to use as few number of resources as possible, learn them as deeply as possible, and repeat. You can use the practice shelf exams that NBME sells or you can save it for Step 2 dedicated. I did some, but largely I wished I would've saved all of them for Step 2 dedicated. YMMV.

Actual shelf: Rather straightforward, felt exactly like medium-difficulty UW questions (around 75%), really hard unknowable questions (5%), and other rotation related medicine questions (10%). The other ten percent were a mix of family medicine questions. There were some outlier questions like ethics and bio stats as well. Finished with about 20-25 minutes left on the clock which I mainly used for the 5-10 really hard questions.

The way I prepared, I never had to cram or stress about covering material the day before the exam. However, shelves are long (around three hours), so I hope you have stamina. I had enough training from doing questions in long sessions throughout my third year.

 

[Noemata]

I had recently gotten much interest on my Step 2CK write-up and was requested my individual shelf prep/experiences, so I'll do a mini-series of listing the pertinent resources I used, how and what I did, and other things. Here goes for IM:

IM Shelf: >99th percentile

Resources: UWorld, SU2M

Approach: Having had an extremely solid foundation from Step 1 (that I took about 5 years prior) was very helpful and, for me, compulsory to do well on this shelf. That being said, I prioritized flying through UWorld as fast as I could. Before the rotation started, I had already read SU2M (actually I wished I did this immediately prior to third-year) and did the questions in the back of this book. Furthermore, I had already finished over half of the UWorld questions before this rotation started. This allowed me to do two things: 1. I wasn't rushed to finish the UW section, and 2. I was able to integrate and review material in a more holistic way with my day-to-day clinical duties (i.e. rounding, presenting, etc.). The key is to use as few number of resources as possible, learn them as deeply as possible, and repeat. You can use the practice shelf exams that NBME sells or you can save it for Step 2 dedicated. I did some, but largely I wished I would've saved all of them for Step 2 dedicated. YMMV.

Actual shelf: Rather straightforward, felt exactly like medium-difficulty UW questions (around 75%), really hard unknowable questions (5%), and other rotation related medicine questions (10%). The other ten percent were a mix of family medicine questions. There were some outlier questions like ethics and bio stats as well. Finished with about 20-25 minutes left on the clock which I mainly used for the 5-10 really hard questions.

The way I prepared, I never had to cram or stress about covering material the day before the exam. However, shelves are long (around three hours), so I hope you have stamina. I had enough training from doing questions in long sessions throughout my third year.

Phenomenal score, congratulations!