Effective Study Strategies for Shelf Exams
Written by Andrew Woods
If you are reading this, congratulations, you have (likely) completed USMLE Step 1, COMLEX Level 1, or both and are beginning your clinical education when the real fun begins! Unfortunately, getting to the third year doesn’t mean your exams have stopped. On the contrary, the shelf exams constitute a large part of your grade for the clerkships. According to the 2021 National Resident Matching Program (NRMP) Program Director Survey, “grades in required clerkships” was cited by 74.6% of respondents as a factor in deciding whom to interview, ranking fourth on the list behind the USMLE Step 1 score, the Dean’s Letter, and the USMLE Step 2 score. You have already given yourself a leg up on your peers by finding #InsidetheMatch, so let’s add to your advantage with some tips to crush your shelf exams!
Tip #1: Realize that Studying for Shelf Exams = Studying for USMLE Step 2 and COMLEX Level 2
If you get nothing else from this, I want you to understand this tip: studying for shelf exams means you are studying for your next round of board exams. “Shelf” exams got their name as a reference to the exam having one source for the questions presented on the exam, in this case, either the National Board of Medical Examiners (NBME) or the National Board of Osteopathic Medical Examiners (NBOME). Since these exams are created by the same people that create the board licensure exams, studying for one is studying for the other. Unlike the normal Step 1/Level 1 studying routine with a “dedicated” period, unless you are lucky enough to hold your vacation until the last rotation of your third year (which I recommend if you can!), you will be taking Step 2/Level 2 while also balancing clinical obligations, so it is essential that you study hard for these shelf exams to set yourself up for success later down the road.
Tip #2: The Resource Well Has Dried Up, So Now What?
Our first two years of medical education are highlighted by resource overload. Boards and Beyond, Sketchy, Physeo, Picmonic, Pathoma, First Aid, Anki, UWorld, Kaplan…I’m sure I’ve missed some. Unfortunately for us, the next two years of clinical education are marked by an almost complete absence of resources. I tried Sketchy but found the videos to be far too long to be useful and stick as they did for Step 1. Boards and Beyond has come out with videos for Step 2 and Step 3, and while I will never doubt Dr. Ryan, they weren’t available soon enough for me to get enough use out of them. So that begs the question, now what? For me, I used Anki throughout my pre-clinical education and decided to continue doing so. If you believe that “Anki doesn’t work for me,” I highly recommend you spend an hour or so watching the Anking videos on YouTube to see how to optimize the Anki settings for optimal success. There are pre-made decks just like there were for Step 1/Level 1 studying on Reddit that are easy to find. My school also required us to use Online MedEd which I found to be pretty good for providing the foundational knowledge you need. It is also important to recognize Step 1/Level 1 material is still very relevant to Step 2/Level 2 (except Biochem!). And of course, the number one resource for studying is….
Tip #3: UWorld, UWorld, and More UWorld
The UWorld question bank is known as the gold standard for a reason, and that doesn’t change going forward. I’ll give you a second to grab your vomit bag… there are more questions in the Step 2 QBank than there were for Step 1! My favorite part of this version though is that you can separate your studying into “Step 2 Review” and “Shelf Review.” The questions are the same, but one allows you to target questions towards the shelf exam you are studying for. My advice here is to complete the “Shelf Review” a couple of days before you sit for the shelf exam, that way you can use those last moments to solidify whatever weak points were found. Some clerkships are easier to get this done on though; for example, there are tons of Medicine questions while not a lot of Pediatrics questions. By the time you sit for your shelf exam, you will have seen every concept they can throw at you and be well set up to excel. In addition, you will complete one full round of UWorld before your Step 2/Level 2, which means you can reset the QBank and go for round two in the “Step 2 Review” mode. As always, don’t focus on the percent you got correct, but instead, use the explanations to learn.
Tip #4: Set Realistic Expectations and Forgive Yourself if You Have to Modify
All the advice above may sound great (shoutout to r/Step2 for most of it) but let me fill you in on a little secret…it is really, REALLY, hard to follow perfectly. In fact, it is so hard, that I didn’t follow my own advice! When I began my first clerkship, I thought that I would just divide the number of Anki cards and the number of UWorld questions by the number of days I had before the shelf exam, and complete that every day because fifty cards and ten questions can’t be that bad, right? By the end of my twelve-hour shift on day two, I realized there was no way that I was going to be able to adhere to the schedule that I had created. Even after modifying it several times, there were days where the space bar was more generous than usual, and I didn’t bother opening UWorld. The most difficult part of the third year is balancing your clinical obligations with your academic and personal obligations. At the end of the day, even the most perfect plans can be modified for your own sanity. This year is a marathon, not a sprint, and as I reflect on my own journey, I wish I hadn’t been as hard on myself because at the end of the day, even following half of what is above will have you well-positioned to succeed not just on your shelf exams, but also on your board exams.
**Andrew is currently a 4th-year medical student and the advice provided throughout this post does not reflect the official stance of any organization that he represents or participates in. Engage with Andrew on Twitter @TheAndrewWoods.
