By Ravish Amin

The internal medicine shelf exam is the most important exam for medical students because it tests your knowledge of the most common medical concepts encountered on rotations such as cardiology, gastroenterology, hematology/oncology, rheumatology, pulmonology, neurology, nephrology, infectious diseases, endocrinology, and primary care medicine. These subjects obviously form a majority of questions and answers on shelf exams, but it’s important to develop core strengths in subjects most interesting to you by devoting extra effort and time to details that could increase scores. While it’s nearly impossible to predict what combination of questions your shelf exam will include, implementing the following study methods may help you get started, and with enough review, prepare you for the shelf exam.

  1. Disease, Symptoms, Treatment – A huge amount of medical literature is available on every concept in internal medicine, yet shelf exams frequently test the highest yield content or the content most relevant to patient care. Initially, I advise looking over multiple board review books such as NMS medicine, FIRST AID for Internal Medicine, CRUSH Step 2, Kaplan, and Pocket Medicine, all of which provide the same information in different formats, which can help you retain important concepts. Next, while studying, focus on diseases, symptoms, and treatments. Compare these across multiple sources.  Most importantly, understand and recite important facts. Next, minimize the number of medical sources by combining medical concepts into one source while making sure you didn’t miss high yield terms.  
  2. On-Wards Studying – While on the wards, the observation of patient health, patient charts, and records on medical history or data from physician reports on lab tests, ECG, radiology images will provide the information you need to solve medical puzzles. Go early into wards or stay late reviewing patient charts and take notes in FIRST AID.  Observe and learn visually. This method may help you avoid cramming and helps minimize buzzwords, which are used less often in question stems. Study in groups and ask questions of attendings, residents, and fellows on difficult concepts.
  3. Q &A Practice – While on rotations, complete Q&A from USMLE-Rx for the internal medicine subjects and use technology to supplement learning. For example, use the USMLE-Rx flashcards app to review common facts and set up a schedule to do daily question and answers. Do 25 questions as group study and 25 test-simulated questions daily. Prioritize subjects you score higher on and develop a log of review topics or cram facts before exam.  Internal medicine shelf exams frequently emphasize clinical content and answer choices require reviewing labs, studies (imaging, ECG), physical exams, and patient presentation to determine appropriate treatments.
    1. Review lab, images, and physical exams from question stems. Write down differential diagnoses which include how to differentiate between answers.
    2. Analyze groups of answer choices and review the differences between answers to determine how authors formed the questions. Determine the requirement of each question; is the question asking you: Provide the most appropriate next step? What is the diagnosis? What is the treatment?
    3. Analyze all of the given information within each question stem –not seeing the t-wave inversion on ecg or focusing on one abnormal lab value could cause you to miss other subtle clues in the question. Develop a method to review and validate all clinical data, and make sure you know either the normal or abnormal signs or the lab values of diseases to get the right answer. Determine your answers according to the severity of each patient presentation. 

Good luck!

Comment below and tell us about your go-to study method for preparing for the internal medicine shelf exam