By Ravish Amin

Are you in the beginning stages of preparing for the family medicine shelf exam? What patients did you see on rotations? Do you have the right books and core knowledge? This blog post will review important tips and study methods designed to help you ace the family medicine shelf.

It’s important on the family medicine rotation to familiarize yourself with the broad topics you may encounter on the shelf exam. Personally, I found it very useful to create my own clinical case vignettes while diagnosing patients on rotations in the outpatient clinic.

Often, the family medicine shelf has subspecialty topics such as migraines, dermatology, physical medicine, and rehabilitation, which may all be incorporated into your core family medicine rotations.

Here are three main tips for success:

  1. Develop differential diagnoses on flashcards: While reading, pay special attention to the differential diagnoses for various presentations. I found it helpful to write down differential diagnoses while on the wards, in the outpatient clinic, doing practice question and answers, and during lectures. While the preference of technology each student uses to study varies, adding a daily review of flashcards or the use of an image atlas may provide enough varying perspectives to help you grasp difficult concepts.
  2. Maximize clinic & question/answer time: The challenge of learning all of family medicine is daunting because the depth of material is so great. To help you identify your strengths and weaknesses, it may be beneficial to spend ample sessions in the outpatient clinic. Ask frequent questions of your attending physicians, residents, nurses, and other healthcare professionals while in the clinic or on wards. As an example, if you see several diabetic patients, immediately go and do some endocrinology question and answers, make flashcards, develop the differential diagnosis, and figure out your knowledge needs so that you can study wisely. Ask mentors open-ended questions about how to approach most common cases of diabetes, hypertension, psychiatry, neurology, migraine, ENT, OB/Gyn, and sports medicine to optimize studying. Board review questions may repeat high-yield concepts, which are in most books, but presentations vary and limited time will require you to absorb all of this knowledge from different sources to become an efficient learner. Important topics to cover include:
    1. Cardiology: ECG, Acute Coronary Syndrome, Angina.
    2. OB/Gyn: Care of Pregnant Patients
    3. Pulmonary Medicine: Chronic Lung Disease: COPD, alveolar diseases
    4. Nephrology: CKD, Nephropathies.
    5. Connective Tissue Diseases
    6. Diagnosis and Treatment of Foot Conditions
    7. Lab Review of Hematologic Cancers
    8. Diagnosis and Treatment of Hepatobiliary Diseases
    9. Pediatric Musculoskeletal Study
    10. Outpatient Presentation Of Vascular Diseases
    11. Respiratory Tract Infections Differential Diagnosis
    12. Wound Care and Skin Ulcers
    13. Psychiatric Assessment
    14. Head & Neck – Eyes, Nose, Throat Differential Diagnosis
  3. Study source selection (in addition to class lecture notes)
    1. Question and Answers: USMLE-Rx QMax, Blueprints Family Medicine
    2. Vignettes, Cases: Case Files Family Medicine
    3. Broad Review: CURRENT Medical Diagnosis and Treatment, AAFP Review articles.
    4. On the Wards: Boards and Wards, Pocket Medicine
    5. Online: USMLE-Rx Step 2 QMax

While internal medicine questions and answers are geared towards core medicine, family medicine is more fun because it provides the instant satisfaction of treating both complicated and everyday patient cases. I suggest going into rotations prepared with an idea of what you want to learn rather than expecting to see interesting cases, and don’t forget to follow up on the topics after rotations.

Maximize your use of practice questions because these are the highest yield and the first step to get you on the right track. Often, it’s familiarity with the differential diagnoses that requires extra cramming to select the best answer (e.g.: causes of secondary hypertension).

Again, the most important aspect here is to know what content you have to know before every opportunity (patient encounter, Q&A, clinical facts learned from physicians, residents). Overall, family medicine is one of the most fun exams to study for!

Good luck!