After Rounds
Student Preparing For Exams

A Primer on Shelf Exams

Balancing clinical obligations and preparation for shelf exams is no easy feat. Here’s exactly what the exams are and how you can gear up for success.

The transition to clerkship year is momentous. Gone are the days of watching recorded lectures at 2X speed from home in your pajamas. As a clerkship student, you spend your days in business casual underneath your short white coat, with a stethoscope around your neck and a study aid in your white coat pocket.

One of the hardest aspects of clerkship year is that you have two related but not identical goals: Demonstrate clinical excellence as a member of the team and demonstrate academic excellence on shelf examinations. So, what are shelf exams and how can you ace them?

An Introduction to Shelf Exams

Here’s a rundown of the basics of shelf examinations.

What Are Shelf Examinations?

Shelf examinations are subject-based, standardized exams meant to evaluate knowledge acquisition in the seven clerkships that have been identified as the foundation of medicine: internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry and neurology.

Who Writes Shelf Examinations?

The National Board of Medical Examiners (NBME) — our friends who write the USMLE exams — are responsible for the shelf examinations. In fact, the questions are retired USMLE questions. Individual medical schools purchase these examinations and administer them to their students.


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When Do You Take Shelf Examinations?

Traditionally, students take each shelf exam on the last day of their corresponding rotation.

Where Do You Take Shelf Examinations?

Although these exams are produced by the NBME, there’s no need to take them at a testing center (thank goodness!). These are web-based examinations, and because they’re purchased by your medical school, they’re administered in-house.

How Long Are Shelf Examinations?

These exams consist of approximately 110 questions that must be answered in the allotted time frame of two to three hours.

Why Are Shelf Examinations Important?

The core rotations are the very foundation of medicine. Ideally, each medical student would see and experience all of the aspects of a specialty while on their rotation, but that’s unrealistic. There’s no way to anticipate or predict what your clinical exposure will be. However, there are certain pathologies it’s important to become familiar with, even if you didn’t have the privilege of caring for patients with high-yield diagnoses or management plans.

The shelf serves as a standardized way to ensure that a student has sufficient understanding of a specialty. Each institution approaches clerkship grades in a different fashion, but what’s important to know is that the shelf score is usually a percentage for the overall clerkship grade — in my experience, the shelf was weighted as 20 to 40%, depending on the clerkship, and a high mark was required in order to honor the rotation.

How to Prepare for Shelf Exams

Admittedly, each shelf exam requires a tweak in your study strategy. Here are some general approaches to these exams.

How Do I Split My Time Between Clinical Duties and Shelf Preparation?

One of the hardest aspects of clerkship year is that your focus is divided. Your priority in the clinical space is to care for and learn from your patients. Undoubtedly, what you learn in the clinical space will help you prepare for your shelfs, but it’s by no means sufficient. You have to supplement — the difficulty is when. Although you spend many hours of the day in clinic or on the wards, not all of those hours are active, so you can optimize your time by having a study aid available. Study material that you can access easily on an iPad or your cell phone is usually the most useful.

After you get a sense of what your clinical obligations are, it’s helpful to make a schedule. This schedule should include your resources and the time when you want to complete those resources. It’s important to schedule some time for wellness, but typical schedules are built around studying five to six days out of the week, with a bit more material covered on days off.

Is It Inappropriate to Study Around My Residents or Team?

Not at all. As long as you have finished your clinical obligations, it’s more than appropriate to make use of your time.

What Resources Do I Need to Prepare?

You need two major resources for every shelf: a solid review book and a question bank. For each shelf, there are different recommendations for which book is the best. It’s largely a personal decision, but the most important aspect of the review book is that you can use it to become familiar with pathologies and presentations that you didn’t encounter on the wards or in clinic. The review book serves as your resource to further explore concepts that you identify as weak points when you go through questions. Ultimately, the most important thing is that the questions you use to prepare for your shelf exam are written in the style of clinical vignettes, the format that you’ll likely see on your exam.

Clerkship year is riddled with challenges, from learning your role on the medical team to learning how to prepare for a new style of exam. It’s not uncommon to find your first clerkship and shelf to be quite difficult. It will undoubtedly take time to find your rhythm, but you’ll come to love clerkship year.

Ajibike Lapite

Ajibike Lapite

Ajibike is a Philadelphia based second year categorical pediatrics resident. She has a passion for narrative medicine, advocacy (specifically refugee health and access to care), and medical journalism. She shares advice on how to approach medical school in her series "How to Survive Medical School" on her blog Stilettos + Stethoscopes.

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