Shelf exams on a time crunch

I freshly remember the horrors of third year. As if clinical rotations weren’t daunting enough, we had NBME shelf exams we had to study for and excel on after every core rotation. I was always on a time crunch during my third year rotations and I thought I would take some time to share my strategies for passing each shelf exam on the first try.

Failing a shelf exam is a rather common occurrence and I personally don’t think it indicates much about a person’s ability to practice medicine. For those with crazy rotation hours it’s sometimes just not that feasible to get through all the reading. While failing a shelf exam is not the end of the world (especially if you pass the remediation), it’s a lot less stress to deal with before Step 2 if you can pass it on your first try. Just as a heads up, I took my shelf exams during the 2015-2016 school year. 

Here’s how I approached studying:


This exam is heavy on management given different labor scenarios and also on gynecologic issues and treatment

  • Know the USPSTF recommendations for OBGYN topics (i.e. mammography guidelines, pap smear guidelines, vaccine guidelines, STD testing, etc)
  • Read through as much of Case Files for OBGYN as you possibly can. They do a great job of reinforcing key concepts and this was the only book I really had time to read on the clerkship. I got through about 50 cases before the exam.
  • Do the OBGYN UWORLD Questions twice (if you have time to write out notes, that’s a bonus)
  • Many have also recommended doing the practice questions on the ACOG website but I never had time to actually get to those
  • If you still need some more basic OBGYN info, the First Aid for Step 2 CK book has some great information


I walked out of this exam feeling extremely confused and yet I got my highest score on this shelf. There are a surprising amount of pediatric diseases tested on this exam. The key here is to know the characteristics of each disease really well such that you can recite the criteria that differentiate them (i.e. Schizoaffective disorder vs Schizophreniform vs Schizophrenia). 

  • I read through First Aid for Psychiatry once to get a primer for the topics (it’s a quick read)
  • I did all the UWORLD questions for Psychiatry once
  • I re-read First Aid for Psychiatry, focusing on the topics I highlighted the first time
  • I re-did all the UWORLD questions
  • I watched Emma Holliday Ramahi’s Psychiatry review video and took notes on a printed copy of her powerpoint presentation (FYI she was my lifesaver for third year)

If you have extra time, you could also read Case Files for Psychiatry. I personally only read through about 5 cases. OnlineMedEd also has some good psychiatry videos, but once again I only had time to listen to a few of them. People have suggested using Lange questions for preparation but I never got around to them. The UWORLD questions are easier than the shelf exam itself but if you study the material hard enough, I believe you will be able to navigate your way through the exam.


I thought this was a very difficult exam. It covers a breadth of topics but one I thing I wish I had studied more were genetic disease and rashes.

  • I printed out Emma Holliday Ramahi’s review powerpoint and listened to her lecture as a primer
  • I then started doing UWORLD and taking notes on key topics
  • I listened to Emma Holliday Ramahi’s lecture again to reinforce topics
  • I tried to do a second run through of UWORLD questions but I really didn’t get through too many questions

I did not get to study for this exam in as much detail as I would have liked because this was a very hectic time for me. If you have time, I would recommend reading through BRS Pediatrics and doing the Pre-Test Pediatrics questions. OnlineMedEd has some excellent videos for Pediatrics (which I unfortunately didn’t get time to watch).

Family Medicine

Many people had scared me for this exam, so I tried really hard to study for this one and actually ended up with a pretty good score.


This exam is basically Internal Medicine. I did pretty well on this exam but I feel I would have done better if it had overlapped with my IM shelf studying.

  • I read through Pestana’s once
  • I did all the UWORLD questions and annotated in the surgery section of Master the Boards
  • I read through Pestana’s again
  • I re-did all the UWORLD surgery questions
  • I skimmed over the surgery chapter of Master the Boards that I had previously annotated
  • I watched Emma Holliday Ramahi’s review video for both Surgery and Internal Medicine. As before, I took notes on printed copies of her review powerpoint.

Internal Medicine

This was my last shelf exam because I am interested in Internal Medicine and I was scared about failing this shelf. It covers a LOT of material and I wish I had more time to study for it, but things eventually turned out okay.

  • I read through the Internal Medicine sections of Master the Boards
  • I did about 500 UWORLD questions in Internal Medicine (very Cardio & GI heavy)
  • I watched Emma Holliday Ramahi’s Internal Medicine review video and took notes on a printed copy of her powerpoint
  • I tried to re-do some UWORLD questions but didn’t get through too many the second time
  • I read through about ten cases in Case Files for Internal Medicine and it seemed like a helpful book but I didn’t get time to finish it completely
  • If I had more time to study, I would have simply read Step up to Medicine and done as many UWORLD questions as I possibly could have. Having this exam towards the end of the year really helped to jumpstart studying for Step 2.


Good luck with your third year shelf exams and feel free to ask any questions you may have!


{The picture in this post was taken in Erie, Pennsylvania after my Psychiatry shelf}

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