There are few Shelf exams more difficult than the family medicine shelf. The unique thing about family medicine is that it covers – in some way – nearly every topic that you’ll see in your clinical year. There are components of pediatrics, OB/GYN, psychiatry, internal medicine, and surgery. Of course, each of these also has its own shelf exam, underlining how comprehensive the family medicine Shelf is. Additionally, there are family-medicine-specific topics such as preventive guidelines, dermatology, and musculoskeletal complaints that aren’t covered nearly as comprehensively in other rotations. Last, there is a mix of both inpatient and outpatient medicine. Taken together, these factors make the family medicine shelf exam one of the most comprehensive, wide-ranging exams you will take during your clinical year. To make things even more difficult, at many schools family medicine is one of the shortest rotations there is.
Rest assured, this post will give you 7 tips to prepare yourself to not just pass but excel on the family medicine Shelf (and prepare you for your Step 2CK in the process!)
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It’s important to make sure you’re using high-quality resources. It helps to have a resource designed specifically for the exam, especially with all the intricacies noted above. I recommend Case Files: Family Medicine . This is a case-based resource that captures all of the most common and important family medicine topics. By reading all Case Files , you’re nearly guaranteed to get a first pass of all the relevant material.
After this comprehensive pass, you’ll need a question bank to solidify the concepts in Case Files and learn how they are commonly tested. UWorld is currently the gold standard for Shelf review, and I’d recommend it for use on this rotation. You can use their very helpful “Shelf Preparation Mode” to only see family medicine and ambulatory content.
Step Up to Medicine is the last textbook that can be helpful. Step Up to Medicine is an extremely high-yield resource for your internal medicine Shelf, so it’s good to have a copy of it for your clinical year. During your family medicine rotation, it’s helpful to review the ambulatory section of Step Up To Medicine . Additionally, this can be a good resource to clarify any difficult topics that overlap (ie. physiology of heart, liver, and kidney disease).
Given that the exam covers so much material, you may need to utilize one or two more resources to round out your understanding of difficult concepts. The resources you use will be different based on the concept you’re working on. But one that covers many high-yield areas is Online Med Ed. They have videos on pediatrics, OB/GYN, medicine, and surgery that can help you understand common topics on the family medicine Shelf.
Last, you should absolutely utilize the NBME Self-Assessment Services to track your progress and estimate how you might perform on a timed exam. Currently, NBME offers two old tests for you to take and use to guide your study. Take these on Standard Paced mode to simulate the exam and get used to the timing of exams.
With so much ground to cover, you’ll need a clear plan of attack to succeed. Take an hour or so to map out your study schedule. Be sure to set a realistic schedule that accounts for your clinical and personal commitments so you don’t fall behind. Additionally, there are a few tenets to a successful study schedule to keep in mind.
First, start early. From day 1 of the rotation, you should be thinking about the Shelf exam at the end.
Second, see all the material early. This is my biggest tip when studying for nearly any exam. You should have a clear plan to expose yourself to all testable material. In this case, I think a thorough review of Case Files Family Medicine will achieve this goal for you. As part of your schedule, map out how many cases you will review each day in order to complete your review by about halfway through your rotation.
Third, incorporate UWorld. While you may be focused on reviewing content and getting used to your clinical environment in the first few weeks of the rotation, by a week in you should add in UWorld sessions. I recommend doing these in timed blocks of 40 questions. This will simulate testing conditions and reviewing the questions after provides an opportunity for spaced repetition.
Fourth, take the NBME exams. I’d take the first one approximately half to two-thirds of the way through your rotation. Use this to recognize your strengths and weaknesses and guide your studying for the end of the rotation. Take the second one 7-10 days out to get a sense of how you might score on the exam, get used to the exam setting, and recognize any topics that need further review in the last week.
Last, work in a few breaks. Clinical year can be long and difficult, and learning how to work in a clinical environment and study for Shelf exams can be overwhelming. You could study every day, all of the time for the entire year, but this is a recipe for disaster. One of the lessons I learned too late in my clinical year is that a healthy student leads to a more successful student. Sometimes, it’s easy to let your sleep, nutrition, and physical health fall to the bottom of your to-do list to make sure that you have time to study. I’m here to tell you this is a mistake. First, you have all your life to practice medicine, and having a short-term mindset will only lead to failure in burn out in the long term. You may not need a full day off, but make time for social activities, family events, exercise, and relaxation.
Some schools give students a say in the order of their clinical rotations. If this is true at your school, placing family medicine later in the year is one way to improve your odds of success. Having more rotations before the exam helps you tackle the immense breadth of family medicine. Seeing medicine, pediatrics, and OB/GY before you take family medicine Shelf will make these topics less difficult when you encounter them again. This is particularly true if you are interested in matching into family medicine and highly motivated to do well on the Shelf.
One thing that can help you stay engaged in and committed to studying is relating it back to your clinical experience. Throughout your day in family medicine clinic, write down questions or diagnoses that come up that you have questions about. When you get home, read about each of these topics quickly and review the highly tested points. For example, you may see a patient with asthma in clinic. When you get home, review the outpatient asthma medication guidelines that are often tested. In addition to being a great review strategy, this can help you stand out in clinic.
One of the most important things to learn on your family medicine rotation is preventative medicine and vaccination guidelines. You’re unlikely to encounter them in other clinical rotations and they can be difficult to remember. Because they are so specific for family medicine, they’re nearly guaranteed to come up on your Shelf exam more than once. They usually aren’t difficult questions if you’ve reviewed the guidelines and you’ll be frustrated if you’re not prepared on exam day.
Like preventative guidelines, family medicine is when you get the most exposure to both dermatology and musculoskeletal medicine. For dermatology, be sure to review the common rashes that bring someone to their primary care provider. There are key clues to remember each presentation that you’ll pick up on as you study. For example, “oily, scaly” makes you immediately think of seborrheic dermatitis. Additionally, topical treatments for these rashes are highly testable on the Shelf and you only see them here.
The field of musculoskeletal medicine is a bit broader than dermatology. You’ll be responsible for physical exam findings at all the major joints. It’s time to finally learn the knee and shoulder exams! Additionally, these will push your thinking on next best clinical steps (Xray or MRI?) and link in neurology and other systems (hello, radiculopathies!).
In addition to trauma and overuse injuries, family medicine tests rheumatology as part of musculoskeletal medicine. This is your chance to review common manifestations of joint pain such as osteoarthritis, rheumatoid arthritis, and other autoimmune conditions.
Clinical year is tough. If you find studying difficult or are worried about your performance on the Shelf, be sure to ask for help. This can be from your medical school’s education consultant, an upper-level student, or a trusted mentor. They may be able to provide additional support, feedback, and resources that can help you be successful.
Additionally, if you feel you need extra help from a 1-on-1 shelf exam tutor, Elite medical prep is here to help! Set up your free consultation to hear more about how we can help you succeed with your shelf exams here.
I hope you found these tips useful. Family medicine can be one of the toughest Shelf exams there is because it covers so much material. By having the right resources, taking care of yourself, and planning properly, you can do great on your exam!
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