OK, so I have my first clerkship shelf exam coming up next week. Finally, my three months of inpatient internal medicine is coming to an end. I say finally because, as much as I enjoyed learning how to practice medicine, I really am coming to dislike constant rounding.
Anyway, my question. Where did y'all find the time to study for the shelf exams? I've been averaging between 12 and 14 hour days and haven't had a lot of time to study. On the few days I have off, I feel drained and haven't had much motivation to study anything other than the 'just-in-time learning' stuff I need to study up on my patients.
I started medicine with great plans. I bought NMS medicine, First Aid for Medicine and Pretest. I've forced myself through the biggie chapters (cardiology, pulmonary, GI and nephrology) in both books and will finish up Pretest. This is just SO much less than I studied for my previous exams.
I feel so inadequate (and, sadly, have insufficient energy to care all that much). Did anyone else have these same issues?
Thanks and take care,
PS, I took my medicine OSCE the other day. It was a 10 station, four hour exam. It had 5 stations with standardized patients and 5 stations that would test us on those patients. We'd go in to see the patient and do a focused history and physical in 15 minutes. Then we'd go to the next station and either fill out a scantron answering questions about our findings, differential or plan or present the patient to a faculty member.
My patient's problems included anemia, syncope, chest pain, RUQ pain and new onset DOE.
While I think it was challenging, I think it was fair and a good representation of what we've been expected to know and do on the wards. The fourth years tell us this was the hardest of the OSCEs. Yeah!
I studied a major Internal Medicine topic each week. Since I had 12-weeks of medicine, I had plenty of time to cover and recover the major stuff. One week was cardiology, then gastroenterology, then pulmonology, infectious diseases, rheumatology, hematology, nephrology, oncology and endocrinology. I used High Yield Internal Medicine as my study guide. I also read and memorized the MedStudy sections for each of the above. I used the Medical Student MKSAP for my questions. If you can answer all of the Medical Student MKSAP questions you have to honor the Internal Medicine shelf exam.
Another useful resource is Medicine Recall by James Bergin (UVA cardiologist). Everything is covered there and you can tear out several pages and stuff them into your coat pocket for down time. You can get all of your reading from Medicine Recall. I read about everything that my patients had in my big text (Harrison’s). Since I was on both Cardiology and Infectious Diseases, I got some good stuff like Toxoplasmosis in an AIDS patient and acute MIs all over the place. If my patient had Ulcerative Colitis, I read in depth about UC in Harrison’s. If my patient had emphysema, I read everything about emphysema. I just used Harrision’s for my in depth reading for patient care. I used Medicine Recall for everything else and I studied from MedStudy outlines. There is one for each major topic in Internal Medicine. They are pretty detailed and have questions at the end.
My neurology was a 4-week separate course but if neurology is mixed in with Internal Medicine, use the MedStudy outlines. They are really complete. Some folks used Baby Cecil’s but that was too much reading for me.
The shelf exam for Internal Medicine was pretty evenly divided with the above stuff. I also knew that most of USMLE Step II is Internal Medicine so I spent a pretty fair amount of time getting the IM into my brain.
Most folks thought the Internal Medicine shelf was the hardest of all the shelf exams. I thought the Family Practice shelf exam was the hardest. Most of my classmates who went into Internal Medicine thought Surgery was the worst shelf exam. I thought Surgery was pretty easy. I guess it comes down to where your interest lie.
If I had to rank my shelf exams from hardest to easiest: Family Practice; Internal Medicine; Neurology; Pediatrics; Surgery; OB-Gyn and Psychiatry.