If you’re in the middle of clinical rotations, you might be wondering how in the world you’re going to make time to study for shelf exams in medical school. Trust me, you’re not alone! 

M3 year is one of the most difficult parts of your med school journey so far. Not only are you expected to be a standout student who helps take care of patients, answer difficult questions on rounds, and help out with tasks around the hospital, you also need to make sure you’re retaining everything you’ve learned during rotations.

I get it—making the time is not easy. I remember a time when I was a third-year medical student during my surgery rotation, where I didn’t finish until 9 p.m. for three nights in a row! When I got home, it felt impossible to find the time (and willpower) to study for my shelf.

While it might be tempting to put off studying until the last minute, you’ll thank yourself later if you start studying early on (and with a solid plan). After all, you take shelf exams in medical school for a reason—they’re designed to gauge what you’ve absorbed during your rotation, and also help you build a foundation of knowledge for Step 2!

If you’re approaching your medical school shelf exam and aren’t sure how to gauge where you are in your studying, use this quiz to find out whether you’re ready for exam day (or if you still need more time to prepare).

Ready to ace your shelf? Take $10 off the Shelf Exam Qbank of your choice with the promo code SHELFREADY and get 500 NBME®-formatted questions, plus a mock exam, personal analytics, and more! 💪

🏥 Emergency Medicine
👨‍👧‍👧 Family Medicine
😷 General Surgery
🫀 Internal Medicine
🩻 Neurology
🫄 OB/GYN
🧒 Pediatrics
🧠 Psychiatry

Common Shelf Exam & Medical School Study Mistakes

If you’re struggling with your prep, check out these common shelf exam study mistakes to see if we can diagnose the problem:

1. Forgetting to check the exam’s content blueprint

One of the top mistakes students make before their shelf exams is studying the wrong material. 

To stay on track, most rotations will have a content blueprint that outlines the information that should be covered throughout your clerkship (and will likely appear on your shelf exam). You can use this blueprint to guide your studies towards the most important concepts!

2. Trying to “DIY” your exam prep

While DIY projects can be fun in your spare time, we definitely don’t recommend applying them to your med school exams. 

Rather than putting together your own study guide from a textbook alone, we recommend using a specific resource created with your shelf exam in mind using the content blueprint. (We personally recommend the Blueprint Shelf Qbanks mentioned above!)

3. Relying on how long you’ve studied rather than the effectiveness of your studying

Can you spot the difference between these two students?

Student A: Studies for six hours while watching a movie and passively answers questions.

Student B: Actively interacts with questions and carefully reads each explanation for three hours, fully immersed with their phone out of sight.

You probably guessed that Student B is going to be far better off on their medical school shelf exams, even with fewer study hours. This approach is called deliberate practice, which helps make better use of your limited time (and makes it easier to correct any practice questions you missed previously).

4. Relying on isolated practice questions rather than practice exams

While isolated questions are great for studying on-the-go and building up your knowledge, practice tests are the best way to practice your test-taking skills and have a “dry run” of your exam day. 

Practice exams allow you to set up in a test-like scenario with a time limit and take an extremely similar test to what you will see on your actual shelf exam. 

5. Memorizing instead of comprehending the material

Instead of simply memorizing the concepts on your Anki cards, take one step further and think about how they apply to patients. How does this relate to other parts of medicine? Where have you seen this before?

Remember, the body is interconnected, so approach your studying more as a system working together (rather than isolated facts).

Don’t forget that learning from your patients and your team is also a huge component of your studies!

6. Lacking a study plan

As I mentioned before, rotations are taxing and your time will be limited. Having a well thought-out study schedule will help you organize your day, sticking with it consistently will boost your confidence before your exam!

7. Not seeking help until it’s too late!

If you’re feeling overwhelmed with a rotation or not reaching where you want to be on your practice exams, I highly recommend seeking help as soon as you can. Specialized medical school shelf exam tutors can be your greatest cheerleaders and help mitigate the stress planning, clarify concepts, and help develop effective studying habits and test taking strategies. You’ve got this!

Congratulations! You’ve completed Step 1 and you’re ready to get started on wards. But now you have a new challenge to face: the shelf exams you need to complete at the end of each clinical rotation. 

These tests are written by the National Board of Medical Examiners (NBME), the creators of the Step exams. Since many schools integrate the score you receive on a shelf exam into your final score for a rotation, they can make the difference between an “honors” score or a “high pass.” In fact, some programs require you to achieve a minimum score on a shelf exam to even be eligible for honors.

So shelf exams matter, and doing well on them is important for your success.

Unfortunately, given how big a milestone Step 1 is, many students focus on it to the exclusion of everything else, and have either not heard of shelf exams or they’ve given them little thought prior to the start of their first rotation. If you’re in this camp, don’t worry—that’s why we’re here!

This blog is a simple guide to answer frequently-asked questions about the shelf exams, such as “How long is a shelf exam?” and “How many questions are on a shelf exam?” We’ll also show you how to develop an effective and systematic approach to NBME shelf questions. 

Let’s begin!

Which rotations have a shelf exam?

There are seven core clinical rotations you’ll complete throughout your third year of medical school, including internal medicine, family medicine, general surgery, neurology, pediatrics, OB/GYN, and psychiatry. 

These rotations are standardized across the United States and are required to be completed by every medical student. Elective rotations, as they’re not standardized or required, don’t have NBME shelf exams, but they may have other (school specific) tests/assignments.

How long is a shelf exam?

Each shelf exam is 165 minutes long. 

How many questions are on a shelf exam? 

Each shelf exam has 110 multiple-choice questions. 

These are much shorter than the Step exams you’ll take—for comparison, Step 2 is eight blocks of (at most) 40 questions, and there are a total of 318 questions on the exam. 

Wondering if you’re on track with your shelf exam prep? Take our FREE quiz from our Blueprint experts to find out!

How do I study for shelf exams while also working in the hospital?

Balancing shelf exams with clinical rotations is the most difficult problem third-year students face. You’re expected to be an effective member of a medical team for many hours a week, on top of studying for the shelf exam, as well as Step 2. Then, towards the end of the year, you’ll need to start working on residency applications!

Luckily, you can rest assured that during your rotations, you’ll be learning material that’s relevant for shelf exams and Step 2. But how can this be done when you’re at the hospital? 

Well, I recommend making it a goal to learn something new from every patient you see. For example, take note of the lab values of one patient with cholecystitis vs. a patient you see with choledocholithiasis, and try to connect those values with biliary anatomy and where the likely pathology is.

You’ll also need to dedicate time outside of the hospital to preparing as well. You’ve learned the bulk of medical material during the first two years of medical school preparing for Step 1, now is when you start to learn management, next steps, and what medications to give. 

A regimen of practice questions with a critical review of the explanations will be an extremely valuable resource that’ll help you get used to shelf exam/Step 2 style questions. Additionally, reviewing flashcards during your few moments of downtime in the hospital is a great way to keep learning and prepare for your tests.

Looking for a Qbank that combines your shelf & Step 2 studying all in one place? Meet Blueprint’s combined Step 2 & Shelf Exams Qbank with 5,500+ high-yield questions that most represents what you’ll see on your actual exam. Get started with 7-day FREE access!

What’s the best way to approach shelf exam questions?

Something that’ll benefit your entire career is developing a systematic method of reading X-rays, EKGs, and evaluating patients you do every single time so you don’t miss anything. 

The same is true for how to approach NBME questions. I’ll summarize my recommended method below, but in the end, you have to decide what you’re most comfortable with. 

Here’s the step-by-step approach that I take: 

1. Read the questions first.

This will help focus your thoughts. Should you be thinking of the best next step in diagnosis? A treatment? Statistics? These questions will be answered by reading the questions first.

2. Glance at the answers.

This will tell you the genre of the question. Whether the question will be about cardiology, pulmonology, ID, etc., can be seen by looking at the answers.

3. Look at the bottom third of the stem.

Most shelf exam questions have a similar structure, where the pertinent physical exam findings, pathology, and more can be found in the bottom third of the question. It’s convenient when you see that a patient was started on a certain medication, and you already know the question is “What is the mechanism of action of this medication?”

4. Review labs/images.

Now is when it’s a good idea to check any labs or imaging that may be available. At this point, you may have a good idea what the diagnosis is—and possibly the answer. 

5. Read from top to bottom.

After you’ve done your initial review of the question, if you don’t know the answer or more information is needed, reading the question from top to bottom will give you the few extra details you need to be fully confident in your answer.

This approach helps guide your thinking to the answer, instead of starting from the beginning without knowing what kind of question you’re dealing with. It’ll help you actively engage with the text and use details as you go to help solidify an answer you already formulated. 

I call this the “pre-charting” method, because it’s similar to a physician checking a patient’s chart and gathering information about their medical history, labs, and imaging so they possibly have a good idea of the diagnosis prior to meeting them. 

Whichever method you choose, make sure you use it consistently and for every question, so you don’t get lost in difficult questions and miss an important detail that would’ve helped you get to the correct answer.

Final Thoughts 

We hope now that you have answers to FAQs such as “How long is a shelf exam?” and “How many questions are on a shelf exam?” your mind is at ease and you’re feeling a bit more confident. Keep the answers to these FAQs in mind during third year, and you’ll not only learn everything you can from your patients, you’ll be a step ahead when it comes to studying for the shelf exams. 

Best of luck on your rotations!

After successfully completing college and all the classes and extracurricular activities it entails, now it’s time to prepare yourself for the next step: medical school. But what, exactly, will that be like? And what do you learn in medical school? 

Medical school curricula can vary widely, but there’s a rough template they’re all based on. In this post we’ll examine the standard course of a medical school education, so you can have a good idea of what to expect as you embark on your journey to becoming a physician. 

Let’s get started by taking a look at what you’ll learn during the first two years of medical school, known as the “preclinical years.”

Year 1 & 2: Preclinical Years 

Luckily, the first two years of medical school (the preclinical years) tend to be much like the college education you’re used to. Lectures, presentations, and more all make their return. 

The first part of the preclinical years tends to be focused on getting a foundational knowledge on how the human body works. Courses on anatomy, biochemistry, pharmacology, pathology/histology, and more start to build what will become an immense fund of medical knowledge. 

The second part of the preclinical years focuses on organ systems and learning their specific anatomy, pathology, and their treatments. You’ll also take courses that highlight patient-physician interaction, how to develop physical exam skills, interprofessional interaction, racism in medicine, international medicine, and other topics about the medical field. 

These courses are integral to becoming a well-rounded physician with a full understanding of the healthcare system and the patient you’re caring for!

Transition from undergrad

The transition from the college classroom to medical school can be challenging because the volume of material you’re expected to learn is so much greater. 

Luckily, many schools have small group study sessions to help you add clinical context to the material you’re learning. These are also excellent opportunities to learn from your peers and practice your public speaking skills through presentations and group discussion. 

While at home, you should plan on spending a significant amount of time studying third-party material, as well as course-specific content to ensure you understand everything and succeed on final exams. 

Step 1 

At the conclusion of your preclinical years, you’ll take the first of three board exams, Step 1. This covers all your classroom material from the first two years of medical school. 

For the past several years, this test has been pass/fail, but it shouldn’t be underestimated. Study hard for it. The knowledge you gain from Step 1 studying will be valuable in subsequent phases of your medical career. 

How should you prepare for Step 1? 

There are many strategies when it comes to studying for Step 1. The most important thing is to pick the right study resources. I’m a proponent of using a small number of high-yield study tools. Questions banks are excellent resources for practicing the types of questions you’ll encounter. Be sure to pay attention to the answer explanations, as they contain a lot of valuable information. 

A good flashcard deck will help you remember lots of facts, and using “spaced repetition” when studying them will ensure you have access to the information they contain come test day. 

One or two supplemental resources that cover high-yield topics will help round out a great study regimen. Finally, practice tests are a must when it comes to exam preparation. Check out this blog post I wrote about how to use practice tests for Step 1!

After passing Step 1, you’re ready to move on to the clinical years and get into the hospital! Let’s take a look at this second phase of your medical training, so you’ll know what to expect. 

Years 3 & 4: Clinical Years

The clinical years are a significant change from the classroom learning you’re used to. Now you’ll be learning from patients, residents, attendings, nurses, pharmacists, and many more while you’re “on the job.” 

This is when you’ll learn how to work in a hospital. You’ll be learning just as much about patient interaction, coworker communication, and the “art” of medicine as you will about disease, differential diagnoses, and treatments. You’ll need to learn what makes you most efficient and effective in the operating room or on the wards. 

This time in your medical school career may come with some growing pains as you make mistakes, get subjective evaluations, and work many hours. Going in with the mindset of trying to learn something from any patient, formulating good questions, and being willing to accept and implement feedback can take you a long way. 

Shelf Exams & Step 2

Despite spending most of your time seeing patients, formulating plans, and getting questioned about all sorts of minutiae, you’ll still need to study specific material during each rotation for its “shelf” exam. 

Luckily, you’ll be learning and implementing much of your knowledge in the hospital, but it’ll still be important to have a study regimen to ensure nothing is missed in your learning and to practice the types of questions you’ll be asked. I suggest using a quality question bank with good explanations and a flashcard deck you can review in your spare minutes at the hospital, like the combined Step 2 / Shelf Qbank from Blueprint Prep.

It’s difficult to study for shelf exams when you’re so busy, but it’s something that’s to your benefit in the end. The knowledge you’ll acquire is important for Step 2, the second board exam of your medical career, which is a summation of what you’ve learned during your clinical years (building on top of your Step 1 knowledge, too!). So think of shelf studying as investing in your future!

Final Thoughts 

What do you learn in medical school? A lot. But you can do it! 

Overall, medical school is a rewarding, challenging, material dense, and fast-paced environment. It requires you to use the same skills you developed in college and to refine them even further. 

Remember, have a structured study schedule with spaced repetition to avoid cramming information at the last moment. Go with the flow and take it all in as you enter the world of medicine, and you’ll do well!

As you progress through medical school and the structure of your educational curriculum evolves, how you learn will also change. The most dramatic transition happens when you start your clinical rotations. In the process, you move from classroom-based or online learning with content developed by your medical school (e.g., lectures, online modules, and labs) to more experiential learning immersed in patient care.

This entails a year-long series of blocks, each comprehensively covering specific areas of healthcare to teach you how providers in these fields practice. Notably, exams remain built into the curriculum, but in contrast to preclinical tests developed by your school, these are often standardized “shelf exams” produced by the National Board of Medical Examiners (NBME).

To make sure you’re as prepared as possible for your clerkships, read on to learn more about what shelf exams are and, even more importantly, how to study for shelf exams.

What are shelf exams? 

Most of your rotations for clerkship year will culminate in a shelf exam. Typically, these exams have 110 multiple-choice questions. Each question has a single best answer and you’ll have 165 minutes to complete the exam. 

What is tested on shelf exams?

In contrast to the questions on the United States Medical Licensing Exam (USMLE) Step 1, shelf exams focus much more on the care of patients, including how to diagnose and treat diseases. You should expect to be tested on the identification of the next steps in management, utilization of appropriate and cost-effective diagnostic tests, and selection of correct pharmacotherapy. 

In general, the questions are very reflective of the USMLE Step 2 CK. Many have likened Step 2 CK to a sampling of questions from all the shelf exams consolidated into one test.

Wondering if you’re on track with your shelf exam prep? Take our FREE quiz from our Blueprint experts to find out!

What topics are on a shelf exam?

Intuitively, the content of each exam will relate to the field of medicine or surgery you just did a rotation in.For more specific details, the NBME publishes a content outline online that provides a breakdown of the different items tested on each exam. As an example, the outline for the internal medicine shelf exam can be found here. 

It’s important to understand that material can overlap across multiple shelf exams. An important example is the surgical shelf exam, which tends to focus less on procedures or techniques and more on the medical management of surgical patients (e.g., diagnosing postoperative fever or recognizing peritonitis). 

Other examples include concepts at the intersection of neurology and psychiatry or internal medicine and pediatrics. This means that, while earlier shelf exams may be inherently more challenging, shelf exams become easier as you see recurring concepts across specialties.

Which resources should I use to study for shelf exams?

The learning you gain from the rotation itself will go far in your exam preparation. However, these exams are wide-ranging enough that you won’t be exposed to everything that might be tested, so you should supplement your “on-the-job” education with independent study. 

The best advice on how to study for shelf exams? Use Qbanks! 

At the core of your approach to every shelf exam should be a good question bank like Blueprint’s combined Step 2 & Shelf Qbank. This Qbank is tailored to the NBME content outline and emphasizes the high-yield content most likely to appear on the exam in a multiple-choice format that makes the learning active and effective. You can categorize practice questions by shelf exam, while also using it to prepare for Step 2 CK!

Study like you mean it with the new Step 2 & Shelf Exams Qbank, the most representative NBME Qbank with test-like questions to help you pass USMLE Step 2 CK and all your Shelf exams. Get started with 7-day FREE access to 5,500 questions!

What else do I need to know about how to study for shelf exams? 

Beyond using a relevant Qbank, the resources you use will depend on the rotation, as different resources are effective for different shelf exams. Some of our best recommendations are summarized below.

1. Internal Medicine: “Step-Up to Medicine”; OnlineMedEd
2. Surgery: “Dr. Pestana’s Surgery Notes”; “Surgical Recall”
3. Pediatrics: “Blueprints Pediatrics”; “Case Files Pediatrics”
4. Family Medicine: “Case Files Family Medicine”
5. Obstetrics and Gynecology: “Blueprints Obstetrics and Gynecology”; APGO uWISE Program
6. Psychiatry: “First Aid for the Psychiatry Clerkship”; “Case Files Psychiatry”
7. Neurology: “Blueprints Neurology”

Remember: shelf exams are still standardized exams, so good test-taking skills will maximize your performance. You should use techniques such as reviewing the question before reading the vignette and the process of elimination.

As you study, you will pick up quick high-yield clinical pearls like avoiding a computed tomography scan for a hemodynamically unstable patient that will allow you to work through patient management questions quickly. Again, practice makes perfect, so make sure you’re building plenty of practice questions into your study plan.

How do I find time to study for shelf exams?

Another aspect of your clerkship year that is different from your preclinical experience is that you will have significantly less time for studying after a long workday in the hospital. To that end, you want to maximize efficiency in how you construct your study schedule. As with every plan, you should determine upfront how much you want to get done by exam day. 

How can I make a study schedule that I’ll stick to? 

First, consider which materials you will use—you can consult the list above for a starting point. You then simply divide how much time it will take to work through those resources by the number of days before the test to get a sense of what you need to finish daily.

Importantly, you must build in plenty of flexibility for catch-up days, practice exams, and days off.

First off, you may have to work extra hours at the hospital sometimes, and consequently not have much time to study once you get home. Furthermore, you should consider spending a day doing a practice NBME shelf exam or two. These provide an idea of what the exam format and questions will entail and can be purchased here for a small fee.

Finally, it is most important that you schedule days off whenever possible to return to work in the clinic or hospital or to your studying feeling refreshed and recharged.

A great resource that can help you keep track of everything is Blueprint’s Med School Study Planner. It takes all the guesswork out of how much time resources require and constructs a reasonable study plan leading up to your exam day in a user-friendly interface. 

Thousands of medical students use Blueprint’s Med School Study Planner to save hours of planning time, see exactly what to do each day, and ace their med school exams. Get unlimited access today!

The bottom line: Knowing how to study for shelf exams paves the way for Step 2 CK!

This recipe for success on shelf exams will pay off again when it’s time to study for and take Step 2 CK, an exam that borrows questions and concepts from each of the shelf exams and incorporates them into one test. Recall that Step 2 CK will still assign a three-digit score to your performance and know that score has been increasingly important in the residency application process now that Step 1 is a pass/fail exam.

Your study plan for Step 2 CK will center again on a quality question bank in conjunction with the same ancillary resources listed above for each of the shelf exams. Therefore, heading into your clerkship year with a good plan of how you will prepare for shelf exams will pave the way for you to do well on almost all the standardized tests you will have in medical school thereafter, including Step 2 CK.

Further Reading

Looking for more (free!) content from Blueprint tutors? Check out these other posts on the Med School blog:

• Which Are the Hardest Shelf Exams?
• How I Balanced My Clinical Rotations with Shelf Exam Studying
• Best Shelf Exam Study Resources: A Comparison & Breakdown

The following post is a guest blog from a Blueprint tutoring student, Katerina, who successfully passed her Step 1 and shelf exams at the same time with the help of her Blueprint tutor. Hear her story below!

The summer before my third year of medical school, I still felt like I wasn’t ready to take Step 1.

Deep down, I knew I needed more time to build the foundation of knowledge that would allow me to pass the exam.

So…how did I get here?

You see, during my preclinical years, I was learning at such a fast pace I simply wasn’t able to create the solid, long-term knowledge base I needed for Step 1 success.

Additionally, I had difficulty applying my knowledge when answering standardized questions, and I felt like I never really managed to tackle this problem. 

My Decision: Study for Step 1 or Tackle Both During Third Year?

With my third year of medical school looming on the horizon, taking Step 1 seemed less than desirable. But I knew I had to make a decision—do I play it safe and focus on just studying for Step 1? Or do I give myself a shot and see if I can pass it while also studying for rotations?

I had two options: either I would 1) push off starting third-year rotations until January and dedicate the fall semester to studying for and hopefully passing Step 1; or 2) study for Step 1 and third year rotations at the same time.

I chose the latter. Making the decision to study for Step 1 and third year at the same time was a difficult one. I knew that if I was going to do this, I couldn’t do it alone.

Why I reached out for help…

As much as I consider myself an organized and disciplined person, I knew the journey I was about to embark on was going to be a very grueling and lonely one.

That’s when I decided to ask for help. I reached out to Blueprint for one-on-one tutoring. I just needed someone to help me organize my study schedule and hold me accountable if I was going to reach my goals while juggling a million other things.

And let me tell you, it made all the difference!

How My Med School Tutor Helped Me Pass My Exams

1. My study sessions were targeted and productive.

When it came to pairing me up with a Blueprint tutor, I was sent a detailed questionnaire to assess what my goals were.

Soon after, my assigned tutor reached out to me to schedule our first session. I met with my tutor about once a week for 1-2 hour sessions.

We reviewed specific high-yield topics, or topics I maybe wanted to review a little further. We also focused on practice questions and question strategy.

The PowerPoints were direct and very interactive, so I didn’t feel like I was just being lectured. Being able to then apply the knowledge we just discussed with practice questions really helped hammer down the content.

2. My tutor was flexible to my schedule.

My Blueprint tutor was always receptive to my school schedule and the importance of taking time to recharge, so she was always very realistic when helping me curate my daily study plan. 

3. My tutor was on my team!

It was also really comforting knowing I had someone on my side, holding me accountable in keeping me motivated and disciplined every step of the way. It made a huge difference during a really isolating process.

Wondering if you’re on track with your shelf exam prep? Take our FREE quiz from our Blueprint experts to find out!

4. My tutor helped me balance my shelf exam and Step 1 preparation.

At the start of my two-month internal medicine (IM) rotation, I did more Step 1 than IM practice questions.

As I got closer to my IM shelf exam, I focused solely on IM. The benefit of starting with IM was that it was really helpful in preparing me for Step 1. The disadvantage was that IM is long hours and has the most Qbank questions out of all the rotations.

The weekend after my shelf exam, I passed my first Step 1 NBME practice exam! That’s when I decided to book my test.

As a side note, I do want to highlight the fact that I was honest with the residents I was assigned to during this rotation. I let them know that I was studying for Step 1 and if there was ever any down time, I’d appreciate it if they would let me study.

The reason I want to mention this is because there’s no reason to feel ashamed or embarrassed for not taking and passing Step 1 during the dedicated period. Everyone is on their own timeline and sometimes it may take longer for some than others and that’s ok!

So, don’t be afraid to ask for help or tell your attending or resident that you’re still studying for Step 1. More likely than not, they’ll want to help you.

5. Blueprint’s Med School Study Planner helped me manage my time.

As much as I made them aware of my situation (and they were extremely understanding of it) I still gave them 100% of my effort on the rotation. I chose to study for both simultaneously, however, that didn’t mean I could slack off.

So, this is when I really had to manage my time well and I created a detailed schedule in my Google Calendar of what I planned to tackle each day.

I also utilized the Blueprint’s Med School Study Planner to help check off my daily tasks. With the unpredictability of my rotation schedule, there was variability in the amount of time I was able to dedicate to studying each day. The study planner allowed me to redistribute tasks with ease to ensure I met my goals for each week.

6. My tutor helped me at a crucial moment. 

At some point during my next rotation (OB/GYN), I was sensing a bit of burnout. I was exhausted, but I wasn’t quite sure how to handle it.

That’s when my tutor realized that I had to slow down. So I started taking one day off each week. And I mean a real day off. I didn’t do any studying that day. It was just what I needed to recharge my battery and continue moving forward.

I know you’ve heard it before and it’s easier said than done, but REST IS PRODUCTIVE! You have to make self-care activities, whether it’s going to the gym or going to therapy, a priority. Your body knows when it’s about to hit its breaking point and we want to avoid that as much as possible. Medical school is a marathon, not a sprint!

7. Working with a tutor gave me a sense of control.

I kept up with my practice exams and Qbank practice questions as I continued to approach exam day. How did I know I was ready?

Well, you never really feel ready. I remember the week of my exam just feeling so done and wanting to get over this exam. I wanted test day to be the last time I had to see a Step 1 question. As much as I was nervous, my gut was telling me I was ready, so I decided to stick with my scheduled exam date.

No one goes into Step 1 knowing everything, but I was confident that I had the prep tools I needed to succeed. And I’m so grateful to say that my hard work did pay off that day!

My Advice to Med Students Considering a Tutor

Now, this isn’t to say everyone should follow in my footsteps, because unfortunately I do know people who have and didn’t pass Step 1. At the end of the day, it comes down to what YOU think you can handle and don’t compare yourself to anyone else.

If you choose to push off third year rotations to study for Step 1, do it. No path in life is linear, there are many twists and turns, but as long as you don’t give up on yourself, you will reach your goal of becoming a doctor.

The bottom line is, make the decision that’s right for YOU! No one knows you better than yourself. No matter what you decide to do it will be hard and frustrating, but lean on your support system and most importantly trust yourself.

And if you need help, don’t be afraid to ask for it, because once I decided to ask for help and make the investment to work one-on-one with a Blueprint tutor, it was a game changer in helping me reach my goals.

So, that’s my story. I share it with you so you can see where one path can lead. Best of luck on your journey, and remember, do what you think is best for you. And reach out to a Blueprint med school tutor for help if you need it!

Looking for more (free!) articles to help you through med school? Check out these other posts on the Blueprint Med School blog:

• Why Asking For Help Is Your Greatest Strength in Med School
• Open These Love Notes to Help You Through Med School 💙
• What Happens if I Fail Step 1 (Now That It’s Pass/Fail)?

Clinical rotations are an exciting time that most medical students look forward to. With them comes the exhilaration of hands-on learning, patient interactions, and teamwork alongside residents and faculty. 

Another, perhaps less enjoyable aspect of clinical rotations are the shelf exams that come at the end of each one. They can be particularly difficult for new clinical students.

Shelf exams are difficult for a variety of reasons. Each shelf exam for the core clinical rotations is different, and the tests cover broad content that requires extensive understanding of medicine and clinical applications.

Additionally, most students transitioning to clinicals are used to preclinicals and the protected study time that came with it. Preclinical years were all about going to class (in-person or attending virtual lectures) or let’s be real, just reading the notes or spending all day on flashcards. 

By contrast, clinical rotations differ drastically and include long hours, sometimes even overnight and weekend duty. All of this is physically and mentally demanding and considerably cuts down on study time, not to mention what it does to your overall stamina. 

In addition, rotations have a steep learning curve, as transitioning from the classroom to the clinical environment requires adapting to new responsibilities, protocols, and expectations. Balancing patient care responsibilities, your personal life, and studying for shelf exams is challenging to say the least.

The purpose of this article is to help you navigate your clinicals by discussing what shelf exams are, and the individual characteristics of each one. We’ll also give you a heads-up on which shelf exams are often considered the hardest, and why that’s the case. This information will help you during the demanding grind of your clinical rotations, setting you up for success on the shelf exam that looms at the end of each one.

Study like you mean it with the new Step 2 & Shelf Exams Qbank, the most representative NBME Qbank with test-like questions to help you pass USMLE Step 2 CK and all your Shelf exams. Get started with 7-day FREE access to 5,500 questions!

What Are Shelf Exams?

A shelf exam is a nationally standardized test administered at the end of a clinical rotation in medical school by the NBME (National Board of Medical Examiners). These exams are typically comprehensive and cover the broad material you’re expected to learn during that specific rotation.

Students at my school claim the term “shelf” refers to the fact the exam scores are used to rank students relative to each other, much like placing books on a shelf in order. However, others say that the namesake is because the exams consist of “shelved” (previous and expired) USMLE Step 1 and Step 2 questions from old exams. An older attending mentioned that he coined the name because his attending pulled a book off a shelf in the office and then tested him on it. 

What’s the format & content of shelf exams?

You’ll usually take the shelf exam on the last day of each rotation, with some schools offering a measly day or two of protected study time prior to the exam. Every shelf exam is 110 multiple-choice questions completed in a span of 2 hours and 45 minutes (allowing you 90 seconds per question). Every shelf exam is computer-based and administered using NBME’s testing software.

The content of the exam often includes topics such as diagnostic reasoning, management guidelines, patient ethics, and clinical decision-making within the specialty of the rotation you just completed. Core clinical rotations that require shelf exams may vary by school but typically include internal medicine, family medicine, surgery, neurology, pediatrics, OB/GYN, and psychiatry. Electives, however (such as pediatric radiology), don’t have shelf exams. 

Each shelf exam has a format similar to the USMLE exams and the content for each specific exam can be found on NBME website.

Do I need to ace every shelf exam?

No, you don’t need to ace every single shelf exam. Various schools weigh the exam grade differently, but for honors or high pass on your rotation, you likely will need to score in the top quarter (top 25th percentile).

There are two main reasons why your shelf exams are important and you should aim to do well: clinical grades and Step 2/COMLEX Level 2 preparation. 

Clinical Grades

Typically your overall clinical rotation grade consists of your shelf exam score, your evaluations from faculty/residents, as well as a standardized patient encounter (OSCE). Schools weigh each component differently, but scoring well on your shelf exams will definitely be a boon, especially if you’re seeking the coveted “honors” distinction. For schools with grades and those that have pass/fail clinical rotations, failing the shelf exam will likely lead to a failure on the rotation, and you’ll have to repeat the test. 

From an NBME survey, “institutions require students to pass the NBME subject exams and use the exam scores to determine honors-level performance. Over 70 percent of clerkship directors who include honors in their grading schema use NBME subject exam scores to determine honors-level performance.”

For example, a school may use a 40 percent clinical performance evaluation, 40 percent shelf exam score, and 20 percent standardized patient simulation encounter formula to calculate your final clerkship grade. Keep in mind that your shelf score is the aspect you have control over the most, as evaluations can often be subjective. 

Remember, it’s important to perform well on the shelf and score “honors” if you’re interested in that subject. For instance, those students interested in applying for pediatrics will find it beneficial to score “honors” on their pediatric core rotation. This greatly helps their letter of recommendation writers, and doing well on their pediatric rotation, including the shelf exam, is important for a good dean’s letter. 

USMLE Step 2 / COMLEX Level 2

Similar to the shelf exam content, many of the questions from USMLE Step 2 and COMLEX Level 2 involve clinical reasoning and patient care scenarios (vs Step 1 questions that focus more on basic science knowledge such as biochemistry, physiology and pharmacology). 

Proper preparation and strong performances on your shelf exams will help you establish a foundation of knowledge that you can carry with you for the Step 2 or Level 2 exams. Since USMLE Step 1 is now pass/fail, a stellar USMLE Step 2 score will be useful in distinguishing yourself from other applicants.

4 Variables That Make Some Shelf Exams More Difficult 

So, you can just buckle down like you did during preclinicals, study hard for your shelf exams, and crush them, right? Well, as we’ll see, that’s not exactly true. 

Here’s four things that can make a shelf exam especially difficult:

1. Your rotation schedule 

Clinical rotations often involve long hours, including early mornings, late nights, and weekends. This leaves limited time for studying outside of clinical duties. Furthermore, after a long day in the hospital attending to patients, reading about medical cases, and updating families, you may feel too tired or drained to dedicate additional time to studying.

Keep in mind that clinical rotation schedules may vary from week to week, making it difficult to establish a consistent study routine. You may rotate on inpatient wards for two weeks and then transition to consults and then outpatient clinics. This unpredictability can disrupt your study plans and make it challenging to create a dedicated study schedule. 

2. The content 

 Shelf exams typically cover a wide range of topics within a specific medical specialty or subject area. They’re designed to assess your ability to integrate knowledge from different disciplines, such as the basic sciences, clinical medicine, and patient management. You need to connect concepts from multiple areas to answer questions correctly (as opposed to just rote recall) , which can be challenging.

Moreover, shelf exams require you to apply theoretical knowledge to clinical scenarios. This means you not only need to understand the underlying concepts, but also how to apply them in real-life patient care situations. This involves critical thinking, clinical reasoning, and decision-making skills in addition to memorizing common first-line treatment and diagnosis options, clinical ethics, statistics, and various management guidelines. 

3. Pressure

Shelf exams are timed and you have 90 seconds per question, adding a time pressure element to the challenge. You need to quickly read the question, figure out what it’s asking, recall relevant information, and make accurate decisions within the allotted time, which can be stressful. It’s common for students to misread one word that changes the entire question (we’ve all been there), and the added time pressure certainly can lead to more mistakes. 

Shelf exams are high stakes and often make-or-break your grade, especially for the core rotations, which are impactful. Failing a shelf has consequences for your academic progression and many schools require you to retake the exam and pass it before you’re allowed to move forward.

4. The variability of it all

Each shelf has its own qualities that make it challenging. Most students would agree the surgical shelf is difficult, not only because of its content, but also because of the time constraints the surgical rotations—after all, you’re in the OR or on the floor for 12+ hours a day and barely have time to study! 

Many students also find that the family medicine rotation itself is not too difficult, but the shelf is particularly demanding because it’s so broad and has components from pediatrics, OB/GYN, internal medicine, and psychiatry. 

Wondering if you’re on track with your shelf exam prep? Take our FREE quiz from our Blueprint experts to find out!

Which Shelf Exams Are the Most Difficult?

Determining which shelf exams are the hardest varies depending on individual experiences, strengths, and interests. However, some shelf exams are commonly perceived as more challenging due to their content or format. 

Here’s a ranking of the shelf exams from most to least difficult, but of course keep in mind, this is a subjective list! 

1. Family Medicine

The family medicine shelf exam covers a broad range of topics, including preventative medicine, pediatrics, and OB/GYN, but you can also expect the occasional and random surgical subspecialist question about Lasik, or bariatric surgery. 

Furthermore, there are questions on the exam that cover topics from medical ethics and biostatistics to MSK and dermatology. FM covers bits of every topic you’ll see in your clinical year including pediatrics, OB/GYN, psychiatry, neurology, internal medicine, and surgery. 

It’s best to take this one towards the end of your clinical rotations so you’re well-versed in other areas, but even then you’ll have to recall what you’ve learned so far. 

Another reason many students struggle with the family medicine shelf exam is that most schools rotate students for only four weeks on the family medicine core rotation, meaning you only have four weeks to study for the most difficult shelf exam. For comparison, you’ll have at least eight (or even 12) weeks to study for something like internal medicine, and eight weeks to study for surgery. 

2-4. Surgery, OB/GYN, and Neurology

Surgery, OB/GYN, and neurology are the three next-hardest shelf exams. Their rankings are interchangeable and depend really on your strengths and how your school approaches the specific rotations. 

In no particular order, let’s have a look at each. 

Surgery 

The surgery shelf exam is difficult because it typically covers a range of topics, including general surgery, trauma, critical care, and various surgical subspecialties such as orthopedics (think MSK questions). It requires a strong understanding of surgical principles, anatomy, perioperative management, and surgical techniques.

The challenge is not so much with subjects tested, but rather the lack of time you have to study, since the demanding surgery rotation requires a lot of time (you’ll be spending 10+ hours a day in the hospital). 

OB/GYN

The OB/GYN shelf exam covers obstetrics, gynecology, and reproductive health. It includes topics such as pregnancy complications, labor and delivery, gynecological disorders, and family planning. The exam requires knowledge of both medical and surgical management of obstetric and gynecologic conditions. 

As was the case with surgery, the rigor for OB/GYN comes from the lack of study time, as the rotation itself requires many hours in the hospital, particularly for the weeks on labor & delivery. 

Neurology 

The neurology shelf exam covers the diagnosis and management of neurological disorders, including stroke, epilepsy, multiple sclerosis, neuromuscular diseases, and neurodegenerative disorders. It requires a solid understanding of neuroanatomy, neurophysiology, and clinical neurology. 

This exam is more niche compared to the others on the list so far. You have to dig deep and recall all you learned from neuroanatomy to figure out nerve innervations and nervous system disorders.

Additionally, neurology is commonly a four-week rotation, and the brevity makes adequate preparation all the more challenging.

5-7. Internal Medicine, Pediatrics, and Psychiatry

Again, the following rankings are interchangeable and depend really on your strengths and how your school approaches the specific rotations. 

Let’s have a look at each, in no particular order. 

Internal Medicine 

The internal medicine (IM) shelf exam is comprehensive, covering a wide range of medical conditions across various organ systems. It requires knowledge of acute and chronic diseases, diagnostic tests, treatment guidelines, and preventive medicine.

The exam is often perceived as challenging due to its breadth of content. However, the content overlaps with other shelf exams and schools usually administer IM as an 8-week or 12-week rotation, allowing you plenty of time to prepare.

Pediatrics

The pediatrics shelf exam covers the care of infants, children, and adolescents, including growth and development, common pediatric illnesses, pediatric emergencies, and preventive care. It requires knowledge of pediatric milestones, immunizations, developmental assessments, and management of pediatric diseases. 

This exam isn’t too bad, especially if you have an 8-week peds rotation you can use to study. 

Psychiatry 

The psychiatry shelf exam encompasses a wide range of mental health disorders, each with its own diagnostic criteria, treatment modalities, and management strategies. 

Understanding the nuances of various psychiatric conditions, their presentations, and differential diagnoses can be challenging, but most of the time, the answer is an SSRI. 

Furthermore, most schools have this as an 8-week rotation, so you’ll likely have plenty of time to prepare. 

Further Reading

In closing, I must reiterate the following: perceptions of difficulty can vary based on individual strengths, experiences, and study strategies. Regardless of which shelf exam you find challenging, thorough preparation, reviewing practice questions, and seeking clinical guidance can help you succeed. Best of luck during your clinicals. And be sure to reach out if you need help! 

Looking for more (free!) content to help you ace your shelf exams and rotations? Check out these other posts from Blueprint tutors on the Med School blog:

• How to Study For Shelf Exams: A Tutor’s Guide
• How I Balanced My Clinical Rotations with Shelf Exam Studying
• Day in the Life of a Medical Student: Surgery Rotation

The equation is simple: solid preparation = successful exam performance. Whether you’re getting ready to take the USMLE or COMLEX, dedicating a large chunk of time exclusively to test prep is how to ensure you’ll crush it on exam day. If you don’t put the time in, you’re going to be disappointed—period. So do yourself a favor, and put some serious prep work in for that upcoming big exam!

Of course, you probably already knew you had to take preparation seriously. But this post is about a deeper subject: what, exactly, does it mean to prepare for a high-stakes exam? Is paying attention in class preparing? Is it enough to make a study plan and answer loads of questions?

Not really. When we’re talking about preparing for an exam, we’re referring to something called “deliberate practice.” But what exactly is deliberate practice? In this post, we’ll examine the study habits of two students, Student A and Student B, to get a sense of what deliberate practice is. Then, we’ll look at some ways to incorporate it into your study plan. Let’s dive in!

What is Deliberate Practice and How Do I Use it in Medical School?

Student A vs. Student B: Which One is Using Deliberate Practice?

Let’s set the scene. Two students are working their way through a Step 2 CK Qbank, building their respective knowledge bases in preparation for the big day.

Student A:

Student A answers a question, and dutifully reviews the learning points after getting it incorrect. He nails question two, and decides to skip the explanations for this question. After all, he got it right, and he’s convinced that he knows the material.

Riding high, he does a quick scroll of Instagram, fires off a text, and then moves on to question three. He quickly chooses an answer, and although he got the question incorrect, he knew it was wrong, and only gives the explanations a partial skim to see why.

Student B:

Student B, on the other hand, wants to emulate true test conditions, so she opts for timed mode instead of tutor mode. Rather than ride the dopamine waves of correct and incorrect answers, she’s going to buckle down and focus hard for the duration of the block.

When she’s finished, out comes a notebook and First Aid for Step 2 CK. She scours every answer, whether correct or incorrect, for bits of information that might bolster her knowledge. There are no distractions, the iPhone is on airplane mode, and her noise canceling headphones are on. She annotates any novel snippets she learned into First Aid. And she lists any confusing topics in her notebook so she can visit them later. 

The answer is: Student B!

Can you see the difference between the two? Student A was practicing, and perhaps “giving it their all,” but student B went the extra mile to emulate the action of top performers in all disciplines—she practiced deliberately. 

So, how can you be more like student B, and make sure that the hours and hours you spend each day studying provide you with the most value? In other words, how can you practice deliberately and maximize your study efficiency?

Here’s some tips for making deliberate practice a part of your exam preparation.

5 Ways to Implement Deliberate Practice Into Your Study Routine

1. Cut out distractions.

Distracted learning is inferior to focused learning and deliberate practice. Why would you want to prepare for exams in an inferior manner? Distractions not only pull you away from the task at hand, but necessitate reorienting yourself to where you were before you got distracted. Distractions are the foils of efficiency.

As I prepared for my board exams, nothing was more valuable than putting my phone on airplane mode. With a single click, I could cut myself off from the endless stream of websites, songs, friends, posts, and news stories. The temptation of all the internet has to offer is almost too strong to organically steer clear of. It necessitates a “kill switch.” That hard stop is airplane mode—turn it on!

2. Do a deep analysis of every question.

The cream floats to the top, and the best question banks have the reputations they do because of their content. The top Qbanks will not only let you know the right and wrong answers, they’ll also give you jumping off points to investigate concepts you need to touch up on.

Whether you get a question right or wrong, you need to understand why the correct answer is the right one, and why every wrong answer is incorrect. If you learned something new, write it down to cement the knowledge you’ve gained. Don’t leave it on the table by deluding yourself with the all too common, “I’ll get that right on the exam when I’m really trying.”

3. Have a deliberate plan. 

The effectiveness of your studying today is only as effective as your overall study plan. As painful as it might be, it’s necessary to create a two-six week study plan (depending on which exam you’re preparing for), and stick to it. If you know what you’re going to be working on every day, more time can be devoted to studying instead of asking yourself, “What should I work on now?”

Need help making a study schedule for your USMLE or COMLEX exams? Blueprint’s Med School Study Planner schedules all of your studying for you with the click of a button—check it out!

4. Identify strengths and weaknesses.

Through both self-assessments and question banks, you should be able to identify concepts you feel good about, and those that make you shudder. Your goal is to take that question you hate answering, and turn it into one you’re excited to see.

For example, if antiarrhythmics make you queasy, your confidence will probably plummet if you come across a question that has lidocaine, amiodarone, sotalol, procainamide, and esmolol as answer choices. Put a few hours into getting them completely figured out, so that next time an antiarrhythmic question comes up, you can approach it with confidence instead of trepidation. 

5. Make preparing for the exam your #1 priority.

The only way you’re going to find the buy-in to devote so much time and energy to test preparation is to realize how important the exam is. In the scheme of things, the time you spend preparing for this test will be a fraction of your medical career. And yet, how you do on it will have a huge impact on your career.

Further Reading

Deliberate practice is a superior form of exam preparation. Use it to set yourself up for success on exam day by following these five tips. Of course, feel free to reach out to one of our tutors if you need additional help!

Looking for more (free!) tips to help prep for your med school exams? Check out these other posts from Blueprint tutors on the Med School blog!

• How I Balanced My Clinical Rotations with Shelf Exam Studying
• Step 1 Pass Rates Are Decreasing: How to Make Sure You’ll Pass
• How (and Why) to Use a Qbank to Prepare for USMLE Step 2

Updated January 2024

As a third-year medical student, you no doubt spend a lot of time going through your Step 2 & Shelf Exams Qbank getting ready for your M3 exams. At some point during your study period, you’ve probably asked yourself how your Qbank provider came up with the questions. Who is making sure the content and format is similar to the questions you’ll see on exam day? How are the topics chosen? And how do you know the information in your Qbank is current?

Blueprint Test Prep is excited to share that our NEW Step 2 & Shelf Exams Qbank is now live! In this post, you’ll find more important info about the Qbank itself, how we made it, and how to use it to prep for your USMLE Step 2 and NBME shelf exams.

Study like you mean it with the new Step 2 & Shelf Exams Qbank, the most representative NBME Qbank with test-like questions to help you pass USMLE Step 2 CK and all your Shelf exams. Get started with 7-day FREE access to 5,500 questions!

What’s Included in the New Combined Step 2 & Shelf Qbank?

Blueprint’s brand-new Step 2 & Shelf Exams Qbank features 5,500 questions to help you prepare for your shelf exams and USMLE Step 2, including 4,000 NBME-formatted shelf questions (500 per specialty) and 1,500 USMLE-formatted Step 2 questions.

The new Step 2 & Shelf Exams Qbank is a combined Qbank featuring questions from the Rosh Review Shelf Qbanks (loved by thousands of medical students across the country), plus all-new Step 2 questions to guide you through M3 year. Our high-yield content aligns with all of your M3 exam content blueprints to guarantee your study time will effectively prepare you for exam day. 

In your Qbank, you’ll get:

– 5,500 total practice questions (1,500 Step 2 questions and 4,000 shelf questions)

– Mock shelf exams for all 8 specialties (110 questions per specialty)

– Detailed explanations for both correct and incorrect answers

– Create-your-own practice exams

– Official exam-like interface and experience

– Powerful performance analytics

– Educators on Call to assist with content questions

As you’ll see, creating high-quality, accurate, and updated questions for your Step 2 & Shelf Exams Qbank is a comprehensive process.

Now, let’s dive into how we made the combined Step 2 & Shelf Exams Qbank!

Who Writes the Qbank Questions?

Usually, we find our question authors through our website or hiring boards. We make sure they have the expertise needed to create questions for the Step 2 & Shelf Exams Qbank by asking them to submit a sample question, which our medical editors, aka “champions,” carefully review. These champions assess writing skills, accuracy in conveying medical info, and suitability for our author teams.

To bring together a diverse group of question authors, we actively look for candidates with different professional backgrounds. This way, we benefit from their expertise and real-world experiences, and we get perspectives from clinicians with varying levels of expertise.

For our Step 2 & Shelf Exams Qbank in particular, our question authors come from various backgrounds. We have talented fourth-year med students who scored exceptionally well on their exams (verified by Blueprint), practicing physicians, and specialists with their own areas of expertise all contributing to the Qbank. Plus, all USMLE content goes through rigorous review and editing by board-certified physicians, too.

How Do We Know Our Content Matches the Actual Exam?

We create content that looks a lot like what you’ll come across on exam day. This is done by identifying important topics and the percentage breakdown based on the exam’s blueprint. For example, our Step 2 content was created using the USMLE Step 2 content blueprint. This means the topics we cover in our Qbank reflect what you need to know for the exam.

Furthermore, the number of questions a particular topic has in the Qbank is proportional to how much emphasis is placed on it in the USMLE blueprint. And as previously noted, the shelf exam portion of the Qbank covers all of the content from 8 specialties (500 questions per specialty, for 4,000 shelf questions total). It’s important to note that all of these questions have just been reviewed and updated, so the content is current!

How Does the Editing Process Work for the Step 2 & Shelf Exams Qbank?

Our content drafting/editing process for the Step 2 & Shelf Exams Qbank is rigorous and guided by experts every step of the way. To ensure you are getting the highest quality content possible, every question goes through the following eight steps before you see it in your Qbank:

1. Authors draft the content.

Using exam (i.e., USMLE) blueprint topics, the champions develop learning objectives. An author team will select a particular topic, formulate questions, and submit them for review.

2. Champions complete an initial review. 

The champions review the questions carefully to be sure they address the learning objectives and are well crafted with challenging answer choices. The correct and incorrect answers are reviewed to make sure the information they contain is correct, up to date, and filled with high-yield teaching points. 

After conducting their initial review, the champions will submit questions back to the authors and recommend changes if necessary.

3. A copyeditor reviews the question. 

After the first review is completed, the questions are submitted to a copyeditor. Before the copyeditors fully read through the content, it’s run through a plagiarism checker to make sure the work is original. Why? Because the wording shouldn’t be precisely what you’d read in a textbook or journal article. It’s supposed to be in the author’s own words.

Once the document is checked for plagiarism, the copyeditor gets to work on it. Our copyeditors are trained to pay attention to spelling, grammar, sentence flow, and inclusive language (among other things) to ensure the information is clear, consistent, easy to understand, and respectful toward hypothetical patients. For example, the copyeditor will make sure you don’t see alternate spellings (like “fundoscopic” and “funduscopic”) occurring in the same explanation.

4. The questions are sent back to the authors. 

After the copyeditor has a look at them, the questions are sent back to the author team for revisions.

5. Champions conduct a second review. 

Once the authors make any necessary changes, our medical champions have another look at the questions, and double-check them to make sure they address the learning objectives and are medically accurate. 

6. A second copyeditor reviews the question. 

After the champions review the questions a second time, they are passed along to a different copyeditor for another round of edits. This copyeditor reads through all of the questions and makes further changes to correct any issues with grammar, sentence flow, or word choice.

This editing process also includes making sure we use inclusive language in all of our practice questions. We’re passionate about using inclusive language because everyone deserves to be treated with respect, whether they’re in a clinician’s office or reading about a hypothetical patient in our Step 2 & Shelf Exams Qbank. This is important because the more we think about how to respectfully discuss people, the more it carries over into our day-to-day activities and patient interactions.

7. Our medical director conducts a final review.

After a copyeditor does a second round of edits, our medical director conducts another review of the questions to make sure everything is accurate and ready for publication. 

8. The question is published in your Qbank.

Once the medical director gives a thumbs up, the questions are uploaded into the Step 2 & Shelf Exams Qbank.

How Do We Create Images for the Step 2 & Shelf Exams Qbank?

During the editing process, after carefully reading the question and associated explanations, the champion picks an image from our large illustration library or requests a new image they feel will best represent and reinforce the question’s teaching point.

If a new image is requested (or an existing one is altered according to current guidelines or other information), the champion creates a mock-up based on a pertinent source. The illustration team then evaluates these mock-ups and determines how they can best present the information. 

The team uses a style guide to keep colors, labels, shapes, and templates consistent and creates the images with standard image-creation software. Then, the illustrations are reviewed by the champion and copyeditors for accuracy and clarity. Once the quality of the image has been verified, it’s uploaded into the Qbank.

Some incorrect answer choice explanations also have links to images, so you get the added benefit of seeing related information on a distractor answer choice. For example, if a question tests whether you can spot the clinical manifestations of systemic lupus erythematosus (SLE), the main image will link to information regarding diagnosis of SLE. If another condition (like rheumatoid arthritis) is included as a wrong answer choice, often there is a link from the wrong answer to an image that has more information regarding rheumatoid arthritis.

How Frequently Do We Update Step 2 & Shelf Questions? 

Rest assured, we’re on the lookout for any changes that would impact the accuracy of our questions. When any guideline updates that result in a clinical practice change are released by different societies, our questions, images, and Rapid Reviews related to the topic are reviewed and constantly being updated to reflect the most current guidelines.

Our Qbanks are also reviewed and updated regularly to provide you with current standard of care information on each topic. In fact, some of these updates are identified through our Qbank by students like you, as each question has a “submit feedback” option that is reviewed by the specialty clinician expert.

Each specialty has one or more content support agents (clinicians who are experts in the field) that are available to answer questions you have about content questions or offer clarifications. These agents work with the champions to update questions based on your feedback, if needed, after a careful review of the content and literature.

As this post hopefully makes clear, we’re always striving to include improvements and make sure our Step 2 & Shelf Exams Qbank remains the most representative of your actual exams as possible. And we’re constantly exploring ways to innovate and integrate new information and technologies into our editing process to assist (but never replace) medical professionals in developing Qbank items.

Further Reading

So, there you have it! Now that you’ve gotten a peek behind the curtain and have some idea as to how we create our content, we hope you can appreciate all the work that goes into your Step 2 & Shelf Exams Qbank. Its content closely resembles what you’ll encounter on exam day, and it should help you take that next big exam with increased confidence! 

And if you’re looking for (free!) Step 2 and shelf exam content written by Blueprint tutors, check out these other posts on the Med School blog:

• How to Prepare for Step 2: The Ultimate Guide
• How (and Why) to Use a Qbank to Prepare for USMLE Step 2
• How to Study For Shelf Exams: A Tutor’s Guide

During my third year of medical school, the first half of my general surgery clerkship was spent on the hepatobiliary and transplant surgery service.

One day, as we were completing the running subcuticular stitch on skin after a Whipple procedure, the fellow looked up at me and asked, “Are you interested in going on a liver procurement tonight?” I responded with a resounding affirmation.

Of course, the procurement meant I wouldn’t be doing any Qbank questions that night. But in retrospect, it was a small sacrifice considering the ensuing experience became one of the reasons I fell in love with surgery and decided to pursue a career in it.

In the end, this decision didn’t impact my performance on the shelf exam because I had a solid study plan. The moral of the story is, while finding a balance during third year can be difficult, it can be done! And I hope over the course of this article, my experiences and perspective can aid you in excelling on your shelf exams while also putting your best foot forward on the wards.

Let’s begin with a brief reminder of why shelf exams matter, and why finding the right balance between your rotations and preparing for them is a huge part of what third year is all about.

Why Shelf Exam Prep Matters

So, why are shelf exams so important, and why do you need to spend time preparing for them during third year? Well, many medical schools incorporate your shelf exam score into calculations for your final grade on the clerkship, which could be the difference between honors, high pass, and pass. For those with a pass/fail grading system during clinical rotations, shelf exams are still important as they can be predictive of Step 2 scores, which are all the more important in a pass/fail Step 1 world. 

Shelf Exam Prep and Wards: Feel the Synergy!

Your shelf exams are a big deal, but the best way to approach third year is to view performance on the wards and preparation for shelf exams as synergistic, not as competing interests.

For example, my first day of third year was on internal medicine and we had a patient with altered mental status get admitted at 5:30 pm. It was up to me if I wanted to stay or go home. After deciding to write the H&P for the patient, the differential diagnosis for altered mental status has been ingrained in my mind ever since—in a way I don’t think a textbook or question bank could have taught me. 

This wasn’t the exception to the rule. During my third year, I often found that learning from an actual patient was far more impactful than anything I could read in a book. Acclimating to this style of learning as opposed to the traditional classroom lectures of preclinical years is one of the most important things that happens during wards. In fact, some of the greatest clinical pearls I gathered over the years were quick tidbits passed during rounds or while at the patient’s bedside. This kind of learning isn’t something that stands in the way of traditional shelf exam prep, it’s actually a great way to complement it.

Some Great Shelf Exam Study Materials 

So, imagine you’re coming home from a rewarding day at the hospital and you’re asking yourself “what should I study?” I found that using a few resources to their fullest potential set me up for the most success.

For every one of my rotations, I completed all the relevant Qbank questions and AnKing cards. I also supplemented this by watching Dr. High Yield, Emma Holliday, and OnlineMedEd videos (they were free when I was a 3rd year).

However, this was what worked for me and it is likely that a different combination of resources may be most effective for you. I have friends who despised Anki and learned best by listening to Divine Intervention during their commute and reading books like Case Files and StepUp. Some of my classmates opted to only complete a portion of the Qbank questions for each clerkship.

Obviously, there’s a lot of ways to study for a shelf exam. It may take a few rotations to find the resources that you like the most and settle into your studying groove. It certainly did for me. Don’t fret—be ok with switching things up if a certain routine is not working for you.

Wondering if you’re on track with your shelf exam prep? Take our FREE quiz from our Blueprint experts to find out!

Creating a Shelf Exam Study Schedule

Another big aspect of studying for shelf exams while on rotations is creating a study schedule that works for you. For example, while some of my colleagues preferred to start their Qbank questions towards the second half of rotation, I am a big fan of doing a few reps everyday leading up to race day.

All my rotations were six weeks in length, with the shelf exam towards the end of the final week. At the beginning of the rotation, I would divide the Qbank questions over the first 5 weeks and leave the final stretch for NBME practice exams and review. I liked this strategy because it divided shelf studying into daily bite-sized amounts that were doable for me. Most days, I had to do 20-30 Qbank questions at home which was manageable. If I ever stayed extra late at the hospital and couldn’t do the day’s questions, I would distribute them over other days.

Studying During Rotations

Additionally, keep in mind that during rotations, you don’t need to wait until you get home to start studying. In my case, I often had downtime when I was done pre-rounding, or even sometimes after lunch. I would use this time to knock out some Anki cards on my phone. Then, when I got home, I just finished what was left.

This approach worked really well for me, but a different approach might be best for you. Also, if the team doesn’t need any help from you, it’s ok to ask if you can use the time to study. They may even do a quick chalk talk on a challenging topic for you! This way, when I got home, I often completed my Anki cards or just had a small portion left.

Again, this method worked very well for me, but a different approach might be best for you. Some of my colleagues would prefer to start their Qbank questions towards the second half of the rotation. There’s a lot of ways to create your study schedule, just make sure you tailor it to your needs. Also, be sure to schedule some catch up and break days into your study plan, as life does not stop during clerkship year.

If you need some help setting up a schedule, I recommend checking out Blueprint’s Med School Study Planner, which automatically schedules your shelf exam studying for you throughout your rotation!

Shelf Exam Prep When You’re Tired After a day at the Hospital

Now let’s go over a common situation. You have come home from a long day at the hospital and are completely drained. The last thing you want to do is type your Qbank URL into your search bar or fire up Anki. You could try to do more passive studying and watch a video or listen to a podcast while cooking dinner. If that’s still too taxing, then take the night off and focus on your well-being. The third year of medical school is like a marathon, so it’s best to take the time to refuel and check in with your support system.

Further Reading

I extend my heartfelt congratulations on entering this exciting period of your medical school journey and I am rooting for you. Remember, third year is about finding a shelf exam prep and rotations balance that works. If you’re having trouble striking this balance, or are interested in medical school tutoring, please contact the Blueprint team. I’d be more than happy to schedule a session with you!

Looking for more (free!) shelf exam and clinical rotation tips from Blueprint tutors? Find more on the Med School blog:

• How to Study For Shelf Exams: A Tutor’s Guide
• Best Shelf Exam Study Resources: A Comparison & Breakdown
• How to Honor Your Clerkships

Finally, you’re done! You spent hours on Excel creating a study plan, and you’re letting out a sigh of relief.

But your joy is short-lived: your professor adds another suggested book to your reviewing list, a friend insists a lecture series is a must-have based on their experiences prepping for Step, or you get an additional research project, become sick, or have to take your cat to the vet. Bam – your study plan doesn’t work anymore.

Does that sound like you? Spending time constructing a new schedule is the last thing you need on top of everything else you’re dealing with! 

That’s where Blueprint’s Med School Study Planner comes to the rescue. Blueprint Prep enables you to create a highly flexible, personalized study schedule to accompany your med school experience, whether you’re just trying to keep up with classes or prep for any one of the many major med school exams.

Thousands of medical students use Blueprint’s Med School Study Planner to save hours of planning time, see exactly what to do each day, and ace their med school exams. Get unlimited access today!

You can always come back to add, edit, or remove resources from your study plan, giving you the luxury of worry-free studying even if your plans change. You can also use the “Edit schedule” page to change or customize any of your settings, any time you want. Whether your first introduction to Blueprint’s Med School Study Planner is today or you’re a power user, this pro tips guide is here to help make your study planning even more helpful and efficient.

Here are some ways medical students can maximize Blueprint’s Med School Study Planner:

Maximize the Value of Blueprint’s Med School Study Planner When You Set It Up

A medical student can get the most out of Blueprint’s Med School Study Planner from the very beginning by paying attention to how you create your plan.

Input your information with your purpose in mind

You will begin by answering a series of questions – what you’re preparing for, where you go to school, and your graduation year. Then, you’ll pick the dates most relevant to you – when you’re testing, when you plan to start studying, and when you want to wrap up your studies.

Blueprint’s Med School Study Planner lets you create multiple study blocks that you can layer as needed, so with each block you build, you should make sure you’re entering your info with that specific purpose in mind. With these blocks available it’s incredibly important to make sure you name your study blocks accurately. Medical students who get the most out of Blueprint’s Med School Study Planner typically create more than one study block so they can stay better organized, and naming is a big part of keeping your blocks straight!. 

Take time to add your resources

Once you’ve set up your plan, it’s time to add your resources. Blueprint Prep has over 400 resources (books, lectures, flash cards, and Qbanks) in our database to choose from.

If you’re still not sure which resources to use, we offer a choice of pre-selected bundles of the most popular resources, as well as bundles of free resources for all major medical exams to create a balanced plan. If you know what resources you’ll be using, just search and add them to your plan.

Once you’ve added a resource, you won’t have to do that work again for a given study block – so take the time to customize as much as you need the first time you’re adding a resource.

Here are some tips for adding resources:

• Looked through our list of Supported Study Resources and can’t find a resource you want? Need anything very specific, like your professor’s handwritten manual that exists in 5 physical copies? We’ve got you covered! You can add your custom book, lecture, question bank, or flashcards right away, or you can ask us to add it for you within 3-5 business days. Add as many resources as you need! You can find detailed instructions on how to add your custom resource here.

• You don’t have to add the whole resource. If you’d like to use your resources concurrently with your school curriculum, use the option to manually select only the lessons/chapters you want to make sure your Study Plan is tailored exactly to your needs. 

Group your resources 

Now that you have all your resources added, group them in a way that works especially well for you. There are 3 options:

1. If you sort your resources by subject (default setting), all chapters and videos on the same subject will be put together in your schedule.

2. If you sort your resources by system, Blueprint’s Med School Study Planner will group all chapters and videos together by system.

3. If you sort your resources by resource, you’ll be able to go from beginning to end of your book or lecture series. All the resources you choose will run concurrently.  

To change the order of the subject or systems, simply drag them into the order you desire, and click Save & Rebalance. 

Take advantage of many time settings  

Set your pace for each resource wisely. Once you’ve chosen your resources, you’ll have an opportunity to customize your plan further by selecting your pace for each of the different types of resources you’ve chosen.

Take a minute to analyze your study habits. Think about how you like to watch your lectures. Do you pause them from time to time to take notes? Or do you speed them up? If you like taking notes, then 1 hour of lecture will take you 2 hours to finish; if you prefer watching your lecture at 1.5x pace, you’ll be done with it in 40 minutes. 

Need help analyzing your study habits? Download our free “Hero’s Guide to Defeating the USMLE” for exercises and action items to help you learn how you learn!

Then, set aside some quality time for yourself! Go to the Time Off & Workload section to schedule some recurring days off and vacations, and treat your downtime activities as seriously as you treat your study time.

Since you’re already in the Time Off & Workload section, take advantage of catch-up days. Whenever you choose a catch-up day, Blueprint’s Med School Study Planner makes sure not to schedule anything on that day. This way, you save up some time to get up to speed if you happen to fall behind. 

Your workload differs each day of the week, and Blueprint’s Med School Study Planner takes this into consideration to keep a healthy balance between your life and studies. Use the Routine function in your Time Off & Workload section to adjust the relative distribution of tasks per day. Set which days you want to have a light, normal, or heavy workload. A light day will have about half as much work as a normal day, and a heavy day will have about twice as much work as a normal day. 

With these few steps, you’re ready to create your study plan! 

Maximize the Value of Blueprint’s Med School Study Planner During Daily Use

Life didn’t go according to plan and you ended up accumulating too many overdue tasks? Just use the Rebalance feature and feel the burden lift off your shoulders – as your overdue tasks get redistributed throughout the rest of your schedule in mere seconds. 

To make sure you’re always aware of the big picture, use Calendar View. It shows you which tasks you are to complete each day, grouped by resource and subject. If you are covering different subjects in the same resource on a given day, those tasks will be shown separately on the calendar. Resources are colored according to the subject covered in the readings or videos; flashcards and question banks can cover many subjects, so those tasks will always appear light gray.

Maximize the Value of Blueprint’s Med School Study Planner to Prepare for Different Medical Exams

Passing your medical exams is your goal, and study blocks are an especially useful tool. In medical school, you don’t always prepare for one exam only during a certain period of time (we wish), so take advantage of creating study blocks. Study blocks are basically concurrent or overlapping schedules, which can be useful in many situations: 

• If you want to create a light studying period during classes, and a dedicated studying period after classes.

• For giving a resource a second pass for review.

• If you need to create study plans for different exams that overlap. 

Use Blueprint’s Med School Study Planner to prepare for Step 1 and COMLEX Level 1

Here’s when the Study Blocks feature comes in handy! You can create a Step 1 Study Plan and a COMLEX Level 1 Study Plan that run concurrently, yet independently.

You even can make your COMLEX study plan a week longer to give you time to cover OMM preparation. 

Use Blueprint’s Med School Study Planner to prepare for Shelf exams

Make separate study blocks in Blueprint’s Med School Study Planner for each rotation as you go. Then, add the relevant resources to each study block – that way, they’ll be spaced out perfectly for the duration of your associated rotation. Feel free to add your framework Step 2 CK resource to your plan for each rotation as part of your pre-dedicated study time. 

While prepping for Shelf exams, try to incorporate watching and reading most of the materials in the first ⅔ of your rotation. Again, you can create a unique study block for each exam, and even for each resource, to go through it most efficiently. This way, you can spend that final lap of your rotation reviewing the areas you feel uneasy about. 

Just remember, it can be tough to fit in Shelf and Step studying during rotations! Use the “workload” tools to plan for only a few assignments on most working days. 

Use Blueprint’s Med School Study Planner to prepare for Step 2 CK

First, don’t forget to schedule a practice exam to figure out your weak areas and focus on the resources that will help you where you need it most. If you did your first pass through Step 2 resources by incorporating them into Shelf exam prep, feel free to choose the topics you struggle with manually in each resource. This way you’ll create a highly personalized plan without overloading yourself with additional topics you covered already. If you’ve used some lecture resources during your rotations and want to use them again, add them to your Step 2 study block, and use accelerated pace settings for your lecture settings. Again, you can manually choose the subjects you want to revise. 

Summing it all up, as a medical student, you’re eventually going to face medical exams, as stressful as they might be. To paraphrase J.R.R. Tolkien, you can’t leave live dragons out of your calculations if you know they’re out there. Blueprint’s Med School Study Planner gives you the freedom to include all of your dragons in your schedule. The more effectively you use Blueprint’s Med School Study Planner at the outset and during the course of your preparation, the less daunting those dragons will become.

Image by Rob Sullivan for Med School Tutors