Managing the clinical rigors of clerkships with the studying needed to excel on a National Board of Medical Examiners (NBME) Subject Exam—commonly called a shelf exam—is no easy task. The COVID-19 pandemic has further complicated the process—with the vast majority of institutions deciding to administer shelf exams remotely, according to the NBME.
Over the years, a number of medical students, residents and educators have offered their expert advice on how to succeed academically during clinical training. Here are some of their thoughts.
When a rotation allows for schedule flexibility, incremental study can better prepare you for both your shelf exams and clinical interactions.
“If you spread out your shelf-studying over the course of your rotation and tackle your studies little by little each evening, you’re better able to apply the knowledge you gained from your shelf books or practice questions when you’re back on the wards the next day,” said Haig Aintablian, MD, an emergency medicine resident at UCLA-Olive View and graduate of the University of Arizona College of Medicine.
“It’s a lot better to invest your time studying after each hospital or clinic day because you’re combining your learning from textbooks and questions to actual encounters in the clinic/ward. You’re more likely to recognize various pathologies or treatment guidelines and reinforce your text-based learning, versus leaving the shelf material to the last week of a rotation and having to cram whatever you possibly can for the shelf exam.”
Between question banks, review books and online tools, there’s no shortage of study materials to prep for shelf exams. Practice questions are best used to determine weaknesses in a student’s knowledge.
“The thing we promote that really seems to work quite well for people is to do a certain number of practice questions on a specialty per day,” said Pamela DeVoe, PhD, director of the Office of Academic Resources and Support for undergraduate medical education at the University of New Mexico School of Medicine.
“Students should look closely at each question’s answer explanations and note what the conceptual gap areas are in their knowledge base,” she said. “You might have time one day to do 10 questions, read through five of the answer explanations and write a list of learning issues then you’re busy. When you come back to studying, you do the rest of the answer explanations, then complete your list of gaps in your knowledge. Then target your study to filling in those gaps.”
With each patient encounter, a medical student is given an opportunity to learn. If you get to know your patients on a personal level, it might help you remember come exam time.
“Let’s say someone came into the hospital with a case of pneumonia, and you treated it and it improved. One of the best things you can do is get to know that patient, and that way [your interaction with the patient is] actually a study aid,” said Michael J. Rigby, an MD-PhD student in the University of Wisconsin-Madison Medical Scientist Training Program.
“The more you know about that patient, their personal life, who they are, what they do, you are actually going to help yourself root that concept in memory,” Rigby said. “So getting to know the patients on your team can actually be very helpful for your own academic needs.”
In the midst of a taxing rotation, incremental study might be difficult. Learning to use downtime throughout the day helps, since good intentions to study in the evening often succumb to other pressing demands or fatigue. Cramming for a shelf exam isn’t advisable. But if you do it, it helps to know the most important focus areas.
“There are high-yield topics,” DeVoe said. “Topics that you better know. Keeping a running list of those through the clerkship is going to be really helpful. ... The concentrated time is on practice questions to show you where you still have gaps in your knowledge and then to be looking at the high yield topics to make sure you understand each one of them.”
If you’re a student looking for resources, the AMA selected Kaplan as a preferred provider to support you in reaching your goal of passing the USMLE® or COMLEX-USA®. AMA members can save 30 percent on access to study resources, such as Kaplan’s Qbank and High-yield courses.
If your medical school is administering the exam remotely, you’ll have a remote proctor monitoring your activity on Zoom. The quicker you get used to it, the better, according to one student who took a remote exam.
“You have to understand there is an individual staring at you through a camera, even though you are unable to see them,” said Devin Morris, a medical student at the Warren Alpert Medical School of Brown University who was among the first batch of students to take the exams remotely in the spring.
“That’s the strangest part,” Morris said. “That’s the only portion that makes a remote exam more nerve-wracking. Once you get through your first 10 or so questions you realize the [test-taking] environment is essentially the same and you forget about it.”
The AMA has curated a selection of resources to assist residents and medical students during the COVID-19 pandemic to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events.