Internal Medicine Shelf
- Hesham Hassan, M.Sc.
- Jan 4, 2018
- 5 min read
Well, I’ve been busy to say the least. My daughter was originally scheduled to come into the world tomorrow, January 5, 2018, because that is the last official day of my internal medicine rotation and I took the shelf exam today. She had another idea and was born midday on December 28, 2017. The lesson for those of you yet to start a 12-week rotation is the same I would give for any rotation: proper planning prevents poor performance. Keep in mind that I still have to wait two weeks for scores, but I did create a study schedule 13 weeks ago and stayed diligent through the course and worked ahead of schedule when I found out about the change in delivery of baby. Going from delivery of a child and stepping back into medicine-mode has been relatively easy. Luckily, I have a fantastic preceptor who has worked with me through scheduling, and I have a mother-in-law able to come out and be a strength for my wife while I still devote some time to studying medicine. Impression of internal medicine: it is the heart of medicine and is the foundation for every specialty. It is a great field to go into but not for me. Although I came into medicine with the generic “I want to be a doctor”, I have found through third year that no rotation has lit my passion for medicine like Ob-Gyn. And, I never thought that my wife’s experience with this delivery would be such a positive reinforcement for my desire to pursue the field. Nonetheless, I respect internal medicine and those who practice in a field that seems to have some of the most changes (like the hypertension guidelines that came out while I was in the rotation…who would have thought you could redefine high blood pressure…).
The Test
The internal medicine shelf covers just that, internal medicine, and your knowledge is assessed over 110 questions in roughly 2.5 hours. It seemed to me that today’s shelf exam was probably one of the better insights into what to expect on the USMLE STEP 2 CK exam. A good way for me to describe the exam is to compare it to Family Medicine. FM tested primarily on what you would go see a doctor outpatient for whereas IM tests on what you would go to see a doctor for in a hospital or acute setting. The test had some of the longer vignettes yet, except for psychiatry because that still wins in the who-can-write-more arena. The details of the vignette are all important to reason through to narrow down answer choices and pick the most correct answer: a concept that was not as apparent as today’s test.
The Topics
My impression of what I was tested over on the exam included the following topics:
Nephrology: all of it and know it well because it seemed to be half the exam today – so many acid-base disturbance questions that will force you to re-evaluate if you know anything about medicine...
Pulmonology: COPD, Asthma, lung cancers, and ICU/Critical Care – high yield topics for sure.
Cardiology: CHF, acute coronary syndromes, familial cardiac concerns.
Dermatology: know your lesions and how they’re described in writing because there are a decent number of derm pictures and vignettes.
Hematology & MSK: RA, OA, dermatomyositis, polymyositis, GB, anemia, hereditary spherocytosis, AML, brachial plexus – seriously, the different impingements/injuries to the hand, neck, knee, cervical & lumbar spine.
Endocrinology: review the thyroid and parathyroid glands in detail as it will help you with a solid 10-15 questions. I wasn’t tested on the other glands in comparison.
Infectious disease: HIV, common cold, PNA bugs, derm infxns, hepatitis… basically micro review.
Urology: this is the only time I think I have seen 5-10 questions on one exam related to how men pee and what happens when it goes wrong…if you remember the urogynecology from the Ob-Gyn rotation then you’ll likely do well otherwise you should do a review or urology to learn about the different causes of incontinence and how the work-up should proceed.
The rest of the subjects were less invasive on the test and had good representations of the systems: GI – know alcoholism and how it affects the body; Neuro – dementia and Parkinson’s vs. depression; Biostats – random and not dedicated to memorized formulas but actually reasoning through data; Ethics – a couple questions here and I thought they were logically framed/know what it takes for hospital admission.
Well, there you have it.
The Studying
Thought I should review what I said in my first Internal Medicine Impressions post. I was write then, “What a mess!” I did create the ideal study schedule and did stick to 70% of it but had to find out the hard way what was useful and what wasn’t. These are the resources I would recommend:
uWorld – I finished the 1368 practice questions, and they are well worth the time. I learned that it is helpful for me to analyze how long it takes me to answer the questions, and the questions I spend more time on (and get wrong) are the ones I dedicate five minutes to read up briefly.
IM Essentials online – these questions are good as well because it is a very different perspective. There are 502 questions, and there is text that you can go read up on the different topics associated with the IM Essentials account. I did all of these once, and if I had time for a second run through then I would have. These will also be good to reference for CK studying.
DIT Step 2 videos – these are good for a refresher on topics you don’t really remember. I ‘watched’ these videos to and from the hospital through my car radio.
The Curbsiders Medical Podcast – not all of them unless you just want to and have that much time but I HIGHLY recommend any episode with Dr. Joel Topf (twitter: @kidney_boy) or Dr. Robert Centor (twitter: @medrants), who will teach you all about his criteria and how they are meant to be used clinically. There are fun episodes that really are irrelevant to this shelf exam so look at the topic for the episode and use your best judgement.
Becker GuideMD – good resource if your rotation has more time for you to basically re-do your basic sciences education (which will make you stronger for Step 2 CK) … so it’s not essential for the shelf but who doesn’t want to be the best doctor possible?
Wrap Up
Internal medicine was 12 weeks that flew by and were stagnant at the same time depending on who I was with and what was going on in my personal life. It really helps frame medicine with focus on proving or disproving your ideas about what is going on with a patient. I start surgery on Monday so watch out for my first impression post for the rotation. And, if you don’t follow #medtwitter, #girlmedtwitter, or #bromedtwitter and you are in med school then you are doing yourself a disservice on quick updates within medicine and/or a place to vent about things that most medical professionals relate to or have experienced. As always, if you have any questions or comments about anything feel free to reach out to me however you know how.
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