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r/medicalschool•
demooo

M3 year- resources to use to excel on your NBMEs to HP/ get your As when it matters most.

Hey guys/gals

NO MATTER WHAT STANCE YOU HAVE ABOUT YOUR CLASS RANK, THIS IS THE YEAR THAT MATTERS MOST. YOU WANT TO DO A SURGICAL RESIDENCY, GET HONORS OR AN A ON SURGERY. WANT MEDICINE, GET THAT HONORS ON MEDICINE.

I'm currently an M3 in the middle of my year. One of the things I found most difficult was preparing for Shelf exams and learning what resources are used since there are no gold standards unlike the first 2 years of medical school. Often times, the best books are outdatted and contain some old information that has now been replaced. Luckily, that stuff is rarely on boards despite what you may hear.

Below are the resources I used for each of my shelf exams, usually in the last 1-2 weeks of the rotation. I have scored in the mid 90s (raw score, so 95-99%). I didn't devote any extraordinate time to preparation. I actually was able to train for a marathon, continue research, and play copious amounts of BF4, WoW and Day Z.

Note that a lot of this is geared to my specific school, but you can take the advice or leave it for the other stuff.

PEDIATRICS

Required Text for my school

  • Nelson Textbook of Pediatrics: Very detailed, and Pediatrics gives you a list of ‘quiz topics’. This involves you looking in the index finding relevant pages. I suggest you give it 1 go, then find the topics with the resources I list below.

NBME and Quiz studying

  • BRS Pediatrics- Outdated, but it is a very well written text. In the same style you of clinical years with chapter, questions, chapter. I tried NMS Pediatrics (another recommended source), but I disliked the organization of the book and quickly put it down.

  • PreTest Pediatrics (500 questions with detailed answers)- Some questions sets are very easy, while some are unbelievably difficult. It’s good to get you thinking, but I wouldn’t suggest making this your only source.

  • Step 2 CK QBank Pediatrics block- Easier compared to Step 1 Qbank, and it tends to repeat itself. I highly recommend sitting down and finishing all 200

  • NBME Subject exams- Pediatrics (2 sets of 50 questions, 20$ each)- you may see 1-4 of these on your actual test.

  • High Yield Pediatrics by Emma Ramahi-(http://som.uthscsa.edu/StudentAffairs/documents/Pediatrics.pdf). High yield PDF that is a good last minute review

Impressing your attendings

  • Uptodate your patients, especially if they are something you’ve never heard of or lovely board material (i.e. Kawasaki, Prune Belly) or on a medication you’ve never heard of. I always left around 10-15 minutes for me to google things between my prerounds and actual rounds with residents/attendings.

SURGERY

General advice

  • hardest rotation to find time to read. Some of services tend to have better hours, while others are 12-16 hours a day during the week. I spent maybe 30 minutes reading a day (for the next day surgeries and weekly quizzes), Saturday catching up on sleep, and Sunday as my study day. Your loved ones will constantly ask you what’s wrong, as you will become a zombie. Otherwise, this is a very fun (but can be stressful) rotation as most the services actually need the medical students for help.

  • Oral boards: basically you will be given a case like this by an attending and upper level resident: ‘A 45 female comes in with complaints of RUQ pain’. You will ask questions to discover the H&P, provide a differential diagnosis, work up the patient to determine the etiology and finally how to treat the patient.

Required text for our course

  • Essentials of General Surgery- Pretty detailed text, and you will have some weeks of 100+ page readings. I would only read this once with some general notes, then focus my efforts on other resources (i.e. Qbank).

NBME and Quiz studying

  • NMS Surgery Casebook-Review book: The style gives a patient presentation, then goes through a number of different scenarios leading to teaching points. It can be read in under 2 days, so don’t get caught up learning graphs and scenarios.

  • Pestano Notes-brief review followed by 180 questions. There’s some PDF floating around that is supposedly better, but the questions are very good in the book itself.

  • Step 2 CK Qbank- Surgery AND Medicine GIT block of questions (~250 questions).

  • NBME Subject Exams- Surgery (2 sets of 50 questions, 20$ each)- you may see 1-4 of these on your actual test

  • High Yield Surgery by Emma Ramahi- (http://som.uthscsa.edu/StudentAffairs/documents/High_Yield_Surgery_Compatible_Version.pdf) . High yield PDF that is a good last minute review.

Oral boards

  • There should be a document in the student room going through the 10 cases that you are expected to be knowledgeable on.

Impressing your attendings

  • Surgical Recall: This is your resource for prepping for surgeries. It contains the most favorite pimping (meaning an attending quizzing you) questions for each surgery and surgical specialty. It won’t help you at all on the NBME or quizzes, but it makes you a rockstar in the eyes of your attendings.

  • Look up the anatomy in the area you’ll be operating on your phone while the patient is in preop or getting brought back. Laparoscopic cases where you are driving the camera give you excellent views of the anatomy and are easy pimping questions from attendings.

MEDICINE

General Advice

  • this tends to be more difficult than other subjects(with easier grading). There is no required text or lectures. Basically, you are given a topic for each week (i.e. Cardiology, Pulm or ID) and you read all you can in whatever source you wish to use. You then have a quiz on that subject.

Required Text for our course

  • None

NBME and Quiz studying

  • MKSAP 4- This is a question bank that Dr. ---occasionally pulls questions from, and it represents a good gauge of the question difficulty on your Quizzes. They tend to be easier than QBank, and they provide explanations and information. There is a CD in the student room with the program on it, or I suggest you have one of your more tech savy classmates to post the download for the program on Facebook. I’ve heard some people with Apple computers have difficulty running the program. Highly recommend doing this QBank the night before your quiz.

  • MKSAP 5- Not used by Dr. ---- for our year, but it’s another source for questions if you enjoy these to learn

  • Step Up to Medicine- By far considered the favored resource. I found it lacking in detail in many areas while excessive in others. Otherwise, it is an easy read that I only used for Quiz preparations throughout the rotation.

  • Master the Boards: USLME Step 2 CK-(chapters of Internal Medicine, Preventive Medicine and Dermatology) I just used this for a quick 2 day read the weekend prior to the NBME without taking notes. Used as a quick, but detailed review source.

  • Step 2 CK QBank-1,300+ questions. Start from day 1 of your rotation, and I recommend trying to do 100-200 a week. You will have time to do it on your rotation during the afternoons, so bring a smartphone or iPad if you can.

  • NBME Subject Exams-Medicine (2 sets of 50 questions, 20$ each). These are more important than doing them on your Peds and Surgery subject exams, as you do not take a mock NBME during your rotation. On Peds and surgery, you will take a mock NBME ~4 weeks into each rotation.

  • High Yield Medicine by Emma Ramahi- (http://som.uthscsa.edu/StudentAffairs/documents/HighYieldInternalMedicinecompatibleversion.pdf) . High yield PDF that is a good last minute review. Here is a video lecture of her going over the presentation: http://atsvid.uthscsa.edu/Mediasite/Play/e18ac39b61e74147a92557429c4672ff

Impressing your attendings

  • Uptodate the basic and common things (COPD, CHF). Focus on medications you’ve never seen (mandelamine) and rare/unique things that your patient may have (carcinoid). Again, try to allot 10-15 minutes between prerounds and rounds to accomplish this.

Jesus dudes. Read the title, this post is tailored at DOING WELL ON YOUR SHELF. This has no hidden nuggets regarding how to match, just the stated importance of getting a good score in the specialty you want. For example, the Gen Surg program at our school will not consider an applicant from our school without an A in the course. It's another check on the long list of items that you need to accomplish.

Additionally, the required texts are in reference to the advice for my school. Those are the books we are assigned chapters in on a weekly basis throughout the rotation. I would never touch Nelsons for a board review. This is a copy and pasted document that is written for my class.

Posted Feb 2, 2014, 3:59 PM UTC · edited

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tigecyclineMD-PGY1•

Solid advice overall. For surgery, the Pestana notes are in book form now so it's unnecessary to pirate the PDFs. There are bootleg audio files from Pestana teaching a Kaplan Step 2 review course, and those are essentially the book in audio form (akin to Goljan audio).

I especially like the plug for BRS Pediatrics. That book is the single best text resource for the shelf. The peds shelf is freaking broad, and that book hits lots of the random stuff that more concise reviews skip, which makes the difference between a score in the 80s and the 90s.

I didn't like Step Up to Medicine, I actually preferred the NMS Medicine Casebook. It's a lot like the surgery one but bigger and better. It's easier to read than Step Up and focus on the "next step in management". I read that thing cover to cover and 99'd the medicine shelf.

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demoooOPMD-PGY1 (Uro)•

BRS Pediatrics is such a gold mine. If they updated it, I figure it would be as highly regarded as BRS Physiology with almost every medical student buying it.

I've talked to a few physicians that publish review texts/ own a small publishing company to attempt to create a gold standard review text for medical student rotation but they all find it too daunting of a task.

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royalmarquis•

What is the best way to read BRS Pediatrics? At 500 pages it's a behemoth. I read four chapters the other day and I don't think I got anything out of it, at least not in memory. Are there some parts that I should be focusing on more than others? Do I try to memorize all the little details?

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tigecyclineMD-PGY1•

Yeah it's gotta be virtually impossible to make the review text bible for a given rotation. Some people like the Casefiles/Casebook format, some like bulletpoints like BRS, some like paragraphs like Blueprints. And there is a fine line between being high yield and being a chore to read. Because clinical medicine is so broad, it's difficult to anticipate what the question writers think are the fringes of reasonable medical student knowledge.

The UWorld people have the best product on the market, probably because they can edit it in real-time and constantly keep it up to date if need be. But, it's not a text book, and there are pros and cons to using it as a textbook instead of a question bank.

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Timborako•

How closely did you follow your own study regimen for surgery? You recommend here doing 1000+ pages of reading plus > 600 questions plus having time to do marathon training/research/other stuff. Yet you say you only spent 30 min/day reading and then studying as well on Sunday. When did you read about your patients? Maybe you are a quick reader but I would find it nearly impossible to absorb any meaningful information at that pace.

Also, how much emphasis does you institution put on the shelf exams vs evals? This plan makes it seems like the shelf exams were make or break.

And your advice here:

NO MATTER WHAT STANCE YOU HAVE ABOUT YOUR CLASS RANK, THIS IS THE YEAR THAT MATTERS MOST. YOU WANT TO DO A SURGICAL RESIDENCY, GET HONORS OR AN A ON SURGERY. WANT MEDICINE, GET THAT HONORS ON MEDICINE.

is not 100% accurate. Third year rotations are certainly extremely important, but residency programs also look at how well you do in your sub-I in addition to everything else that goes into a candidate (geography, research, etc).

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demoooOPMD-PGY1 (Uro)•

This advice is not tailored towards getting your residency. I attempted, albeit poorly, tried to state the importance of your clerkship grades and shelf in the rotations that you hope to match. Obviously Step1, Step2CK, research/ publications, LoR etc are incredibly huge deals. This doesn't say 'how to succeed in match', it says 'how to excel on your NBMEs'.

The point is that this is how you get the grade you want, as many schools either assign class rank/ AOA purely on clerkship grades.

Now in terms of my school, we tend to be 50% evals, 30% Shelf exams, 20% other grades (Quizzes, OSCEs, written, or oral exams depending on the subject). You College of Medicine policy for NBMEs is that your grade is your raw score, so even if you score national average in the 70s, that will be a C. This is a big deal for those that tend to be weaker test-takers, as it is very difficult to get a perfect set of scores on your evals and other scores (i.e. oral boards or OSCEs). Thus, the shelf is pretty important and often makes/breaks the grades of my classmates.

Now for my study schedule, the 30 minutes refers to the first 6 weeks of my rotation. This is doing the readings assigned to us typically (i.e. the 100 pages of information). I do most my readings on my patients at school itself by giving myself time between rounding on my patients and rounding with my attendings, which is usually 15 or so minutes to skim UpToDate articles on my new patients or figure out what changed overnight on my old patients. During the day, I do Question sets on my phone or on the computer during down time. For example, on outpatient Pediatrics or my 8 weeks of in-patient medicine at the VA, we were not allowed to put in orders. This left down time most days, 30 mins to an hour, to still study and put some work in. I found this much more enjoyable than reading MSN or reddit. I don't want to do medicine, so I'm not going to go to all the events and things that don't interest me during the day (i.e. resident rounds, journal clubs, etc).

The last 2 weeks study time is greatly increased. We tend to have oral boards, or some other examination that I need to prep for that I spend time on. The last 7 or 8 days is NBME mode where I poop sock.

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tigecyclineMD-PGY1•

I dunno about surgery, but I almost went into medicine. The common knowledge is that top programs care a shit-ton about grades. Even sub-I honors (because seriously, lots of places will inflate those grades) don't entirely make up for a non-honors in medicine at competitive medicine programs.

But, I applied to radiology so I don't have too much first hand experience on that.

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adenocardPGY1 Internal Medicine•

Also note he says

I'm currently an M3 in the middle of my year.

Translation: he doesn't really know anything about what it takes to match at a residency program, or what he does know is limited to 2nd and 3rd hand information/advice he's been able to pick up along the way. I think most of of his reading recommendations are good (based on my own personal experience), but I wouldn't put too much stock in what this one 3rd year says in regards to ranking importance of various activities for the match.

Source: I'm also a 3rd year, and I don't claim to know shit about this process yet.

-4†
demoooOPMD-PGY1 (Uro)•

Does no one read titles?

M3 year- resources to use to excel on your NBMEs to HP/ get your As when it matters most.

At no point do I attempt to discount the importance of other factors of residency applications. I'm discussing how to do well on your shelf.

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tigecyclineMD-PGY1•

The OP is talking about doing well on shelf exams and rotations, not the nuances of matching.

It's painfully obvious to nearly everyone how important 3rd year grades are. And if you're shooting for something more competitive, the more honors the better.

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heavyeyesMD-PGY3•

That's a lot of reading for MS3....

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demoooOPMD-PGY1 (Uro)•

You can do most the readings in 1 week. Exceptions are obviously Medicine with MKSAP 4/5 and QBank having well over 2,000 total questions. That's why I focused on them during my rotation itself (especially the afternoons when interns are nose deep in paperwork).

I always take Thursday night (unless a Friday quiz), Friday night and all day Saturday completely off studying/readings to make sure my girlfriend doesn't hate me.

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heavyeyesMD-PGY3•

So you read Nelson's, BRS peds, and pretest all in 1 week? I find that really hard to believe unless you're reading for quantity and not for retention.

Regardless, the books you recommended are good, but I typically only had 1-2 resources max per rotation with similar results.

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demoooOPMD-PGY1 (Uro)•

Nelson's was just for our weekly quizzes. I copied and pasted from a more extensive document tailored to my school that detailed which were used in the last week specifically.

Also, I read for quantity for shelf exams. I'm comfortable in my general knowledge base, so I try to add as much as I can to be able to associate answers.

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catachipMD/PhD-M4•

I guess that works if you don't have to work on the weekends. We are allocated three days off per month during the Medicine clerkship.

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[deleted]•

damn thats cruel...we are supposed to follow intern work regulations. We get 4!

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catachipMD/PhD-M4•

Well, I guess it would be 4 days for a complete month, I was just thinking until the last Friday. It's the same schedule as the interns, yeah.

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demoooOPMD-PGY1 (Uro)•

We get 4 off, and typically hours on those days are like 700-1300.

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gapteethinyourmouthMD-PGY1•

Jesus christ. Does your school make your shelf exams worth a large percentage of your grade or something? I went through my rotations second year and shelf exams were at most 20% of the clerkship grade.

I didn't devote any extraordinate time to preparation.

OK, sure. I don't know anyone who read this much at my school. Reading Nelson's? LOL. Are you trying to fuck people over?

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demoooOPMD-PGY1 (Uro)•

Nelson's was during the rotation itself, not for Shelf prep. I put Nelsons under the required reading because that's what is required for our rotation throughout the 8 weeks. That's why it is not included in the NBME prep section.

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gwink3M-3•

It is pretty cool to see that you are suggesting a resource by a UTHSCSA student! I was just reading a "how to succeed at UTHSCSA" by a fourth year and she suggested Emma Ramahi's stuff as well.

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knowsgoesM-3•

Hey a fellow UTHSCSAer! Where can I find "How to succeed at UTHSCSA"?

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gwink3M-3•

Maybe blackboard under the last big folder for our clinical course. There's a list of ppts and such you can review about how to be good at the different specialities.

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demoooOPMD-PGY1 (Uro)•

That's crazy, I had no idea she was a student?! Damn, if you ever get a chance, tell her thanks from across the nation! Her stuff is golden for a concise review!

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gwink3M-4•

I think it might be from years gone by but I am not sure. Maybe a MD. I kind of figured it was from an upperclassmen that has just circulated around for a number of years. hmmm. I could be wrong.

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deepblueXIXM-3•

Thank you. commenting to save.

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List05•

This is great thank you!

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FumbleszM-2•

Thank you!

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catachipMD/PhD-PGY1•

Question... did you do random uWorld internal medicine questions, or by subject? I have waffled back and forth on the best way. I think i've settled that random is better. It keeps you up with everything simultaneously and is more representative of the real thing. For example, when you're doing cardio questions (or you know you selected cardio questions) you're already in the mindset and it helps you pick an answer. I take notes from uWorld in tutor mode, so I just need to keep separate sheets for Heme, Cardio, Pulm etc as I go. What was your experience?

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tigecyclineMD-PGY1•

I went with random. Like you say -- it's more representative of the real thing. It gets your brain to think more as the questions pop up out of the unknown. You consider the wide gamut of possibilities (like, if a shortness of breath question comes up and you know you're doing cardio questions, your brain will not consider pulmonary causes very seriously). I didn't take notes really from UWorld, though in retrospect I should have (probably into something MTB 2).

Before I dove into UWorld, I did lots of MKSAP 4, which is structured in organ system mode. So I'd do those questions after studying a specific section. It worked well.

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demoooOPMD-PGY1 (Uro)•

Subject.

I don't like random because it requires more time for me to figure out where and how I'm weak in certain subjects. In addition, I hate getting nephrology questions when I haven't read a chapter on nephrology since my surgery rotation.

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anonchica•

saving this. Thanks so much.

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getthepointe77M-3•

THANK YOU

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fairbianca•

Should you happen to have any reccs for reading on derm, please also pass it along, I would love to frontload as much as I can - thank you so much for this resource!!

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demoooOPMD-PGY1 (Uro)•

Man I'm sorry, but I don't have any derm resources. Besides from the tidbits in Step Up to Medicine and Master the Boards, I would guess google 'derm medical student syllabus' or something similar.

(I'm shooting for urology, so I did the same thing to prep for my rotation: anything in the above books combined with some random online syllabus/reading. I think I ended up with a syllabus from Texas that made me look golden.)

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fairbianca•

thank you I will for sure try that - and best of luck to you!! :D

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spoktacus•

Commenting to save.

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