Shelf Exams and Clerkship Exams:
What do medical students need to know to score well on these tests?
Medical Students take shelf exams at the conclusion of basic science courses and
clerkship exams at the conclusion of clerkships. These subject exams are created by
the National Board of Medical Examiners (NBME), the same organization that
constructs the licensing exams (i.e., Step 1, Step 2 CK, Step 2 CS, and Step 3). The
subject exams are taken by medical students across the United States and overseas
and are patterned after a generic medical school curriculum. The exams are not specific
to the curriculum at IUSM and are not tailor-made for a specific course and professor at
IUSM – with an exception or two. Often, the content outline for an NBME shelf exam
varies from the outline of the corresponding basic science course at IUSM, and the
content outline for an NBME clerkship exam varies from what is experienced in the
corresponding clerkship setting. Students have failed clerkship exams because what
they studied corresponded poorly with what the exam tested.
Content Outlines. The first step in preparing for a subject exam is obtaining the content
outline for the exam and budgeting study time among the various topics. The content
information is available on the NBME website (http://www.nbme.org/Schools/SubjectExams/Subjects/Exams.html). The content outline delineates the topics that are
assessed and the percentage of questions allotted to each topic. For example, the
content outline for the shelf exam in Pharmacology shows that most of the questions
assess knowledge of drugs for the central and peripheral nervous systems (35 – 40%).
Few questions assess knowledge of drugs for the skin and connective tissue,
musculoskeletal system, respiratory system, gastrointestinal system, reproductive
system, and endocrine system (1-5% each). Thus, a student should spend more time
studying drugs that act on the nervous system than drugs that act on the other systems.
Additionally, the content outline delineates 12 subtopics under the nervous system. With
this knowledge, a student won’t inadvertently omit a subtopic from their study schedule.
Sample Questions. Accompanying each content outline are sample questions
(http://www.nbme.org/PDF/SubjectExams/SE_ContentOutlineandSampleItems.pdf ).
These questions are representative of the actual exam questions with respect to detail,
difficulty, and cognitive demands. With this knowledge, students can shape their
studying in anticipation of their actual exam questions.
Practice Exams. Before taking clerkship exams, medical students can take web-based
practice exams (http://www.nbme.org/students/sas/MasterySeries.html) at a cost of $20
per exam. As with the sample questions, the questions on the practice exams resemble
those on the actual exam. Also, the content outline for practice exams and real exams is
the same. Taking practice exams can reveal students’ areas of strengths and
weaknesses and help them revise their study agendas to maximize their test scores.
When students take the timed practice exams, they can practice budgeting their time
among all questions and minimizing last-minute random guessing. Students with testtaking anxiety can experiment with various calming strategies during practice exams.
Recommendation. Medical students should add the NBME website to their favorites
list and use the content outlines, sample items, and practice exams to optimize study
time and increase their scores on shelf and clerkship exams.
Patricia Wade, PhD
IUSM Learning Specialist
patwade@iupui.edu
317 274-2042