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    What to Expect From NBME Shelf Exams During Clinical Rotations

    As a medical student, you are well aware of the numerous exams and assessments that you must complete on your path to becoming a practicing physician. One of the most critical components of your clinical years is the National Board of Medical Examiners (NBME) Shelf Exams. These exams provide a vital evaluation of your knowledge in various medical disciplines, and success on these exams is crucial for your medical career.

    What are NBME Shelf Exams?

    NBME Shelf Exams, also known as Subject Examinations, are standardized assessments administered by the National Board of Medical Examiners. They evaluate your knowledge and understanding of specific medical subjects during your clinical rotations in the third and fourth years of medical school. These exams serve as an essential tool for schools to gauge your progress and ensure that you are ready to move forward in your medical training.

    What do NBME Shelf Exams cover?

    NBME Shelf Exams cover various medical subjects related to your clinical rotations, including:

    • Internal Medicine
    • Surgery
    • Pediatrics
    • Obstetrics and Gynecology
    • Psychiatry
    • Neurology
    • Emergency Medicine
    • Family Medicine

    These exams are designed to test your knowledge of the relevant medical concepts and their application in clinical settings.

    How to prepare for NBME Shelf Exams?

    Preparing for NBME Shelf Exams can be a daunting task, but there are several strategies that you can use to ensure success:

    1. Start early
      • Begin your preparation as early as possible to give yourself enough time to cover all the necessary material. Waiting until the last minute can lead to anxiety and poor performance on the exam.
    2. Use multiple resources
      • Use a variety of resources to prepare for the exam, including textbooks, online resources, and review courses. This will give you a more comprehensive understanding of the material and help you identify any gaps in your knowledge.
    3. Practice with practice questions
      • Use practice questions to assess your understanding of the material and identify areas where you need more review. Practice questions can also help you get familiar with the format of the exam and improve your test-taking skills.
    4. Study regularly
      • Study consistently throughout your clinical rotations, rather than cramming at the end of the rotation. This will help you retain the information better and reduce stress during the exam period.
    5. Get feedback
      • Get feedback from your peers, mentors, and professors to assess your progress and identify areas for improvement. This feedback can help you adjust your study plan and focus on the areas where you need more review.

    What is the passing score for NBME Shelf Exams?

    Passing scores for NBME Shelf Exams can vary by school and subject. However, most schools set their passing standards around the national average, which is typically a score of 70 or higher. Achieving a score above this threshold is essential for success in your clinical years and beyond.

    What happens if I fail an NBME Shelf Exam?

    If you fail an NBME Shelf Exam, your medical school will determine the appropriate course of action. This may include retaking the exam, completing remedial work, or repeating the clinical rotation. It's essential to understand your school's specific policies regarding exam failures - most are going to have different approaches depending on whether you are on academic probation or not.

    Do NBME Shelf Exams impact my residency application?

    While your NBME Shelf Exam scores are not directly reported to residency programs, they can still impact your application. Some medical schools use Shelf Exam scores to calculate class rank or determine honors designations, which can influence your residency application. Additionally, strong Shelf Exam scores can reflect well on your clinical knowledge and understanding of a specific medical discipline. Your school’s MSPE standards may vary.

    What is the Comprehensive Clinical Science Examination (CCSE)?

    The Comprehensive Clinical Science Examination (CCSE) is a comprehensive exam that assesses your readiness for the United States Medical Licensing Examination (USMLE) Step 2 CK. The CCSE covers a range of topics, the same as the NBME Subject Examination. Format for the exams is the same.

    • Medicine
    • Surgery
    • Pediatrics
    • Obstetrics and Gynecology
    • Psychiatry
    • Neurology
    • Emergency Medicine
    • Family Medicine

    Question formats for the NBME and CCSE are the familiar single-answer multiple-choice format, typically presented in case-based formats. They may include ECG and imaging with the presentation.

    Shelf Exams As a Stepping Stone

    From Shelf or Clerkship exams, to USMLE, to ITE, to (finally) your specialty boards exam, this type of assessment is a stepping stone to the next one. Questions you see on the Shelf exams will be seen on the USMLE or COMLEX, and on ITE’s, and on your final boards specialty exam. Learning the best methods, and structuring an approach to Shelf exams will serve you well as you progress through graduation and residency.

    Example Questions - Internal Medicine Shelf Exam

    Questions on the actual exam will not include key points, nor remediation. We’ve included it with these questions to demonstrate how the multiple-choice questions on exams or in preparation question banks are written to draw out key knowledge points.

    A 65-year-old man presents to the clinic with a 3-month history of progressive fatigue, dyspnea on exertion, and bilateral ankle swelling. On examination, you notice jugular venous distension and hepatomegaly. Chest X-ray reveals cardiomegaly and pulmonary congestion. Which of the following is the most likely diagnosis?
    A. Congestive heart failure
    B. Chronic obstructive pulmonary disease
    C. Pulmonary embolism
    D. Pneumonia
    E. Asthma
    Key Point: Recognize the clinical presentation of congestive heart failure.
    Congestive heart failure presents with fatigue, dyspnea, peripheral edema, jugular venous distension, and hepatomegaly. The chest X-ray findings of cardiomegaly and pulmonary congestion further support the diagnosis.


    A 48-year-old woman with a history of hypertension and type 2 diabetes presents to the clinic complaining of frequent headaches and blurred vision. Her blood pressure is consistently elevated during multiple readings. Which of the following medications is most appropriate as initial therapy for her hypertension?

    A. Lisinopril
    B. Amlodipine
    C. Furosemide
    D. Metoprolol
    E. Clonidine
    Key Point: Understand the initial management of hypertension in patients with diabetes.
    In patients with hypertension and diabetes, angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, are the preferred initial therapy due to their renal protective effects.


    A 56-year-old man presents to the emergency department with a sudden onset of severe, tearing chest pain radiating to the back. His blood pressure is 200/110 mmHg, and his pulse is 110 beats per minute. A chest X-ray reveals a widened mediastinum. Which of the following is the most likely diagnosis?
    A. Myocardial infarction
    B. Pulmonary embolism
    C. Pneumothorax
    D. Esophageal rupture
    E. Aortic dissection
    Key Point: Recognize the classic presentation of aortic dissection.
    Remediation: Aortic dissection presents with sudden, severe, tearing chest pain that radiates to the back, hypertension, tachycardia, and a widened mediastinum on chest X-ray.