Studying for Third Year NBME Shelf Exams

[The original version of this newly updated/revised post was first published way back on August 19, 2012.]

Chances are, your third-year clerkship grades will hinge more on your NBME Shelf exam scores than on your clinical evaluations. The strategy I advocate is to come off of Step 1 strong by immediately shelling out for the UWorld Step 2 question bank for the entire year. Do the questions for each rotation.1 Take your shelf exams, nervously wait 1-3 weeks for your scores to come back, and soldier on. Then at the end of third year, reset it so you can start fresh and use it to study for Step 2 CK. If you’ve studied for and done well on your shelf exams, UW and Wikipedia should basically be sufficient for Step 2 CK, which for at least the near future will be an extremely important non-pass/fail exam. The best way to perform well on Step 2 CK is to also prepare for and do well on your shelf exams.

While UW is, I believe, indispensable for several of the shelf exams, it is not sufficient. (Related: If you’re in the market for an additional question source, I do have some qbank discounts on the support page.) There are also a variety of online-based curriculum replacements that one can use for longitudinal learning during third year. But for book people, here’s how I would approach each clerkship:

 

Psychiatry

First Aid for the Psychiatry Clerkship is your must-read. It’s extremely quick, readable, and hits everything. You can read this book in a day if you want to; it’s that short.

The only book you would need after FA is Case Files Psychiatry. It’s a good volume in the series, and some of the cases do a nice job of distinguishing between adjustment disorder in its many forms (recognizing adjustment disorder versus MDD, GAD, acute stress disorder, and PTSD etc is extremely important for the psychiatry shelf). You don’t need more reading beyond that, just UW. Enjoy the psycation.

More than any other shelf, the psychiatry shelf really stresses adverse effects of its medications. Every important drug has its one or two, and you need to know them cold. All of them.

You also need to pay special attention to medical disorders with psychiatric manifestations (depression and pancreatic cancer, Addison’s disease; pheochromocytoma or carcinoid tumors masquerading as panic disorder; etc).

 

Ob/Gyn

Case Files Obstetrics and Gynecology is your first book of the rotation. When in doubt, you can always get through a Case Files book quickly and know that it will hit the highlights (i.e. common board/pimping questions). It’s an excellent foundation for your rotation, and you should read it as fast as possible.

Many people advocate Blueprints Obstetrics and Gynecology, as it is quite readable and nearly exhaustive. I would caution you that unless your rotation has light hours, many many students don’t have enough time or energy to slog through it. Many of my peers who started with Blueprints never finished a single book before taking the exam. They just didn’t have time. Finishing a single book is the most important thing; you need to have one cohesive point of view. Even Case Files alone is better than 3/4 of Blueprints. Don’t get yourself in trouble. Most OBGYN clerkships are exhausting.

If your school pays for the ACOG/APGO question bank, great. Definitely use it. If not, I’d just read Case Files again and do UW. Always focus on things that might seem similar and be able to tell them apart (placenta previa vs vasa previa vs abruption). You may benefit from a qbank supplement (or even PreTest) if you have time and no APGO access.

 

Pediatrics

Blueprints Pediatrics is the common favorite (and my wife’s personal favorite as well), and though I personally don’t care for the series, it is certainly sufficient. First Aid is overkill. Case Files Pediatrics (my favorite), patient reading, and UW for me was enough, but if you have the time and drive to read a more thorough text, I think BRS Pediatrics is actually the best.

As far as entries in the series go, Pediatrics PreTest is one of the better ones, and if you need more questions in book format, then it would be a reasonable use of your time (I personally wouldn’t bother).

You probably need two sources. Blueprints or BRS + Case Files is a common combination, if you can stand the cardiology section of BP.

Don’t go overboard on vaccine schedules and developmental milestones. You can sink a lot of time into that for little to no benefit. You should know a couple of big milestones per age group. Know the contraindications for vaccines; don’t learn the actual timelines.

 

Surgery

As always, crank through Case Files Surgery as fast you can so you don’t look like an idiot. Crush Step 2 / Step 2 Secrets (essentially the same book in different formats, one of which you’ll probably want/have anyway, I prefer the former) can also help you get a rapid-fire overview of surgery in less than a night (and is also a particularly nice way to quickly learn the very basics of the many surgical subspecialties, which are fair game on the shelf). However, the single best rapid review text is actually Dr. Pestana’s Surgery Notes, written by a now-retired faculty from the University of Texas Health Science Center at San Antonio. For years before the official version, a more informal packet was widely used and beloved by students around the world for being extremely quick and extremely high yield (you can find copies of that old standby pdf online).

Then, before slamming into UWorld with all your might, I’ve classically recommended the NMS Surgery Casebook. This dense book has been an essential read for the clerkship: excellent, organized well, good diagrams, and contains everything you need to know. Note, this is not the NMS Surgery textbook. Don’t bother with that thing. The Casebook is the better resource by far. In recent years, many institutions and students have recommended the newer Surgery: A Case Based Clinical Review, which is also excellent. They are analogous, so just pick one. After that, just do questions. Pay special attention to trauma management, which makes up a lot of the test. Many questions hinge on applying the ABCs properly, often comically obviating the need to know definitive management. If you would do two things simultaneously in real life, never forget that one of them technically comes first based on the ABCs.

Many students use Surgical Recall to help prep for pimping and an overall understanding of the day-to-day business of surgery. Surgery Recall is a good book for reviewing the common questions you are likely to receive/knowledge you need to succeed in-person and on the wards/in the OR. It’s a good book to carry in your white coat and pull out when you have a few minutes of downtime. I would not, however, rely on Recall as a primary studying guide when it comes to the shelf. Details about actual surgeries are not on the exam, but the management of surgical patients is. The portions that do apply to the shelf though are full of rapid-fire high-yield facts.

 

Internal Medicine

The best way to study for IM is to do all of UW Medicine. This will take several weeks but will be worth it. The second most important thing you can do is pay attention on the wards.

The favorite medicine text nationwide is Step-Up to Medicine, which is the best (and the third edition just came out). It’s a bit long, and you may find yourself dropping it in favor of getting through the question bank. Case Files Internal Medicine is decent (helpful mostly if your background is poor and because it’s shorter). First Aid isn’t worth your time. For practical knowledge on the wards, huge swaths of students swear by Pocket Medicine (formerly “the green book,” it’s been changing colors with each edition), though I personally think UpToDate is more interesting and more complete when a computer is nearby.

If you finish UW, do more UW. Nothing else comes close to being what you need.

 

Family Medicine

I leave Family Medicine for last because it’s one of the more irritating tests to study for. Take it later in the year, and it will be mostly straightforward. Taking it toward the beginning of your clerkships can make it the hardest test of the year given its broad scope and the handful of seemingly random questions on every test. If you have the choice, doing it toward the end of third year makes the test far more reasonable.

Medical students can become members of the AAFP for free and then use the AAFP question bank. I thought these questions were more resident-level than the real thing and didn’t love them, but they are undeniably a solid resource. You can slog through a ton of UW and that would work, but that’s a daunting task for a shorter rotation. To historically prepare via UW, you would ideally get through the OB, Peds, IM, and preventative sections. That’s a lot. UW recently began offering shelf mode, which includes family medicine, so at least that makes the prospect approachable, but this selection is still more tailored than you’d get from months of organic review. Definitely hit up UVA’s free online mini-qbank, which has 125 high-yield questions.

In the beginning of the year, Case Files Family Medicine would help give you the basics. Later in the year, it will likely just remind you of things you already know quite well. The ambulatory section of Step Up to Medicine is certainly a good idea. Some people use Blueprints FM (breadth but not depth) or Step 2 CK review books (try Crush Step 2, if you must). There just isn’t a great resource geared for the clerkship. That said, some students swear by the use of Swanson’s Family Medicine Review, which is written for the FM boards but has a nice case-based question-heavy format that would likely serve you well. If that seems too daunting, reading the pediatrics and ob/gyn sections of Crush Step 2 will at least help you rapidly hit the highlights.

In the end, family medicine is not a discrete field; it’s a combination of everything else: mostly medicine, a good helping of peds and ob/gyn, and even a bit of psych, surgery, and EM thrown in. My advice is to schedule it for later in the year, especially after medicine, which makes it much more manageable.

Questions, questions, questions.

Elective and sub-I book recommendations are here. Some thoughts on how to approach irritating/difficult clinical science questions can be found toward the bottom of this page. Step 2 resources are detailed here.

Looking for information on the preclinical shelf exams?
Anatomy, physiology, biochemistry, and microbiology are here.
Pathology is here.

The Truth about Private Equity and Radiology with Dr. Kurt Schoppe

Have you ever talked to someone above you on the food chain—usually with the word manager, director, or Vice President somewhere in their job title—and after they depart, you just stared blankly into the distance while slowly shaking your head thinking, Wow, they really don’t get it. What a useless bag of skin?

Well, that’s the opposite of my friend Dr. Kurt Schoppe, a radiologist on the board of directors at (my friendly local competitor) Radiology Associates of North Texas and payment policy guru for the American College of Radiology where he works on that fun zero-sum game of CMS reimbursement as part of the RUC. He’s whip-smart and has a unique perspective: Before pursuing medicine, Dr. Schoppe was a private equity analyst.

Consider this transcribed interview a follow-up to my essay about private equity in medicine published a few months ago.

Here’s our (lightly edited conversation):

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Physician Survey Signup Bonuses

Many survey companies don’t have great offerings for residents, but several do offer bonuses for signing up/when you attempt a survey or two:

I maintain an up-to-date list of healthcare survey companies here. These links are referrals that also support this site–so if signing up meets your needs/desires, thank you for helping me write.

Recommended Books for Radiology Residents

[This updated/revised article was originally published way back on December 21, 2013]

There are lots and lots of radiology books out there.

Rather than list oodles of options, I’ve made a short editorial selection for each section. There are obviously many good books, but your book fund is probably not infinite and you need to start somewhere.

First-year residents, in addition to Brant and Helms Core Radiology, might start with these recommendations prior to buying any additional texts that they are unlikely to read at length during their first exposure to each section.

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Recommended reading for first-year radiology residents

[This updated/revised article was originally published way back on December 12, 2013]

Expectations for first radiology residents include a whole lot of reading. Tons and tons of reading. The follow-through on that expectation may be somewhat less impressive, but you’ll still do your best to pretend. Given the dizzying array of options, a curated list of book recommendations seemed like a good idea.

With your limited resources, as an R1 I recommend first buying the general books that will serve you well throughout the year (and beyond). If you still have more funds, you can figure out what to buy next based on your interests and needs (and this list) after you’ve read what you’ve got. At that point, your program’s library (and/or unofficial digital library) will be a good place to see what’s worth your money. You’ll be doing a lot of your reading for free online anyway.

Last Updated April 2022. Since I initially wrote this list, I’ve also added an additional post on Approaching the Radiology R1 Year.

General goodness

The quintessential Brant and Helms’ Fundamentals of Diagnostic Radiology was historically gifted by many programs. Find out if your program still does so before buying your own copy.

The huge single edition looks better on a bookshelf but is cumbersome. It’s too heavy to carry in a bag and honestly too heavy to sit in your lap. Get the 4-volume edition if you actually want to use it. I owned the single edition, and as a result, I only really used the online access. And, to be frank, while B&H may be the classic introductory text, it’s overrated and definitely not uniformly good throughout. Too much text with too few pictures, often overwhelming for the junior resident. If your program doesn’t use it, I probably wouldn’t bother.

Core Radiology: A Visual Approach to Diagnostic Imaging is the “new” monograph (first published in 2013, its title shamelessly taking advantage of CORE exam dread and a pattern subsequently used in many radiology books since). It’s a better introductory approach than B&H for new residents (or those at the beginning of board review). It was finally revised for a second edition in September 2021, so it’s fresh. Bullet points, shorter paragraphs, bigger font, more diagrams, and (an initially) single authorship with tailored content mean that this volume presents a coherent and more practical approach than the old standby.

Aunt Minnie’s Atlas and Imaging-Specific Diagnosis is a fantastic quick read. It’s organized by section with a collection of classic “Aunt Minnie” cases that you must learn because they’re common or classic fodder for conferences and the like. Each section is short so you can spend an evening or two reading it at the start of a rotation.

Top 3 Differentials in Radiology is another quick, excellent general book. While Brant and Helms may have been the quintessential introductory text, textbooks don’t necessarily serve as the best introduction to day-to-day work. Each page presents a single finding (e.g. solitary pulmonary nodule), the most likely diagnoses with brief descriptions, and a few pearls.

The text that concisely supplies the radiology facts (but not the images) was classically the Primer of Diagnostic Imaging (the “purple book” aka “First Aid” for radiology), which has lists, outlines, and diagrams galore. It was historically well-liked but has the potential to cause death by bullet point (personally not my cup of tea), and I’d argue Core Radiology now handles this task better overall. A slightly cheaper, question-and-answer formatted alternative is Radiology Secrets Plus. In my opinion, these two volumes are more of historical interest and can be safely skipped.

One step up in terms of detail from Top 3 Differentials is Clinical Imaging: An Atlas of Differential Diagnosis, which is organized by a pattern recognition approach. It’s a huge, atlas-like book, which you may or may not be that interested in reading.

So, in my opinion, Core Radiology, Aunt Minnie’s, and Top 3 Differentials are three things I would buy at the very beginning, as they’ll serve you well throughout the year.

Some people like to start with textbooks. Others prefer cases. I think there is something to be said for cases and classic findings, which give you a sense of familiarity with the subject prior to digging into a dry textbook chapter. For every rotation, you could go over your atlas to get a grip on the anatomy, then follow it with the relevant sections of Top 3 Differentials and Aunt Minnie’s, and the combination wouldn’t take more than a few days.

Most books focus on pathology and rarely provide a practical approach for how to review studies in real life (i.e. how to develop a search pattern). It’s something people slowly figure out on their own or try to derive from attendings. One adjunct some might find useful for approaching different exam types is Search Pattern.

Anatomy

You can use a variety of free online atlases and tutorials as early anatomy resources:  UVA’s  Introduction to Radiology, Radiology Masterclass’s CT Brain anatomy, the very cool RAAViewer software, HeadNeckBrainSpine (RIP), FreitasRad’s Musculoskeletal MRI, Stanford’s MSK MRI, CaseStacks, Learning Neuroradiology, etc etc.

Good dead tree atlases include Fleckenstein’s Anatomy in Diagnostic Imaging (on the pricey side) and Imaging Atlas of Human Anatomy (on the affordable side, and well worth it for someone who wants a paper atlas). Sectional Anatomy for Imaging Professionals is more of an anatomy textbook, with descriptions, diagrams, and selected cross-sectional images.

The most useful overall is IMAIOS’ e-Anatomy, which is an excellent website and app available as an annual subscription. If your program doesn’t buy you access, you should come together as a residency and request it. Radiopaedia has supplanted StatDX in a lot of use-cases, but e-Anatomy is pretty clutch (though still painfully detailed in some situations and yet wimpy in others).

Physics

Physics may be essential for the boards (and life), but understanding MRI physics is the subset most likely to help you both interpret studies, troubleshoot technical challenges, and understand pathophysiology. Learning MR physics early will help you make the most of your MR rotations (if your program relegates you to reading plain films for your first nine months, then nevermind). My favorite introduction is the Duke Review of MRI Principles, which is surprisingly affordable for a radiology book and a must-buy content-wise. It’s quick and case-based.

Another fantastic MR physics book for the non-physics crowd is MRI made easy (well almost), which is old but relevant, out of print, impossible to buy, and very easy to download online. For the rest of physics, the cheap book is Huda’s Review of Radiologic Physics (Bushberg’s costs more and says more than you probably want to know; I’m not sure anyone reads it anymore in the era of the Core exam). You don’t necessarily need either. The RSNA modules are fine content-wise, but the online flash design/format is truly horrible and painful to behold.

Sectional

What books you should supplement with on each rotation will depend both on what rotations you have during your first year and how much reading you actually get done. A more complete list can be found here, but here are a couple of guaranteed hits:

On chest, Felson’s Principles of Chest Roentgenology is what you need to read for plain films. For cross-sectional chest/body, Fundamentals of Body CT is a more portable and readable replacement for Brant and Helms.

Call-Readiness

A new resource (as of April 2020) that I think is super neat is CaseStacks, a new subscription service that puts a ton of high-yield bread and butter cases with actual DICOM images and a serviceable web-based PACS that lets you actually experience real scrollable pathology as you do in real life (and not just an image or two as in most question banks). Each case also has findings (often including ancillary findings, like real life) and a pretty solid sample report, which will help you see practical examples of how to put some words on the page. I would absolutely have done this as a first-year or early second-year before taking call. (If my program had a subscription, I’d probably try to knock out the relevant cases first thing during the rotations like neuro CT as well.) As per my usual affiliate MO, I reached out and was able to secure you 15% off with the code benwhite.

What should I read as an intern to prepare for radiology?

Nothing. You can go in blind and not look particularly stupid.

That said, you can often pick up old books for ridiculously cheap if you want to get a headstart. Most of it won’t stick without having the volume of daily reading and dictation to put it into context.

A more useful book to read as an intern (any intern for that matter) is Felson’s, which is the book for plain film chest interpretation. Everyone should know how to do this. As a bonus, you may get to see how full of it some of your senior residents and attendings are “who read all of their own films.” Save the big book-buying for when you have a book fund to burn through.

If you’re really interested, you can hammer home some anatomy and familiarize yourself with basic radiologic pathology online. The Radiology Assistant is a really nice concise resource for a wide variety of normal and pathology. Radiopaedia concisely explains a great number of topics and has become the true Wikipedia of radiology. You can also browse the web and watch online lectures. Most societies have oodles of resources and free membership for trainees.

Once you’re ready for further reading, here is my compilation of highest yield texts for residents broken down by section/modality.