Month: May 2021

Internal Medicine Shelf

Sup ya’ll!

So you are looking into taking your internal medicine shelf or COMAT for your third year of medical school. Well, I didn’t do terribly on it but I am definitely a middle of the road type of student. So if you need some advice on just passing, then this is the place for you!

Your internal medicine shelf will be like a mini level 1 or step 1 exam. Internal medicine spans MANY different specialties and is the actual base of the medicine stepping stool. You need to know a lot about a lot for this shelf. So pace yourself a bit because it is a lot of information. Topics they like (at least on my shelf):

  • Screening. Know the different indications for this. I.e. colonoscopy, breast cancer screening, AAA screening, vaccinations for adults, etc.
  • Cardiac basics. I.e. ACS vs MI vs NSTEMI. How do you diagnose it. What do you order vs next steps. How do you treat?
  • Cardiac continued: there are several classifications. I.e. Diamond classification for ACS, CHADS2VASC score for anticoagulation, NYHA for CHF. They will ask questions about these. So will your preceptors, so just be familiar with them.
  • INFECTIONS. Oh man I was so mad about this. I’m terrible with infections and antibiotics. They will ask.
  • Sepsis is hit or miss. I had a lot of sepsis practice questions but didn’t feel like I had that many on my shelf personally. But either way, it is a big hitter in medicine in general and patients die from it, so understand it and how to treat it.

How I prepped:

My internal medicine rotations were back to back. So I started studying during my first rotation a little bit throughout regardless of if I was in clinic or not to try to get through some of this.

  • Online med ED videos and questions. There is a lot, and it can be difficult to get through all of it. I started with one topic and tried to dive into it. Some of it will come back from your first two years. The rest you will see for the first time (or at least your brain will think it has). You will be exposing yourself to a lot, so take it chunk by chunk.
  • Case X. Yes, very helpful!
  • Aquifer cases: more helpful for screening and outpatient medicine guidelines. Less helpful I thought for inpatient medicine.
  • Anki Dorian deck: oh yes. Wish I would have been able to get through more.
  • U world and Truelearn questions. Even if I only did 10 at a time, I tried to go through all those incorrect answers. I would pick the topics I was studying from the videos I was on at the time to really drive in the content home in my brain.
  • Case files. Helpful, just couldn’t get through that much. A good quick way to see high-yield or common presentations and how to assess them.

On my off days, weekends, or weeks where I was off to do my assignments as I am a hybrid student I tried to do a good mix of my assignments and the above. Weirdly enough my school didn’t require me to watch the OME (online med ed) videos/do questions for internal medicine which I thought was just whack. But I did it anyways, because it was a good source of information/study material for me.

My shelf exams were 125 questions. I think it is around 2 hours for a time limit? For the most part I was able to pace myself. The ending there I was a little peeved because I was worried I would run out of time. Just try not to spend too much time on one question. You can always guess, flag it, and if you have time go back and try to glean a better answer.

Anywho, good luck and cheers!

Surgery Shelf

Hey ya’ll.

This will be a super short blog post but I’m currently studying for my surgery shelf and need a distraction. 🙂

Because surgery is a 2 rotation requirement (at least at my school) I didn’t need to study for a shelf when I did my general surgery rotation. However, since ENT was my second surgery rotation, I did need to study. I am incredibly thankful that I did have two weeks off to study, because ENT kicked my ass. See that post if you want to know what that was like!

The biggest topic that I thought I understood and clearly I didn’t were fluid questions. There are more on there than I thought there would be. So understanding fluids is a big topic. Otherwise, burns, trauma, and general surgery are what the remainder of the questions focused on. A lot of, what is the next step? How do you treat? What type of imaging is best? etc.

What I used:

So, I have required assignments in third year. It was my school’s attempt to equalize learning. On top of that as a 2+2 or hybrid student I have more assignments. The additional assignments really aren’t helpful. Sometimes the assigned topics are, but usually they aren’t.

Useful assigned content:

  • Online med ed (OME)
  • Case X (OME)

Initially I just did the assignments and hoped that it stuck. Some of it did, most of it didn’t. Additional resources I used:

  • Truelearn questions (good place to start but not sure they are very similar to the shelf questions)- COMQUEST are better
  • Dorian Deck from Anki

Not useful content:

  • Assigned standardized patients (useful in 1st and 2nd year, not useful at all as a third year when you start regularly seeing patients)
  • assigned powerpoints
  • assigned case presentations
  • aquifer cases – not much for the second surgery rotation, but wasn’t helpful from my first rotation in surgery
  • Wise MD and Wise MD on-call: these are videos. Some of my assigned videos would have been SUPER HELPFUL if they were assigned for my first month of surgery. Like what are the instruments you are using in the OR and how to suture… The rest were supposed to be case-based assignments but I just personally didn’t jive with the way they were presented.

How I studied:

So the first two weeks I was in ENT, and didn’t get much studying for my shelf in. I was mostly trying to stay afloat in ENT. Which my “give a shit meter” would drop significantly after 1.5 weeks- not going to lie.

After that I worked on my assignments. This was a good base, but I really wasn’t retaining as much as I’d hoped.

About 1.5 weeks out was the following:

  • 200-500 Anki reviews a day (brutal yes – probably should have spread that out more)
  • About 10-25 Truelearn questions a day (there are only like 140 total. Most of my classmates bought COMQUEST which gives you a simulated shelf score)

Few days before:

  • 2-3 days before I rewatched all the surgery videos and trauma videos on OME to refresh my memory (super helpful after doing so much Anki)
  • Watched the Emma Holliday presentation for surgery on YouTube. Even just listening to them or attempting to answer the question myself before she stated the answer was helpful for me.

I was going to add in some Uworld questions but didn’t have the time or energy. The procrastination game is strong on my end. I’ve always been a last minute blitz studier. Wish I wasn’t as it is stressful, but it is what it is. I’m 30 and I doubt I will change that habit.

Hope this was helpful!