Studying for Shelf exams can be difficult. You woke up at 5 AM to get to the hospital in time for sign-out. You ran around the hospital for nearly 12 hours, seeing patients, making calls, and maybe even answering pages all day. Now it’s 5 PM and you finally get home. You snarf down some dinner, plop down on the couch, and pull up your laptop. The glow of the question bank sign-in screen is so draining to your exhausted soul that you just don’t think you can force yourself to study today. But, you find a way to power through. I have been there, trust me. I know that your study time is precious. So here are my brief thoughts on how to study efficiently and effectively for the Shelf in my favorite specialty, pediatrics.
1. Earn, Not Just Learn, Your Bread and Butter
Most of the pediatrics Shelf tests you on “bread and butter” conditions and their management, or the “horses,” not the “zebras.” Luckily, because pediatrics is usually high-volume and high-turnover, you will probably be able to see most of these conditions on the hospital wards or in the outpatient clinic. My advice is to make a conscious effort to actually learn how these conditions are recognized and treated WHILE you are at the hospital.
This may seem obvious to some, but I don’t mean trying to sneakily do an Anki deck on your iPad during rounds. What I mean is that on rounds you should pay attention to the presentation and treatment plan for EVERY patient that is discussed, not just the ones you are personally caring for. If you don’t understand how a diagnosis was reached for a patient or why a particular element of the plan is being done, ASK. Nine times out of ten it is not a silly question and the student next to you is wondering the same thing. Most pediatricians are also incredibly friendly and excited to have a teaching opportunity. So not only will this approach make you have less to study or look up when you get home, but it will make you look interested (and maybe even smart) in front of your residents and attendings. Plus, in my experience, it makes long rounds fly by faster than if you’re just twiddling your thumbs and staring at the clock.
I call this approach “earning your bread and butter” because you will know the material based on your work with actual patients, not based on just memorizing tables. By earning this knowledge through your work, you will remember it better and longer. On the test, you will find yourself vividly remembering Timmy’s cough when asked about RSV or Sally’s rash when asked about coxsackievirus, rather than trying to think about that faceless patient in that one practice question you did that one time.
2. OK, But For Real, How Do I Study?
Learning at the hospital is fine and dandy, but at the end of the day, you still have to study at home, too. There are a lot of resources out there. Here is how I approached the sea of pediatrics resources and created a study plan:
First and foremost, you have to do practice questions. Practice makes perfect, right? You need to get used to being asked questions similar to the real Shelf AND doing them under a time constraint. (Luckily for you, TrueLearn has a Shelf-specific SmartBank.) I also liked to try to integrate the topics of questions I was doing with whatever part of the rotation I was on, like doing questions about newborns while working in the nursery, etc. Finally, make sure you are doing a large volume and variety of questions, as pediatrics covers quite a breadth of information. I would recommend doing at least 400 questions and reading a little more in-depth about the topics of the questions you miss. This sounds like a lot, but over an eight-week rotation, it is only about ten questions per day. Not too overwhelming, right?
Secondly, I would recommend reading about common cases you haven’t yet seen on the wards or cases you keep missing questions about. There are many case-based books out there, but I liked Case Files Pediatrics. The cases go over all the Shelf-level information you need to know for the most commonly tested topics. I would recommend reading 1-2 cases per day. Again, this is pretty doable even after a long day in the hospital.
About two weeks before your test, I’d recommend doing a “mock exam” that gives you a final score and is at least 50 practice questions long. This will help get your test-taking stamina back up and help you gauge what you need to be studying most during the last two weeks of the rotation. If you bomb it, don’t panic. You will have plenty of time to reach out to your pediatrics clerkship director or another advisor for help. As I said, most pediatricians are friendly and like to teach, so they will help you!
Lastly, the week before your test, I would recommend doing some kind of general overview, either by reading through the questions you missed, watching review videos, or getting together with a friend and going over tough topics, etc. There are also great free overview videos online. Most importantly, if your school offers a review session before your exam, go!
3. Just Gimme the High Yields
Let’s say you’re reading this one week before the exam and are totally freaking out. You didn’t do any of the things I said in #1 or #2. Maybe it is your last rotation, and you’re just worn out. Or perhaps you aren’t one bit interested in pediatrics, and you just gotta pass this thing. Here’s what I think you should spend your time studying this week. (Please keep in mind this is not at all meant to be comprehensive. It’s just my opinion on the topics I think are most important to focus on.)
- Identifying normal development/milestones
- Identifying normal puberty/differential for abnormal puberty
- Presentation of TORCH infections
- Presentation of pediatric infectious diseases/vaccine-preventable diseases
- Identifying and treating sepsis or jaundice in the newborn
- Differential for common causes of neonatal vomiting and abnormal stooling
- Physiology and murmurs of congenital heart diseases
- Identifying pediatric/neonatal rashes and other abnormal skin findings
- Identifying common pediatric injuries and when they are suggestive of abuse
- Outpatient asthma management
- Common ear infection pathogens and management
- Diagnosis of cystic fibrosis and sickle cell disease
Feeling good about #1-12? If you have a little more time, study these.
- The vaccination schedule
- Presentation of chromosomal abnormalities
- Differential and treatment of pediatric seizures
- Differentiating pediatric nephrotic syndromes
- Diagnosing pediatric cancers, especially ALL
Best of luck to you on your Shelf-taking endeavors! And remember, the pediatrics Shelf is just one exam. You have taken many exams before and will take many more. Whether you go into pediatrics or not, this test will not define your career. Just do your best, and remember it isn’t about the score; it’s about learning to become a better doctor.
Dr. Kelsey Rowe, MD/MBA, graduated from Saint Louis University School of Medicine and Richard A. Chaifetz School of Business in 2020. She is currently a first-year resident in pediatrics. She has published research related to herpes virus vaccine development and is the author of Vax-Force, a children’s book that explains how vaccines work. Kelsey is originally from Topeka, Kansas. She enjoys running, painting, and drinking coffee.