29 July 2010

shelf exams

At the end of each rotation in your third year of medical school, you sit a national exam called the "shelf". It's made up of questions very similar to what will be on the USMLE step 2 (which you sit during your fourth year). Unlike USMLE step 1, the shelf exams and the step 2 are more clinically oriented; however, they are no less frustrating. Step 1 was a pain because of questions like "what arm of what chromosome is implicated in ridiculously rare disease X?" Answer: No idea, not relevant, don't care. The medicine shelf exam, it seems, will be a pain for an entirely different, but equally irritating reason: apparently I'm supposed to be psychic. For example, one question was about a 10-week pregnant woman with a swollen leg and shortness of breath. I was apparently supposed to deduce that her main problem was vomiting, despite the fact that pregnancy is known to place an increased risk for DVT (which the swollen leg would fit with). Another example? A woman with arthritis symptoms comes back for a follow up visit with gastric discomfort. I was supposed to infer that she was having methotrexate side effects, despite the question never describing any treatments being started. This all brings to mind another, perplexing question. I'm not a stupid person and I struggle with these exams. I know some stupid people who are doctors... how the hell did they pass them all?!

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