How to Honor the Psychiatry Shelf Exam

This was my strategy. This page includes My Resources, The Honors Study Plan, and a few Tips for the Test to honor the Psychiatry Shelf Exam.

 

A. My Resources

These include books I used for initial reading and knowledge gathering; question banks for practice and review; and practice tests to prepare for the feel of the actual exam.

 

a. Reading Material:

 

*First Aid: Psychiatry. It’s short, and if you want honors (and you are lucky enough to have good hours on your rotation), finish it in the first 2 weeks. I used an older edition, and it served me well for the 2015 exam; however, you may want an updated version that contains the new DSM V criteria…

 

*Case Files: Psychiatry. First Aid is ultimately more helpful, but Case Files is good practice, and helps to fill in a few gaps left by First Aid.

Based on my plan, you’ll start the book after you finish First Aid, and finish just before the last week of the rotation.

 

*Concise (our school’s online textbook). I used this for clarification where First Aid over-simplified, but your own school’s textbook would surely do the trick. For a book called “Concise”, it was actually quite dense…

 

*First Aid for the USMLE Step 1: Oh, this dreaded book…it’s a blessing and a curse, isn’t it? I have the Kindle version, and I referenced it occasionally for some of the neurology and pharmacology material that you’ll see on the exam.

 

b. Questions:

 

*UWORLD: This is your bread-and-butter question bank for every rotation. These questions are great early-on in your studies to solidify the basic foundations of psychiatry. However, you will find many ethics and personality disorder questions, which are absolute rubbish for the actual exam…and, overall, the questions are much easier than the actual shelf exam…which is why you need…(see next).

 

*LANGE: This book is fantastic! It is wildly outdated, but in all honestly, it didn’t really matter. It is solely a question book, and it is divided into chapters by subject matter. It’s only 9 chapters, and the last 2 are practice exams. Take notes on the questions you answer incorrectly!

Skip the Ethics and Legal chapter. There are a LOT questions so you’d just be wasting time with that chapter.

 

c. Practice tests:

 

*NBME, Forms 1 and 2: These will give you a feel for what test-takers want you to know for the actual exam. I had one or two questions on the real test that were almost identical to these questions. Taking one would suffice for someone who wants to pass; if you want honors–do both. I took the exams untimed because I was more focused on critically thinking through the answers than my speed.

Keep in mind: your score on these tests will overestimate what you may get on the actual exam. The test has gotten much harder since these tests were retired, and students are doing much better overall. So don’t stop studying if you get the 80th percentile–I know someone who did, and got the 20th percentile on the real exam!

 

 

B. The Honors Plan in 6 Weeks

 

Week 1 and 2:

 

a. Readings:

 

*First Aid for Psychiatry: Type up your own outline for all conditions from First Aid.

 

Emphasize the criteria and treatment for each condition.

 

*Optional: Make flash cards for each drug class, using First Aid. Pharmacology is highly emphasized on this exam.

 

The cards should include: The class, mechanism and neurotransmitters involved, contraindications, and side effects.

 

Week 3 and 4:

 

a. Readings:

 

*Case Files Psychiatry: Read 5 cases/day, 4 days/week. There are 60 cases total so your goal is to finish these in 3 weeks.

 

Add your notes from Case Files to your First Aid outlines, and medication notes to your flashcards.

 

*First Aid for the USMLE Step 1:

In Week 4: Review the First Aid, psychiatry section. You’re probably well familiar with it from Step 1, so it shouldn’t take that long to review and add in a few important notes. Start with the pharm section first.

-Briefly flip over to the neurology section. Add info from the Alzheimer’s and Parkinson’s medications to your flashcards. I had many dementia questions on my exam (not to mention I saw a lot of these patients too on my rotation) so you don’t want to miss something important.

 

*Concise (your textbook):

-Supplement with this for anything that’s confusing or unclear.

 

b. Questions:

 

*UWORLD: Try to do 7 questions/day, 4 days/week, starting in week 3.

 

*LANGE: Finish up to chapter 3.

 

c. Testing

–End Week 4: Take NBME Form 2 on Saturday. Then, take some time a few hours later when your brain is less drained to go through each question to get a thorough understanding of what they’re trying to emphasize with each question.

(It doesn’t really matter which one you take, but that’s just what I did).

 

 

Week 5:

 

a. Review:

 

*Go through and try to memorize/learn your outlines and drug flashcards, clarifying things you don’t understand clearly.

 

b. Questions:

 

*LANGE: Finish up to chapter 7 at the end of Week 5. This is harder than you’d think, but try to push through it! Again, add things you missed to your outlines. Skip the legal and ethics chapter to make your life easier.

 

*UWORLD: Finish all questions at the end of week 5!

 

Week 6:

At this point, you should know everything so well that you just want to get the darn thing over with. This is a good sign. But keep reviewing!

And for goodness’ sake…consider taking the day before the exam off, if you feel comfortable doing so.

 

a. Review:

 

*Go back through all of your outlines

 

b. Questions:

 

*If you’re feeling up to it (and have the time…), work on Lange chapters 8 and 9, which are practice exams. I actually never got through these (my rotation schedule got rough), but I highly recommend trying to push through it, if you can!

 

c. Practice test:

 

-Go through NBME Form 1. Again, review what you got wrong and add this to the outlines.

 

d. GET HONORS!

 

 

C. Tips for the Test

 

1. Scoring: The rationale for shelf exam scoring really stumps me. To me, if you get 75% of the questions right, you should be proud of yourself and deserve an honors score…but of course, that’s not how it works. Instead, we have to crawl our way to the top of the pecking line and beat out our neighbors for a top-notch score. That just doesn’t seem like a very smart way of doing things, to me. Basically, for the psychiatry shelf more than any other, there is a significantly large proportion of students who get scores of >90 (which on every other shelf, correlates to around the 98th percentile).

 

What I’m trying to convey is the fact that even if you know psychiatry really well, so do the rest of the students that you’re competing against. The bell curve on this thing is ridiculously skewed. That’s why minutia becomes so dang important to get the honors grade! Don’t let the tiny details escape you because ultimately (I hate to say it), that’s what’s going to put you a step above your peers, and get you the honors grade on this one.

 

That being said, the majority of the questions are not minutia. They’re your basic diagnosis of adjustment disorders, schizophrenia spectrum, childhood psychiatric disorders, and pharmacological side-effects. It should go without saying that you should know the basics of psychiatry inside and out.

 

2. Question stems: The question stems are LONG. Honestly, timing was my greatest challenge. My suggestion is to skip past the ones you don’t know, and gather all the points on the ones you do know. Don’t linger on tricky questions (like I did…)

 

3. The night before: Don’t stay up late studying, and buy a Monster the night before to keep you pumped. Eat a monstrous breakfast, but nothing too heavy or sugary that it will make you sleepy. For me, a couple of eggs, some toast, yogurt with berries, and a glass of OJ did the trick.

 

4. Question Content: This was a post on SDN about the content seen on his exam, and I thought that it was very accurate. His words, not mine!!

• Obviously you need to know all of the mood disorders, psychotic disorders and anxiety disorders. Most of the major diseases are going to have multiple questions on the exam and the questions may be somewhat vague where at least 2 answers seem plausible. Focus on the key distinguishing factors like age of onset (Ex. antisocial or conduct disorder), duration of symptoms (Ex. Schizophreniform vs. schizophrenia), presence or absence of loss of function (Ex. Dysthymia vs. major depression), presence/absence/type of acute stressor (Ex. Bereavement vs. depression vs. adjustment) and severity of symptoms (Ex. Hypomania vs. mania, delusional disorder vs. schizophrenia). Don’t waste time trying to memorize DSM criteria unless one of the criteria is a key buzzword that helps you differentiate it from a very similar disorder.
• Learn all of the major side effects for the psych drugs, but don’t spend too much time on the more mild side effects. For example there aren’t a lot of questions on things like nausea, small weight changes, or mild sleep changes. Know the big stuff like neuroleptic malignant syndrome, serotonin syndrome when combine 2 antidepressants without washout or add something like diphenhydramine, kidney damage from lithium, agranulocytosis with clozapine, hypertensive crisis with MAOIs, prolactin changes in typical antipsychotics, hypothyroidism with lithium, metabolic syndrome with atypical antipsychotics, seizures with bupropion in bulemics, priapism with trazodone, EPS with typical antipsychotics (which I had multiple question on including how to manage them once they occur and the answer was diphenhydramine instead of the traditional benzotropine)
• There was a fair number of “test” findings differentiating different diseases. So learn MRI findings (ventricle enlargement in Schizophrenia, gross atrophy in alzhiemrs, caudate and frontal lobe atrophy in tourettes…), laboratory findings (like amylase in bulemics, hydroxyindoleac acid in suicidal), EEG findings and sleep study findings (decreased sleep latency in Narcolepsy, obstructive sleep apnea…). Also had 1 on Sensitivity to lactate infusion for Panic attacks
• I had a few on neurotransmitters. So learn the neurotransmitter pathophysiology of psychiatric diseases as well as the neurotransmitter mechanism of medications and illicit drugs.
• Multiple EPS questions with the treatment option of diphenhydramine
• There is some Neuro stuff that is fair game. I had TIA/Stroke, seizure & parkinsons
• For most of the questions they ask you to choose a treatment, there is only one option from each class. So learning the general indications for a class is important, but knowing the exact indications for a particular drug within a class isn’t as important. For example, you aren’t gonna have a question with 4 different SSRIs listed so learning the FDA indications for specific SSRIs compared to other SSRIs is a waste of study time. As is always the case there are only generic names on the exam which is tough because during my rotation at least we used almost exclusively the trade names for psych drugs
• Tons of questions on illicit drug use. Be able to identify the drug used based on the vitals, how the pupils look and key buzzwords like “bugs crawling on their skin,” “turbinate erythema” or “conjunctival injection.” No to use benzos in alcohol withdrawal and naloxone or methadone in opioid abuse. Be able to recognize the different stages of alcohol withdrawal in a person who has been in a hospital for some time for an unrelated health problem without access to alcohol.
• The practice NBMEs had odd poisoning questions like methanol, ethylene glycol and aspirin poisoning. I had an acetomenophen poisoning question on the real exam.
• There was a surprising number of Sleep disorder questions specifically on rare disorders so learn things like obstructive sleep apnea and narcolepsy but also look into restless leg syndrome, nightmare disorder, sleep terrors, circadian rhythm disorder, REM sleep disorder etc.
• There were also more sexual dysfunction questions than I expected so learn erectile dysfunction (treated with fluoxetine), vaginismus, sexual desire…….
• I had some random neuroanatomy questions like penetrating trauma to the frontal lobe causes what symptoms, olfactory seizures are related to the temporal lobe, what part of the brain is atrophied in disease X etc.
• I had a tourettes question and one on P.A.N.D.A.
• Like 4 or 5 eating disorder questions on the exam
• 2 questions on developmental milestone like a kid this age can do this and this, but not that. Are they normal or not. Also had a totally random question on encopresis on the exam
• I can’t remember any personality disorder questions on the practice NBMEs, but I do think there some on the actual exam where those disorders were at least answer choices listed.
• I had a few questions on depression secondary to or comorbid with other medical conditions so learn about hypothyroidism, HIV, anemia, cancer etc.
• There were some random questions on things like normal puberty, klinfelters….
• Know developmental disorders like fetal alcohol and trisomy 21. I can’t remember any autism spectrum or mental retardation questions on my exam, but I’m sure that could show up in other versions as I had some on the practice NBMEs.
• 1 Abuse question
• 1 Random question on Vertigo
• A few social anxiety/specific phobia
• I had a couple malingering questions. I can’t remember too much hyprochondriasis or somatizization but I think those are high yield too cuz it showed up a lot of the practice exams.
• 1 Pain disorder
• 1 tourettes
• 1 on Tau protein

 

Stuff not on the Exam the I thought was High Yield Based on Some Study Aids:

• Zero forensics questions on my shelf or the NBMEs
• Zero ethics, legal or “doctoring” type questions on my shelf or the NBMEs
• Zero Freudian ego defense type questions on my shelf or the NBMEs
• I didn’t have any impulse control disorders on my real exam or practice NBME exams, but others have posted they saw 1 question on things like trichotillomania so it may still be something worth studying.
• I wouldn’t spend much time learning about the specific types of therapy. Cognitive behavioral therapy is almost always the right answer for disorders that require therapy, because it has way more evidence to support its use that other types of therapy. I think I also had a question where family therapy was the answer because much of the problem was stemming from familial stress, but they made that extremely obvious. Other than that I didn’t need to know about specific types of therapy
• No prader willi, angelman or rett on the actual exam, but they were on practice exams so I would learn them.
• No separation anxiety questions on the actual exam, but saw a few on the NBME practice exams so its worth knowing and being able to differentiate from social anxiety and normal

 

@–,—‘—-@—-,—‘—–@—-‘—-,——-@—-,’—–

 

That’s all I have to say about it! Beyond that, impress your preceptors and have a good time. The stories you will gather from psychiatry are out of this world. I truly enjoyed and felt comfortable with psychiatry after this rotation. I hope you will too!