One of the exams medical students consistently dread is the surgery shelf exam.
Why is the surgery shelf so challenging?
For a couple reasons: you spend so many hours in the operating room that you don’t have any time to study (or you may be too physically exhausted to study), and there are very few resources out there that actually address what’s actually going to be on the exam itself. Not daunting at all, right?
The reason there are so few study resources is because there is actually some confusion over what is tested; many students (and even textbook writers) anticipate that they are going to be tested on anatomy and surgical techniques, when this is almost never the case.
Instead, you’ll be asked about the medical management of surgical patients. An example of this could include a patient who you suspect might need to have their gallbladder taken out (AKA cholecystectomy). In that situation, you would expect to be able to know the indications for medical management as well as the indications for surgical management.
Therefore, you can think of the surgery shelf as testing a pretty large subset of what’s going to be on the medicine shelf. This makes studying medicine and even potentially taking the medicine shelf before the surgery shelf important.
The following techniques will help you maximize your performance on the surgery shelf:
1. Pick a good book and start studying very early.
The options for surgery textbooks out there are limited, but almost every single person recommends Pestana’s Surgery Notes. Other books include De Virgilio Surgery and Step Up to Surgery. The earlier you can begin building your surgical foundation, the sooner you’re going to be able to start doing questions and excelling.
2. Once you’ve begun building your foundation, you should start to do questions as early as possible.
The problem with the surgery shelf is that there are actually very few questions that are exclusively "surgery shelf" in nature. Therefore, especially if you haven’t taken the medicine shelf exam, it is to your advantage to actually do medicine questions as well.
The following systems within medicine are the most relevant surgery shelf questions that you can do from medicine: GI, cardiology, pulmonary. The best questions bank is, as always, UWorld. Alternatives include AMBOSS and USMLERx.
3. Spend more time rounding and less time in the OR.
This may seem counterintuitive, but the things you learn on rounds--both on pre-op and post-op surgical patients--are actually going to be significantly more valuable than any skills, anatomy, or techniques (such as closing a wound) that you can learn in the OR.
With this in mind, if all you care about is doing well on the shelf, the times of the day to really make sure you’re maximizing your attentiveness are going to be early morning rounds and any possible late-afternoon rounds and admissions that you might get. That being said, you still need to pay attention and spend time in the OR to do well on the clerkship!
4. Like any other shelf the surgery shelf, studying is going to be spent mostly outside of the hospital on evenings in which you are very tired from a long day of work.
There is simply nothing you can do about this. In this particular situation, you want to consider having a very strict study schedule, especially because the hours of your surgery rotation can often be the longest hours you will work on any rotation. Set aside at least an hour every day to read and at least an hour to get some questions done, and force yourself to stick to this rigorous schedule no matter how tired you are.
5. Consider taking the medicine shelf exam first.
This is one of the few situations where the order in which you take shelf exams could matter. Definitely consider the order of these exams if medicine or surgery what you want to end up applying to for residency.
The rule of thumb is that taking the medicine shelf before your surgery shelf will help you do significantly better on your surgery shelf. The flip side is that taking the surgery shelf before your medicine shelf will also help you do better on your medicine shelf. Therefore, you should consider which shelf is more important for you to do well on (i.e. do you want to go into surgery or medicine?) and schedule your shelf exams accordingly.
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