Shelf Season

True to life, everything has its pluses and minuses. I've enumerated quite a few of the positive aspects of the Asheville Longitudinal Curriculum in earlier posts, but as the year ends, we are overwhelmed by the sheer number of tests we have to take. At the conclusion of each clerkship, most medical schools require their students to take a "shelf exam." Why they are called "shelves," I have no idea, but these are the subject exams for each individual specialty. For each clerkship we are required to take a 100 question multiple choice exam related to that field (although the questions come from other fields of medicine as well and are often obscure/esoteric). In the traditional model, students do six weeks of a specialty, then take a shelf; another eight weeks of that, then a shelf; another four weeks... you get the picture.

In Asheville, on the other hand, this structure would be impossible. Since we do all of our clerkships together (essentially), we take all our shelves at the end of the year. So starting on March 20th, we began the never-ending season of tests, aka "shelf season." We started with Psychiatry, then comes Neurology, Pediatrics, Family Medicine, Outpatient Medicine, and Inpatient Medicine. The culmination of all these exams is Step 2; a clinical version of the Step 1 exam. Basically it's a combination of all the NBME subject tests: eight 1-hour blocks of 44 questions. This test is on June 27th. So between now and June, that's...

Step 2 + 6 Shelves = (8 x 44 Qs) + (6 x 100 Qs) = 952 Multiple Choice Questions

Add in the Surgery and OB/GYN shelves we took earlier in the year, and that's a total of almost 1,200 Qs. Isn't fourth year going to be wonderful when the total number of multiple choice tests will be ZERO??

What complicates this picture is all the odds 'n ends and nick-nacks that we must finish up from here on out. Tidying up all the loose ends. Oral exams in Pediatrics and Psychiatry, extensive H&Ps for this and that, extra half-days, etc. All of this indoors work when it is finally 70 degrees and sunny... almost every day! Happy Hour is sooo much more tempting when it is outside at the Wedge drinking a pitcher of Payne's Pale in the warm sun. Children frolicking across the grass, hipsters playing cornhole, and a cool breeze from the south caressing the nape of your neck...

But no, I would prefer to study for more and more multiple choice tests.

I should say, however, that all of these tests being at the end are actually a blessing in disguise. Beginning in January, all of the clinical experience really started to crossover into each individual clinic. Learning the preventative guidelines for lipid and cholesterol management in Family Medicine really started helping me counsel my Internal Medicine patients. Working with Psychiatric patients made it easier to recognize people with underlying depression and anxiety in all my other clinics. All the medicine has begun to intertwine and mesh, which makes studying for these tests much easier. Instead of just focusing on one specialty, I can bring in my experience from all 8 clerkships into each question. This would be much harder if I was in block scheduling (but obviously, we are the outliers).

It is also a blessing because I will not have to study much at all for Step 2. These months and months of reading and practicing multiple choice questions are gearing us up for the second part of the national board exams. Thus, I am taking Step 2 just a week after our last shelf exam, and only a few days after our final day of clinic. I will spend most of this time relearning OB/GYN and Surgery, since those are the only two specialties I won't have studied in the past 3 months.

So with that being said, it's off to Bywater for good company and a Greenman Porter... followed by some Neuro questions.