One down, many to go …

So I have several posts in the armamentarium waiting to be finished and unleashed upon the mighty (nonexistant) readership … but first I thought I would take a minute to talk about my recent first experience with the NBME clinical shelf exams.

Our outpatient medicine class finished with a bang – an OSCE, a written exam (by hand! in blue books!), and the NBME shelf exam for adult outpatient medicine.

After about fifteen minutes of palpitations and ridiculously sweaty palms (autonomic dysfunction secondary to bluebookitis), I stopped procrastinating and banged out my essay on the treatment of diabetes hypertension and hyperlipidemia. I definitely made a few stupid mistakes, but all in all the suprising thing was how easily the treatment plans came to me. I’m really glad that I had a clinic where every patient had hyperlipidemia/htn/T2DM (mostly well-controlled), and since I got to read their charts and see several different stages of each disease. The ink just flowed out of my pen – it was kind of a cool experience. It made me feel like a real doctor for exactly 0.02 seconds until I remembered that this was the easy, bread and butter case, not the real-life complicated cases that real doctors have to deal with …

The OSCEs went well, again having seen dozens of geriatric and diabetic patients, I felt comfortable in spending less time on some of the areas knowing what I needed to do. For instance, in the diabetic patient OSCE, I got to the physical exam with 5-6 minutes left (out of 20). I wrapped up the exam (fundoscopic and extremity/neuro with quick HEENT, CV, pulm, abd) and even had time to ask the simulated patient if he wanted to talk about anything else (he said no, thankfully) as the clocked tick-tocked down to 00:00.

The shelf NBME exam, on the other hand, was a little bit of a charlie foxtrot. I haven’t felt that badly about an exam since I took a CBSSA in december of my MS2 year (aka halfway through the year, I took an exam covering the content of the entire year). As some of you may recall, I barely passed. Then again, barely passing wasn’t so bad in that context. In this context, it was shocking and kind of dispiriting to walk out of a test feeling confident about 50/100 questions.

I got my shelf grade today and got a raw score of 77 which is equivalent to the 84%ile of test takers for this exam at this point in the year. So, okay, I guess I didn’t fail and being in the top 15-16% of test-takers isn’t that bad considering. However, I know I can work SO much harder without increasing my stress level (see upcoming post about my current 25-hour work weeks), and I’m planning to engage that during the upcoming month. I think, for me, knowing that I didn’t max out at this point in the year is a good feeling. I’m far from complacent, and, believe me, the feeling of not knowing a single damn thing on that outpatient medicine exam is going to stick with me for a very long time.

Stay tuned for a recap of outpatient medicine, and some upcoming thoughts on family medicine (aka non-geriatrics). My two clinics couldn’t be more different.

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