This is another flashback post to my Family Medicine rotation and some reflections about the rotation and how I prepared for the Shelf exam.
I previously mentioned that my last four weeks of Internal Medicine was outpatient which is essentially Family Medicine, so I was grateful for the preparation but also going into Family, I felt well versed with what was likely to be expected. Additionally, I spent a significant portion of time prior to medical school working in the outpatient/family medicine arena, so I had that little bit of knowledge through that as well.
It was not until I had talked to some of my other colleagues from other medical schools that I found that many schools no longer require a distinct Family Medicine core but rather it is interspersed either through a longitudinal approach throughout weekly visits with a preceptor for the entire duration of their their year (US MD) or they just do not do it at all. I low key (but not so low key at all) felt jilted especially because with these differing approaches there is also no requirement to take the universally dreaded Family Medicine Shelf Exam. For whatever reason, the family medicine shelf is known to bring presumably the most accomplished test takers to their knees and gravel for mercy (I may be exaggerating but you get the point). Nevertheless, I will discuss the shelf exam later but on to my rotation.
Like most rotations but I think more so than others, your experience in Family Medicine can be largely dictated by your preceptor. This is primarily because it is just you, your preceptor and the patient (especially in the outpatient setting). I was extremely fortunate to have an awesome preceptor who was both Board Certified in Family and Sports Medicine which I absolutely loved. For me, I am a little selfish when it comes to rotations. Do not get me wrong, I absolutely love working with other students, making new friends and helping each other along this journey. However, for a rotation like family medicine where depending on the size of your office, being the lone student can prove to be a benefit because it is just you, your doc, your patients and the other staff. That is how it was at my office and I really appreciated because not only was able to I take the lead with the majority of the patients, but I really appreciated having the individual attention, especially for our sports medicine patients because MSK exams were always my worst in the past. Having 6 weeks filled with complete shoulder exams, knee exams, wrist exams, back exams and every joint in between, I left feeling much more confident in my assessment, plan, diagnosis and treatment of MSK injuries. Obviously, I by no means am anything close to an expert, but I also know that if my office were larger or if there were another student, I would not feel nearly as comfortable as I do now with those assessments.
In addition to my quest to become apt at MSK exams, I had a two patients in particular that both challenged me in ways that were unexpected. We had a patient that came in with a specific chief complaint with a well documented history of what would be expected to be the cause of that chief complaint. Given the history and presenting symptoms, I completed my exam and presented my A&P to my preceptor. However, after discussing the case with my preceptor, he started to talk to me about how he had recently went to a talk and the presenter was discussing how sometimes what is presented to us in the history can pigeon hole us too much in our diagnosis and we can potentially miss a life-threatening diagnosis. With that, he had me rethink other possible diagnoses for my patient. It easily dawned on me that I had failed to address a major differential, one that could possibly kill my patient if not properly addressed. This is a diagnosis that given any other patient, I most likely would not have missed but because I allowed myself to be pigeon-holed into what I thought the patient had primarily based on the PMH rather than looking at all the other factors that were in play. Although, my initial diagnosis did end up being correct (Thank God!), it was a humbling reminder about being confident in your knowledge but never too confident and also not allowing what you think the patient should have blind you from seeing an integral differential. I won't rehash a previous post, but my other patient that was particularly challenging and rewarding was the patient who I talked about in my post called "The Feeling". I highly recommend that you take a read if you have not because let me tell you, there are fewer things more rewarding when knowing that you have truly built a rapport with a patient in a short period of time that they feel comfortable opening up to you about something and that you were able to perceive that there was more to their visit then what they initially led on. It was one of those "This is what I was meant to do" moments. Those are the best moments.
Ok now Shelf Studying. As previously mentioned, family medicine shelf is one of the most dreaded shelf exams that we have to take (for those of us who have to take it). I am not sure if it is because it covers EVERYTHING or if it is because people underestimate how tough it can be, but it is definitely not an exam that you want to take lightly.
SHELF STUDY MATERIALS
"Your" Dedicated CK Study Book (MTB, First AID CK, Step Up)
Whatever book(s) you plan to use for CK studying is the book I recommend you use for Family shelf studying. The "medicine" that is on the Family shelf is primarily Internal medicine based and that is a significant portion of the test, so that will be the most helpful. The "prevention" part of the exam will also be covered in the majority of these books. But there is not really a special additional book that you will need for your shelf exam.
***I would read my post about Internal Medicine because that is where I talk in depth about the aforementioned review books
This is the Case Files book that I absolutely recommend you buy and read every case. For both Surgery and IM, I had the time to read the cases but I just did not find them useful enough to warrant reading through them and that ended up working out fine for me. However, because questions are at a bare minimum for family and it is difficult to find what you really need to study, this particular Case Files is actually golden. More so than any other shelf, the family medicine shelf is largely based on management and that is what I think Casefiles does best in their layout. It really highlights the "next best step" and also all of the important studies to do and when to do them and you really won't find a case on your shelf (well except for those curve-ball-you-never-would-have-known-the-answer-to-this-because-you-actually-never-get-taught-it-because-it-is-about-dentistry type questions) that it is does not cover adequately. The difficulty of the Family Medicine Shelf is that it covers everything, so by having cases that cover adolescence to Geriatrics, OB/gyn to Psychiatry-- it is probably the Book resource for this exam.
USPSTF (AHRQ ePSS)
One of the best apps for both family and outpatient IM is the USPSTF app. The app allows you to input the age, gender, tobacco use and sexual activity of your patient, and it will automatically populate all of the USPSTF screening recommendations for that particular patient. Although this might not help you study "directly" per se, it does help you indirectly study because just by becoming accustomed to what the screening recommendations are for your patients based on age, gender and sexual activity is management. Many times you will read this huge vignette about this patient and all of their complicated medical history with their interesting chief complaint, and the question will ask you "the next best step" and it will be a screening test and the answer will be something like "Give them the Influenza Vaccine". So, I found that by using this app and forcing myself to really understand when and what screening tests are recommended for all ages of patients, it helps you know it for the test but also for real life when you are practicing.
Up to Date
Most of us know what up to date is so I am not going to really elaborate on it, but get the App if you can. Most medical schools provide free membership for their students, so ask your medical school about it. But the reason why it is so beneficial in family is because the recommendations and guidelines on the Family Medicine shelf are pretty current (within 2-3 years), and Up to Date is aptly defined by its moniker and is the most up to date source of information out there.
The biggest issue with studying for the Family Medicine Shelf is that there is no distinct set of questions on UWORLD. I know some people who did half of the Medicine Questions for UWORLD for IM and then the other half for Family, so that is an option.
App/Qbank: ABFM Exam Prep
Next to Case Files, this is probably the best resource you have for shelf studying. This app has almost 700 questions just on Family Medicine and they are legit. The App is created by the American Board of Family Medicine, so clearly they have an idea of what they are doing in terms of content and most up to date information. It is NOT like Uworld where you have options to select timed/untimed and tutor/vs. not tutored-- everything is untimed and Tutored. Additionally, missed questions get cycled back, so you will see the same question again until you get it right. This is a "must download" situation if you have to take the family Medicine shelf and guess what, it is completely FREE. Winner Winner Chicken Dinner.
Tried and true, you should do your NBMEs. Up until recently, there were not any NBMEs for the Family Medicine shelf but now there are TWO with plans to increase it to four eventually. So, I definitely recommend you do these in addition to the Qbank to round out your studying.
No reason to talk about the necessity of this gain but yes just watch the videos. Even if you watched them for IM. The best thing about MedEd videos is the plan they set for each rotation- so watch the videos that are recommended for the Family Medicine Rotation because it goes through the Peds, Ob and Psych videos that are also pertinent for the exam.
My biggest piece of advice for your family medicine rotation is take the time to become really good at the basics. Focus on taking that beautiful H&P and mastering the art of the presenting in a SOAP note format. Perfect your clinical skills and improve your active listening skills. Learn how to take a great history in a short period of time and build a good rapport with your patients in 5 minutes or less. Practice perfection in the basics, in the foundation and it will help set you up not only for the rest of your rotations but more importantly for the rest of your life.
Well that's "All in the Family". It was a rotation that I continued to grow, learn and sharpen both my clinical skills and knowledge. I hope you find this helpful and next up will be OB/Gyn!!!! I cannot wait to tell you all about it-- look out for the next post in about a week and after that, we will be all caught up! Wooohooo!