Why is Surgery Shelf So Hard?

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After weeks and weeks of general surgery clerkship, considered one of the most challenging rotations for medical students, students are exhausted enough without having to sit for an exam. Usually, you’ll spend anywhere between 6 to 8 weeks in the wards and the operating room, learning from other doctors and preparing yourself for the career.

After you’re done with this period, you’ll face the Surgery Shelf Exam. In a sense, it’s the end of your surgery rotation. Doing well on this exam will place you in a good stance within the medical school. Hence, performing well is something you should strive for. But that’s easier said than done because the Surgery Shelf Exam is considered one of the most challenging ones during medical school.

In this article, various aspects of the exam are discussed. You’ll learn why the exam is considered difficult and how to manage to study for it.

Is the Surgery Shelf Exam Really Hard?Is the Surgery Shelf Exam Really Hard?

If you ask any medical student which Shelf Exam was their most demanding, you’ll get various answers. Something to note is that the difficulty of the exam will vary according to which year you’re sitting for the exam and when you’re taking it.

For instance, if the exam is the last subject Shelf Exam you’re sitting for, then you might already be incredibly exhausted. Hence, your mind might associate the exam with being the most challenging and strenuous as you’re approaching the end of your examination period.

But is the surgery shelf exam hard? It involves multiple different aspects of medicine, although the exam itself does not center around medicine. To elaborate, the Surgery Shelf Exam centers around patient care and management. However, if you’ve already taken the Medicine Shelf Exam, things will be easier for you. You can even use the same resources to study.

Surgery Shelf Exam Outline

Here is a breakdown of what to expect during your Surgery Shelf Exam:


  • Immune Systems (1-5%)
  • Skin & Subcutaneous Tissues (1-5%)
  • Male Reproductive System (1-5%)
  • Social Sciences (1-5%) – includes medical ethics and issues related to death
  • Musculoskeletal System (3-7%)
  • Renal & Urinary System (3-7%)
  • Female Reproductive System (3-7%)
  • Endocrine System (3-7%)
  • Blood & Lymphoreticular System (5-10%)
  • Nervous System & Special Senses (5-10%)
  • Multisystem Processes & Disorders (5-10%)
  • Respiratory System (8-12%)
  • Cardiovascular System (10-15%)
  • Gastrointestinal System (20-25%)

Physician Task

  • Applying Science Concepts (8-12%)
  • Pharmacotherapy, Intervention & Management (30-35%)
  • Diagnosis: Patient History, Exam, Diagnostic Studies & Patient Results (50-60%)

Site of Care

  • Emergency (25-35%)
  • Inpatient (30-35%)
  • Ambulatory (35-40%)

Patient Age

  • <17 years-old (8-12%)
  • 18 to 65 years-old (60-70%)
  • >66 years-old (20-25%)

Keep in mind that you’re generally not required to sit for the NBME Surgery Shelf Exam to obtain your medical license in the U.S. However, according to which medical school you’re attending, it could be a fundamental part of your curriculum.

That’s because almost all medical schools will require a surgery clerkship. The best way to test their students on their retention of information is through an examination. You’ll most likely have to pass the Clinical Science Surgery Subject Exam. It’s usually one exam within many that you’ll be asked to sit for.

What Makes the Surgery Shelf Difficult?

What Makes the Surgery Shelf Difficult?

Once medical students sit for the exam, or due to the critiques they’ve heard from other students, they all wonder why is the surgery shelf so hard. Well, it boils down to several reasons. First of all, the exam outline is quite extensive, as you’ve seen in the list above. Hence, you have to go through a large volume of material.

That’s usually hard to do because of the time constraints you have. You’ll be preparing for the Surgery Shelf Exam while doing your rotations, which makes fitting in a few hours a day to study incredibly challenging.

For a more extensive explanation of what makes the Surgery Shelf Exam difficult, here are the most common complaints from medical students:

Large Volume of Study Material

We’re not even talking about study resources; the amount of information you’ll need to digest is enormous. Hence, finding the time to study effectively could be pretty challenging since you’ll be spending a good chunk of your time in the operating room.

First of all, always keep notes on what’s happening inside the operating room. While you’ll simply be observing, the patients you see and the surgeries you’ll be a part of will leave a mark on your brain. It’s always easier to recall something you’ve witnessed than something you’ve read.

However, since you’ll only spend around 6-8 weeks on your rotation, it’s impossible to see everything. Hence, you’ll have to cram in your study sessions whenever you have time, even in a hospital or between shifts.

Heavily Based on Internal Medicine

If you’ve taken your Medicine Shelf Exam already, things will often be easier for you. Surgery Shelf Exam is basically the medical exam with a few added steps. While that is good news if you’ve passed the Medicine Shelf Exam with flying colors, it could be your culprit if you’re yet to sit for it.

Hence, a proper and extensive understanding of internal medicine is vital here. However, keep in mind that the surgical exam requires you to handle patients and know when a patient needs surgery or not. Hence, while it includes internal medicine, you should learn to deal with patients rationally and systematically.

Isn’t Related Much to the OR

Yes, we know. You’re expecting to answer surgical operation questions on the exam, aren’t you? While that’s a small part of it, it mainly focuses on your ability to present to patients, diagnose, and manage them after their surgery.

Hence, a common mistake is that students resort to surgery-based textbooks to study. While you’ll need some information, you’ll have to focus much more on patient care and management. That’s why it’s always a better idea to consult non-surgery resources.

What is a Passing Shelf Score?

What is a Passing Shelf Score?

There isn’t a set passing score for the Surgery Shelf Exam. It will be determined by the medical school you’re attending. Hence, you’ll have to consult with your own school. However, a general score you should aim for is a minimum of 65. While that’s not a set number, it will most likely place you in a safe position.

While some schools require you to score a minimum score, others will ask you to be within a specific percentile. This is calculated based on how many answers you’ve gotten correctly on your exam. Then, you’ll be placed in a particular position compared to national grades.

Your Surgery Shelf percentile allows you to determine how well you’ve performed on the exam compared to all students nationwide. For instance, if you’re placed within the 80th percentile, you’ve answered more correct questions than 80% of students who sat for the exam.

But the burning question still persists; what is the passing score for the Surgery Shelf Exam? Well, here is a breakdown based on some medical schools across the states:

  • NYMC: 2 standard deviations below the national mean
  • Northwestern: either a score of 60 or two standard deviations below the national mean
  • John-Hopkins: >5th percentile of scores
  • University of Alabama School of Medicine:score of 60
  • Penn State: minimum of 10th percentile
  • University of Miami:5% above of national average
  • Southern Illinois School of Medicine:score above 60
  • UCSF: score above 60
  • University of Toledo COM:above the 10th percentile
  • Howard:score above 62

How Long is the Surgery Shelf Exam?

How Long is the Surgery Shelf Exam?

The length of the Surgery Shelf Exam is 165 minutes, where you’ll have to answer 110 multiple-choice questions. Remember that you can only sit for the exam within authorized testing centers. Hence, you’re likely to take it in a Prometric test center or on a school’s campus.

How to Study for Surgery Shelf?

How to Study for Surgery Shelf?

One word of advice: be prepared to study a lot. You should be able to fit in study time during rotations and whenever you have time. A good rule to stick by is finding resources that don’t require you to be connected to the internet. You won’t always have direct access, and it’ll be easier to have all your resources ready whenever you need them.

A Solid Study Plan

While you need a flexible study schedule as you’ll be exhausted due to your rotations, you also must have an extensive yet malleable study plan. After long hours in the ward, you’ll be tempted to go home, sleep or watch your favorite TV show. That simply isn’t feasible when you’re studying for the Surgery Shelf Exam.

Write up a calendar, or print one out. Then, divide all the topics and material you need to review into specific days. Aim to have 1-2 hours daily dedicated to your studying. Moreover, we recommend you leave out 3 days before the Shelf Exam for question-solving and reviewing.

Find Resources Offline

Everyone knows that the wards don’t specifically have a good WiFi connection. If you’re someone who would rather listen to their study material, check out the Divine Intervention Podcast. You’ll be able to download them to access them offline.

Be an Active Medical Student

It’s pretty common to feel social anxiety as a medical student. A study found that 51.9% of medical students think some variation of Social Anxiety Disorder. However, that should not stop you from interacting with doctors in the ward and making sure they’re familiar with you.

Once you introduce yourself to the doctors and residents, you’ll be able to ask them more questions. Moreover, over time, volunteer more often to do tasks to help you learn some hands-on knowledge about surgery.

Focus on Patient Need

While patient care is vital, the Surgery Shelf Exam focuses more on whether a patient requires surgery or not. Hence, while you’re answering questions, be logical and focus on whether the patient you’re assessing needed surgical care or not.

Solve Questions

Board Vital offers over 450 challenging surgery shelf exam questions. You’ll be able to choose from various plans according to how much time you have till your exam. Brainscape also offers numerous Shelf Exam Questions through multiple different practice tests.

We recommend you go through as many practice exams as you possibly can. An excellent way to go around this is spending an hour a day studying, then another hour dedicated to solving questions.

Wrapping Things Up: Why is Surgery Shelf So Hard?

The Surgery Shelf Exam won’t be a piece of cake. It is challenging for a reason. All the Shelf Exams are meant to prepare you to become a successful doctor. Hence, while you might struggle to study for the exam, it’s important not to cram all the study material in the last week.

Whenever you have time between rotations or on a break, listen to a podcast, read an article, or go through your main study book.

Picture of Professor Conquer
Professor Conquer

Professor Conquer started Conquer Your Exam in 2018 to help students feel more confident and better prepared for their tough tests. Prof excelled in high school, graduating top of his class and receiving admissions into several Ivy League and top 15 schools. He has helped many students through the years tutoring and mentoring K-12, consulting seniors through the college admissions process, and writing extensive how-to guides for school.

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