MD How bad is it to fail a shelf exam third year?

[gregoryhouse]

Asking on behalf of a friend.

If you have otherwise good stats and honors in other rotations, how bad does one failure look on your application? If the goal is to go for a residency like peds or IM, will this person still have a decent shot at matching at a good program? At our school, a failing grade is reported on the MSPE along with the remediated score. The plan is to retake it and do well and take Step 2 early and do well. This person should have no trouble doing well, the failing grade was a consequence of family issues that occurred around the time of this shelf so I have no doubt that the rest of the shelf exams and step 2 scores will be good.

Just curious on what advice to give, so I thought I'd turn around and ask here.

Thanks!

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[JP2740]

Depends what you think good is. I don't think the top IM programs would accept people with failed rotations, but then again that's n = 0. I am sure most if not all people who match into top IM programs do not have any failed rotations. Usually someone who has the great step scores, honors in rotations, and is otherwise a great student, which is needed to an extent to get into the very top IM programs, they do not have a fail on their record. There are always exceptions, and once again, depends on what is "good"

 

[Crayola227]

Just a shelf?

You can get a decent peds and IM program if the rest of your app looks good, no problem.

 

[Stagg737]

Depends what you think good is. I don't think the top IM programs would accept people with failed rotations, but then again that's n = 0. I am sure most if not all people who match into top IM programs do not have any failed rotations. Usually someone who has the great step scores, honors in rotations, and is otherwise a great student, which is needed to an extent to get into the very top IM programs, they do not have a fail on their record. There are always exceptions, and once again, depends on what is "good"

Lowly M3, so my opinion probably doesn't count for much, but I'd think if there were extenuating circumstances it could be overlooked. If they did well as a whole on the rotation and had strong letters from their attendings but had some event (illness, family death, etc) that caused them to bomb the shelf I'd like to think even top programs would be understanding of that.

I'd also guess it would depend on how the school gives out clinical grades. If it's mostly based on feedback with less weight towards the shelf I'm sure it would look a lot worse than at a school where the shelf is the entire clinical grade and attending feedback is just part of the MSPE. Maybe that's just me hoping that programs would be understanding though.

 

[JP2740]

Lowly M3, so my opinion probably doesn't count for much, but I'd think if there were extenuating circumstances it could be overlooked. If they did well as a whole on the rotation and had strong letters from their attendings but had some event (illness, family death, etc) that caused them to bomb the shelf I'd like to think even top programs would be understanding of that.

I'd also guess it would depend on how the school gives out clinical grades. If it's mostly based on feedback with less weight towards the shelf I'm sure it would look a lot worse than at a school where the shelf is the entire clinical grade and attending feedback is just part of the MSPE. Maybe that's just me hoping that programs would be understanding though.

The reality is that there are screening methods used and a fail can be an automatic screen out

 

[Crayola227]

The reality is that there are screening methods used and a fail can be an automatic screen out

This wasn't a failed rotation or step though - a shelf.

Not sure that its mention in MPSE but not the transcript is something ERAS has filters for.

My own shelf, which was not a fail, just low, was mentioned in one of my letters, this was asked about at 1 program of 24.

So I don't think this is auto-screen electronically, but "top" programs can do what they want.

I urge students to consider what they mean by "top", - consider your ultimate 5-10 year plan (I was asked this at interviews) even your 20 year. It doesn't have to be exact. What are you trying to do? 90% of doctors don't need "top" 10% programs to train in - this opens the playing field, and makes things like a repeat *shelf* much less of a potential roadblock.

 

[hallowmann]

The reality is that there are screening methods used and a fail can be an automatic screen out

Yeah, I don't think ERAS can screen for info only in the MSPE. From a data and program standpoint, this would be a very difficult thing to do given the non-standardized formats of MSPEs across schools.

That said, it could be caught by the human screening it and deciding on the invite. I honestly don't know if this will matter much. A single isolated incident, one shelf failure, surrounded by successful stats may not be as good as an applicant with no failure, but its much more likely to be forgiven than multiple redflags, especially if there is an explanation. Will the MSPE mention something about the surrounding personal events? Like will it have dialogue surrounding it, or will it just list it?

Either way, its over and they really shouldn't worry about it. Just make sure it doesn't happen again and apply broadly when the time comes. There really is no point worrying about it.

 

[JP2740]

Oh, I didn't realize you can pass a rotation and fail a shelf. That's odd

 

[gregoryhouse]

Yeah, I don't think ERAS can screen for info only in the MSPE. From a data and program standpoint, this would be a very difficult thing to do given the non-standardized formats of MSPEs across schools.

That said, it could be caught by the human screening it and deciding on the invite. I honestly don't know if this will matter much. A single isolated incident, one shelf failure, surrounded by successful stats may not be as good as an applicant with no failure, but its much more likely to be forgiven than multiple redflags, especially if there is an explanation. Will the MSPE mention something about the surrounding personal events? Like will it have dialogue surrounding it, or will it just list it?

Either way, its over and they really shouldn't worry about it. Just make sure it doesn't happen again and apply broadly when the time comes. There really is no point worrying about it.

I will tell my friend to talk with the clerkship director about the circumstances surrounding the failing shelf so that it could be talked about in the MSPE. They were also told by one of their letter writers that they would write in the surrounding circumstance in the LOR and how otherwise the student has been doing very well.

Also for the record, by good program, I think this student is aiming more for strong middle tier program and not necessarily a top program.

Thanks everyone for the advice. Please add more if anyone else has anything to share.

 

[gregoryhouse]

Oh, I didn't realize you can pass a rotation and fail a shelf. That's odd

At our school, you can retake the shelf and you can no longer honor but you will pass. From what I understand though, the failing shelf grade is still mentioned in addition to the remediated shelf score.

 

[Crayola227]

I will tell my friend to talk with the clerkship director about the circumstances surrounding the failing shelf so that it could be talked about in the MSPE. They were also told by one of their letter writers that they would write in the surrounding circumstance in the LOR and how otherwise the student has been doing very well.

Also for the record, by good program, I think this student is aiming more for strong middle tier program and not necessarily a top program.

Thanks everyone for the advice. Please add more if anyone else has anything to share.

 

[Seroquel]

Some schools like mine don't include the failed shelf score, just the passed one. You end up passing the rotation itself, but that's what stands out even if the failed score doesn't show because third year grades are the most important ones. If you are aiming for a very competitive specialty (derm/plastics/ortho/ophtho/ENT) or top programs, the pass will hurt you, especially if it's a major rotation like IM/surgery or in the specialty you are applying for. Otherwise not a red flag provided the actual rotation is passed. Your friend should focus on doing as well as they can for the retake and moving on.

 

[ewax]

This wasn't a failed rotation or step though - a shelf.

Not sure that its mention in MPSE but not the transcript is something ERAS has filters for.

My own shelf, which was not a fail, just low, was mentioned in one of my letters, this was asked about at 1 program of 24.

So I don't think this is auto-screen electronically, but "top" programs can do what they want.

I urge students to consider what they mean by "top", - consider your ultimate 5-10 year plan (I was asked this at interviews) even your 20 year. It doesn't have to be exact. What are you trying to do? 90% of doctors don't need "top" 10% programs to train in - this opens the playing field, and makes things like a repeat *shelf* much less of a potential roadblock.

Jesus....you interviewed at 24 programs?

 

[OrangeOrange]

My own shelf, which was not a fail, just low, was mentioned in one of my letters, this was asked about at 1 program of 24.

One of your LOR writers talked about your shelf score???

 

[iceman55]

Some schools like mine don't include the failed shelf score, just the passed one. You end up passing the rotation itself, but that's what stands out even if the failed score doesn't show because third year grades are the most important ones. If you are aiming for a very competitive specialty (derm/plastics/ortho/ophtho/ENT) or top programs, the pass will hurt you, especially if it's a major rotation like IM/surgery or in the specialty you are applying for. Otherwise not a red flag provided the actual rotation is passed. Your friend should focus on doing as well as they can for the retake and moving on.

Then your school is an example of why third year grades don't hold much value. At my school a failing shelf score would give one a conditional pass, which is lower than a pass. at my school 60-65% of students get pass on any given rotation. Thus getting a pass isn't a red flag as it is at a school where only the bottom 15% get pass.


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[Crayola227]

One of your LOR writers talked about your shelf score???

Standard part of the Chairman's Letter.

 

[Crayola227]

Jesus....you interviewed at 24 programs?

I had a competitive app. For geographical reasons.

 

[ewax]

I had a competitive app. For geographical reasons.

I was dead after 12...I couldn't imagine doing 12 more.

 

[Stagg737]

Oh, I didn't realize you can pass a rotation and fail a shelf. That's odd

Just out of curiosity, when people say "fail a shelf", what does that even mean? Not hitting the score your school requires or is there some threshold that is actually considered a fail? It's pretty difficult to fail a shelf at my school, I'm just wondering how true that is for other schools...

 

[sazerac]

Just out of curiosity, when people say "fail a shelf", what does that even mean? Not hitting the score your school requires or is there some threshold that is actually considered a fail? It's pretty difficult to fail a shelf at my school, I'm just wondering how true that is for other schools...

At my school a fail is 5th percentile (nationally). So if a class of 200 was performing at the national average, 10 students would "fail" each exam.

 

[acapnial]

Just out of curiosity, when people say "fail a shelf", what does that even mean? Not hitting the score your school requires or is there some threshold that is actually considered a fail? It's pretty difficult to fail a shelf at my school, I'm just wondering how true that is for other schools...

<5th percentile compared to the rest of the NRMP taking nation at my school.

 

[MSTP18]

Just out of curiosity, when people say "fail a shelf", what does that even mean? Not hitting the score your school requires or is there some threshold that is actually considered a fail? It's pretty difficult to fail a shelf at my school, I'm just wondering how true that is for other schools...

Maybe the 3 of us all go to the same school, but my school also uses the 5th percentile nationally (based on what quarter of the year you took the exam such that the failing raw score is typically lowest at the beginning of the year) as the failing mark.

It is indeed pretty rare for a student to fail a shelf at my school. There are certainly people who do well below the class average though and tank their clerkship grade as a result.

 

[zeppelinpage4]

Asking on behalf of a friend.

If you have otherwise good stats and honors in other rotations, how bad does one failure look on your application? If the goal is to go for a residency like peds or IM, will this person still have a decent shot at matching at a good program? At our school, a failing grade is reported on the MSPE along with the remediated score. The plan is to retake it and do well and take Step 2 early and do well. This person should have no trouble doing well, the failing grade was a consequence of family issues that occurred around the time of this shelf so I have no doubt that the rest of the shelf exams and step 2 scores will be good.

Just curious on what advice to give, so I thought I'd turn around and ask here.

Thanks!

Not sure about the really competitive or prestigious programs, but a number of my classmates, including myself failed shelf exams 3rd year and they seem to be happy with the way their interview season went. Of course, I can't speak for match results yet *fingers crossed* but I think your friend will be fine. Failing a shelf doesn't seem to be that uncommon.
Also, your friend has a reasonable explanation for it, and it's clearly a one time issue.

From my own experience, I failed 2 shelf exams and had a very low Step 1 score due to mental health reasons. I ended up taking a leave of absence, got treatment and got better, then came back and safely passed the rest of my shelf exams as well as making a big improvement in my Step 2 CK. Ultimately got 13 or 14 interview invites iirc, and programs I interviewed at seemed to be very understanding about my shelf failures since I had an explanation, addressed the issue, and came back strong.
If your friend crushes Step 2CK and takes it early, and the rest of the app is good I think he or she should have a great shot at getting a program they like in peds or IM.

 

[W19]

Do all US students take the same shelf on a particular calendar year?

@zeppelinpage4 How many IM programs did you apply to? You can PM me if you don't feel comfortable answering in an open thread...

 

[W19]

Just out of curiosity, when people say "fail a shelf", what does that even mean? Not hitting the score your school requires or is there some threshold that is actually considered a fail? It's pretty difficult to fail a shelf at my school, I'm just wondering how true that is for other schools...

At my school, <70% is a failed score, but there is always a generous curve (~12 points on average). I am not sure whether it's a NBME curve or my school makes the adjustment...

 

[sazerac]

At my school, <70% is a failed score, but there is always a generous curve (~12 points on average). I am not sure whether it's a NBME curve or my school makes the adjustment...

Ah yes, the 70% rule. Of course the problem with the "70% rule" is that there are multiple ways to grade a shelf exam, and it was never very clear what it was 70% of, exactly. 70% raw? 70th percentile? 70% cooked? 70 questions of exam? Raw score of 70? Cooked score of 70? Nationally curved 70? School curved 70?

I remember one time in orientation trying to pin down a clerkship director as to exactly which 70 they meant when they said "you'll need a 70," and my conclusion was that even the director had no idea what it was 70 of. The director started getting mad at my questions, and the other students were getting miffed at the delay in the orientation presentation, so I shut my mouth.

For what it's worth, they tell us a 70 in my school's system maps to the 5th percentile of all medical students. And I'm sure the clerkship directors have a hell of a lot of leeway determining who actually passes and fails each shelf.

 

[Light at end of tunnel]

hard as all get out; and one of the only objective measures during clinical rotations

Try your hardest to pass.

 

[Mad Jack]

Depends what you think good is. I don't think the top IM programs would accept people with failed rotations, but then again that's n = 0. I am sure most if not all people who match into top IM programs do not have any failed rotations. Usually someone who has the great step scores, honors in rotations, and is otherwise a great student, which is needed to an extent to get into the very top IM programs, they do not have a fail on their record. There are always exceptions, and once again, depends on what is "good"

Op never mentioned a desire for a top IM program, just IM or peds in general.

 

[JP2740]

Op never mentioned a desire for a top IM program, just IM or peds in general.

Thanks for contributing with this vital post. He clearly mentions "good program." People have different standards for what that means

 

[Mad Jack]

Thanks for contributing with this vital post. He clearly mentions "good program." People have different standards for what that means

It was said for a reason- if they just read your post they'll start catastrophizing. A failed shelf exam isn't ruining your shot at getting an academic IM spot. Maybe state what they can do, not just what they can't? If they do well throughout the rest of third year, they'll probably get a spot that can get them a fellowship of their choice down the line. It's one shelf exam, hardly the end of the world.

 

[JP2740]

It was said for a reason- if they just read your post they'll start catastrophizing. A failed shelf exam isn't ruining your shot at getting an academic IM spot. Maybe state what they can do, not just what they can't? If they do well throughout the rest of third year, they'll probably get a spot that can get them a fellowship of their choice down the line. It's one shelf exam, hardly the end of the world.

And if you read further in the thread, you'll see where I was mistaken that failed shelf does not equal failed rotation. It was a mistake, how many times do I have to say it

 

[Mad Jack]

And if you read further in the thread, you'll see where I was mistaken that failed shelf does not equal failed rotation. It was a mistake, how many times do I have to say it

Ah, I missed that. My apologies.

 

[Stagg737]

Maybe the 3 of us all go to the same school, but my school also uses the 5th percentile nationally (based on what quarter of the year you took the exam such that the failing raw score is typically lowest at the beginning of the year) as the failing mark.

It is indeed pretty rare for a student to fail a shelf at my school. There are certainly people who do well below the class average though and tank their clerkship grade as a result.

It's the same at my school as well (~5 percentile to fail). The difference with my school is our clerkship grade is 100% dependent on your shelf score, attending/preceptor comments don't count towards our grades at all. Fail is scoring below 5th percentile, honoring is above ~80th percentile, everything else is a pass. All our shelfs are NBME except family med (gotta work that OMM in somewhere...).

 

[Anicetus]

Op never mentioned a desire for a top IM program, just IM or peds in general.

Exactly. That's always the question when people note IM as their interest. There are a ton of not-top IM programs and a crapton of land inbetween SF/LA and NYC/Boston with plenty of IM spots to fill.

 

[gregoryhouse]

Not sure about the really competitive or prestigious programs, but a number of my classmates, including myself failed shelf exams 3rd year and they seem to be happy with the way their interview season went. Of course, I can't speak for match results yet *fingers crossed* but I think your friend will be fine. Failing a shelf doesn't seem to be that uncommon.
Also, your friend has a reasonable explanation for it, and it's clearly a one time issue.

From my own experience, I failed 2 shelf exams and had a very low Step 1 score due to mental health reasons. I ended up taking a leave of absence, got treatment and got better, then came back and safely passed the rest of my shelf exams as well as making a big improvement in my Step 2 CK. Ultimately got 13 or 14 interview invites iirc, and programs I interviewed at seemed to be very understanding about my shelf failures since I had an explanation, addressed the issue, and came back strong.
If your friend crushes Step 2CK and takes it early, and the rest of the app is good I think he or she should have a great shot at getting a program they like in peds or IM.

This is good to know. Thanks for sharing!

Good luck with the match!

 

[zeppelinpage4]

This is good to know. Thanks for sharing!

Good luck with the match!

Thanks! Best of luck to you and your friend as well!

 

[CharlieBillings]

It's the same at my school as well (~5 percentile to fail). The difference with my school is our clerkship grade is 100% dependent on your shelf score, attending/preceptor comments don't count towards our grades at all. Fail is scoring below 5th percentile, honoring is above ~80th percentile, everything else is a pass. All our shelfs are NBME except family med (gotta work that OMM in somewhere...).

Is there a way to find this out before you attend a school besides finding an M3 or M4 there?

 

[sliceofbread136]

It's the same at my school as well (~5 percentile to fail). The difference with my school is our clerkship grade is 100% dependent on your shelf score, attending/preceptor comments don't count towards our grades at all. Fail is scoring below 5th percentile, honoring is above ~80th percentile, everything else is a pass. All our shelfs are NBME except family med (gotta work that OMM in somewhere...).

Dang that sounds pretty sweet

 

[Stagg737]

Is there a way to find this out before you attend a school besides finding an M3 or M4 there?

You should be able to look it up in any schools online curriculum catalog, or if you can get in contact with admissions they should be able to tell you in general what goes into the grade or point you to the website/link where you can find it.

Dang that sounds pretty sweet

Most of the time it is. It sucks when you get a super busy rotation where you do really well on the unit but get no downtime to study though. One of my rotations I was working 8 am to 7-9 pm pretty much every day (including some weekends) with minimal downtime during the day. On top of that the preceptor really didn't teach much and we were basically free labor, so my shelf definitely suffered for that section. Fortunately it was in a field I have zero desire to go into, but if you get screwed on multiple rotations it can kill your shot at honoring multiple shelf exams.

 

[MSTP18]

It's the same at my school as well (~5 percentile to fail). The difference with my school is our clerkship grade is 100% dependent on your shelf score, attending/preceptor comments don't count towards our grades at all. Fail is scoring below 5th percentile, honoring is above ~80th percentile, everything else is a pass. All our shelfs are NBME except family med (gotta work that OMM in somewhere...).

Very interesting. Ours are capped at 20%. Unfortunately the other stuff doesn't have a particularly wide distribution so that 20% usually makes or breaks your grade anyway.

 

[michiganpsych08]

Asking for a friend too...student failed the surgery shelf but interested in surgery. Is surgery now a no go? Is it less of a blow if the failed shelf is not in your intended field?

 

[MSTP18]

Asking for a friend too...student failed the surgery shelf but interested in surgery. Is surgery now a no go? Is it less of a blow if the failed shelf is not in your intended field?

Not sure about the first (e.g. would a great LOR from a sub-I overcome it). The answer is definitely yes for the 2nd though.

Also, isn't gen surg like medicine where it's tough to get into the top programs but it's not that hard to get into the specialty overall?

 

[bannie22]

It is extraordinarily bad. You should never be failing a shelf. It is a big red flag and it will hurt.

 

[zeppelinpage4]

It is extraordinarily bad. You should never be failing a shelf. It is a big red flag and it will hurt.

I hope you're being sarcastic.

 

[bannie22]

I hope you're being sarcastic.

Absolutely not.

 

[zeppelinpage4]

Absolutely not.

I guess it's all relative, maybe a red flag for prestigious or competitive programs, that are picker, but I don't think it's a big deal if your goal is simply to match at a solid mid-tier program that you'll like and will train you well.
Speaking from experience a failed shelf doesn't look good, but it won't sink an application. After evals, third year grades, Step 2CK, Step 1, LORS, and how you do on the interviews...I'd say it's pretty low on the priority or importance list.

Obviously it should be avoided, but the OP's friend seems to be a solid student otherwise with no other red flags, no need to scare them or freak them out.

 

[bannie22]

I guess it's all relative. But speaking from experience from myself and others, a failed shelf doesn't look good, but it won't sink an application. After evals, third year grades, Step 2CK, Step 1, LORS, and how you on the interviews...I'd say it's pretty low on the priority or importance list.

Obviously it should be avoided, but the OP's friend seems to be a solid applicant otherwise, no need to scare them or freak them out.

I dont think OP's friend can avoid the circumstances. But I think it hurts because failing a shelf is very uncommon when most people are trying to Honor.
Its not good to standout for the wrong reasons when the Match is so competitive already.

 

[zeppelinpage4]

I dont think OP's friend can avoid the circumstances. But I think it hurts because failing a shelf is very uncommon when most people are trying to Honor.
Its not good to standout for the wrong reasons when the Match is so competitive already.

It's definitely uncommon, but again, I feel it's low enough on the priority list that the OPs friend will be just fine for match unless they decide to go for something really prestigious or competitive. None of my interviewers grilled or gave me problems about my shelf exam failures. I don't recall any of them really bringing it up unless I said something.
But again, I only speak from my experience...I'm sure it still hurt me some, but I didn't feel like it affected my ability to match as a whole.

 

[bannie22]

It's definitely uncommon, but again, I feel it's low enough on the priority list that the OPs friend will be just fine for match unless they decide to go for something really prestigious or competitive. None of my interviewers grilled or gave me problems about my shelf exam failures. I don't recall any of them really bringing it up unless I said something.
But again, I only speak from my experience...I'm sure it still hurt me some, but I didn't feel like it affected my ability to match as a whole.

That would be encouraging for OP

 

[sazerac]

Not sure about the first (e.g. would a great LOR from a sub-I overcome it). The answer is definitely yes for the 2nd though.

Also, isn't gen surg like medicine where it's tough to get into the top programs but it's not that hard to get into the specialty overall?

Can the friend even get a surgery Sub-I? At some schools the surgery Sub-I's are very competitive and a student can't even sign up for one if they show problems like failing the shelf. I suppose there are always away sub-I's though.