Studying for the NBME Pathology Shelf

Because Pathology is a cumulative all-encompassing subject, it makes sense that preparing for the Step 1—reading the First Aid—would be good preparation for Pathology Shelf. And while that would work, I don’t think that’s the best use of your time if you only have a few days to try to cram it all in. Pathology is cumulative, but the types of questions the National Board tends to ask demand a specific subset of knowledge: histology, gene mutations, responsible enzymes—these are the core of the pathology. Furthermore, reading a book (be it the First Aid, Goljan’s Rapid Review, or Robbins) is also a dangerous plan if you’re pressed for time. A) You probably can’t get through it. B) Knowing facts and applying them toward answering a question are separate steps. It’s not uncommon to need to see a question about a concept in order to the “bind” that knowledge appropriately.

A good Qbank (like USMLE World) works, but I think the very best way to review pathology is the Robbins and Cotran Review of Pathology, the question-book-companion of the big Robbins that many/most schools use. Benefits of this book:

• Complete, system-organized review of pathology that covers all the important topics and factoids
• Shelf-style questions and focus
• Contains clear and concise but complete explanations—which is key. You’ll get a lot of questions wrong, but this review teaches you the salient distinctions quickly without being cryptic when you do.
• Because it’s organized by system, you can tease apart related conditions and presentations. If you just do a blanket review, it’s hard to do this. Even if you use a Qbank instead, I would still recommend you do a run-through of the pathology questions by system first.

The link above is to the 3rd edition. I used a copy of the 2nd edition I bought at a local Half Price Books, and it certainly didn’t feel out of date. It’s also cheaper online. I think either one would work fine, though I’m sure there have been improvements made in the intervening five years. It’s a high quality resource; I only found two typos/mis-keyed answers in the entire book.

The point is this: there is so much material on Shelf and Step exams that literally anything you learn could be useful. Time and brain space are the limiting factors, so what you need is an efficient study aid. For the NBME Pathology Shelf, I had four days off to study. The Robbins question book is roughly 400 pages. I was able to do 100 pages a day and then follow it up with a few tables in the First Aid (important cytokines, for example), and that was 100% sufficient for Shelf purposes.

Sometimes when you do questions without having read a text first, the whole experience is just frustrating. Studying for the shelf is inherently painful, but this book really does it right.