I Failed My Psychiatry Shelf Exam… Now What?

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July 8, 2022
Imagine you’re a new MS3 just starting out on clinical rotations. You’d like to eventually pursue a career in surgery, but your first clerkship happens to be in psychiatry. You go through the motions of the rotation, taking detailed histories and obtaining collateral from your patients. Generally, you perform well and receive solid evaluations from your team. Everything seems to be going well until the shelf exam arrives, where most questions are about the “best next step in management” rather than the content you reviewed.
You’re flustered and score below the 10th percentile, ultimately failing the shelf exam. Now, the best you can hope for is a pass for the clerkship despite this blemish on your MSPE dean’s letter. This frustrating situation can happen to anyone, but if it happens to you, don’t worry. Here are some next steps to take after a failed psychiatry shelf exam.

Figure out what a failed psychiatry shelf exam means for you

Each school has different grading standardizations for clinical rotations. For some schools, the shelf exam counts for 50% of your grade, while the standardized patient exam and evaluations are 25% each. Other schools may have more heavily weighted evaluations.

Your school may have a policy that permits you to retake shelf exams if you fail on the first attempt, as long as you complete all other clerkship requirements. Often, the next steps after failing a shelf exam are meeting with your course director and working with student affairs to schedule the retake. Your school may also offer exam preparation tools such as review materials or even a personal tutor.

Until you pass the shelf exam on your second attempt, your clinical grade for the rotation will be deferred. Once you pass your retake exam, you will receive a pass for the clerkship on your transcript. 

However, if you fail the second shelf exam attempt, you will fail the clerkship. In that case, you will be required to repeat the entire rotation. Furthermore, there will be a note about your remediated exam in your dean’s letter, and you only will be able to receive a maximum of a pass in your clerkship. Above all, ask your clerkship director about how your program handles failed shelf exams

Identify knowledge gaps from your first attempt

Once you consult your clerkship director and schedule your retake, figure out what went wrong on your first attempt. If you’re like most students, you may have the most difficulty with your earliest shelf exams. Make sure you’re familiar with the exam structure and other FAQs to set yourself up for success on your retake and future shelf exams.

Next, identify any areas of weakness. Keep in mind that you won’t encounter every scenario, diagnosis, and medication you’ll need to know during your psychiatry rotation alone. Were there any concepts on the shelf exam that you hadn’t seen before? Take note to address these subjects early on.

The psychiatry shelf exam is difficult because it covers such a broad range of material, so it may be helpful to reference your psychiatry clerkship curriculum. Treat this curriculum as an outline of the material you need to include in your study plan.

Change your study approach to pass the second time

Figuring out how to study for your shelf exams, identify the best resources, and find time to review after a busy clinic day are just a few challenges you’ll face when retaking your exam. Excelling on one shelf exam does not guarantee success on another, so it’s a worthwhile investment to find a study approach that works for you.

The purpose of shelf exams is to evaluate your practical application of medical knowledge. Consider your previous study approach—were you more focused on memorizing the material or applying it in a scenario? When you learn a new concept, try thinking about it in various contexts to solidify your knowledge. Hear more from Adam Rosh, MD about the #1 reason for failing an exam:

Your study resources are the building blocks for a good study plan. Ask your clerkship director, classmates, or upperclassmen who have passed the psychiatry clerkship successfully about the resources they recommend. Stick to one or two resources to avoid being overwhelmed by the amount of review material. To save time, you may consider studying with a Qbank that covers the same material as your psychiatry clerkship curriculum.

Another way to boost your confidence is by taking a mock psychiatry shelf exam. While a Qbank is a great way to create custom practice exams and learn with answer explanations, mock exams are precreated assessments that replicate the shelf exam as closely as possible. Try simulating your test conditions while taking the mock exam for the most accurate projected score.

Give yourself grace

Remember, a failed psychiatry shelf exam does not put you out of contention for your desired specialty. Don’t stress yourself out too much—instead, take this opportunity to learn from your experience. Focus on passing the retake exam. Once you figure out what went wrong and develop a detailed action plan, you’ll be set for success.


Rosh Review is a board review company with products for your psychiatry board exam, shelf exams, and more. Get started with the Shelf Exam Qbank in the specialty of your choice (or a bundle of all seven specialties!) today.

By Mike Ren, MD


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