5.0The family medicine shelf is the NBME Family Medicine Modular Subject Exam, and it is the only shelf set entirely in clinic: NBME lists ambulatory care at 100%. It is also modular. Your school chooses the modules, and on NBME's timing chart the exam is 90 questions in 2 hours 15 minutes for Core, 100 in 2 hours 30 minutes with Chronic Care added, and 110 in 2 hours 45 minutes with Musculoskeletal added.
Family medicine tests breadth across every age group and a heavy dose of prevention. Health maintenance, prevention and surveillance is 20–25% of the exam, more than on any other shelf.
The family medicine shelf at a glance
| Topic | Official rule | Source |
|---|---|---|
| Questions and time | Core 90 questions in 2 h 15 min; with Chronic Care 100 in 2 h 30 min; with Musculoskeletal 110 in 2 h 45 min. A 15-minute tutorial comes first. | NBME timing chart |
| Setting | Ambulatory care 100%. Patients 18 to 65 are 55–65% of questions. | NBME content outline |
| Scoring | Equated percent correct (EPC), 0–100%: the share of the content you have mastered. | NBME Subject Exam Program Guide |
| Passing score | None set by NBME. Your clerkship sets pass and honors, with help from NBME grading guidelines. | NBME Program Guide |
| Results | Often posted to your school the day after the testing window, up to three business days. | NBME Program Guide |
| Official practice | Clinical Science Mastery Series: 50 questions per form, $21. | NBME self-assessments |
What family medicine shelf questions look like
Family medicine questions read like a clinic schedule: a well visit, a follow-up for blood pressure, a sore knee, a teenager asking about contraception. Many ask what this patient is due for today, rather than what disease they have.
The best answer is often the simplest: reassurance, a lifestyle change, or one targeted test. Choosing an expensive or invasive option when the patient needs none is a common way to lose points.
What the Family Medicine shelf covers
NBME's Family Medicine Modular outline gives these ranges. See the outline.
| By system | Share of exam |
|---|---|
| General principles and care of the well patient | 5–10% |
| Behavioral health | 5–10% |
| Musculoskeletal system (more with the Musculoskeletal module) | 5–10% |
| Cardiovascular, respiratory, gastrointestinal, endocrine | 5–10% each |
| Social sciences: communication, ethics, systems-based practice and patient safety | 5–10% |
| Skin and subcutaneous tissue | 3–7% |
| Biostatistics, epidemiology and the medical literature | 1–5% |
| Immune, blood, nervous, renal, pregnancy, reproductive, multisystem | 1–5% each |
| By physician task | Share of exam |
|---|---|
| Diagnosis, including foundational science concepts | 40–50% |
| Pharmacotherapy, intervention and management | 25–30% |
| Health maintenance, prevention and surveillance | 20–25% |
Patients 18 to 65 make up 55–65% of questions, children 15–20% and adults 66 and older 15–20%, so you will see well-child visits, adult chronic disease and geriatric care on the same exam.
How the family medicine shelf is scored, and what a percentile means
NBME reports the family medicine shelf as an equated percent correct, or EPC, on a 0–100% scale. NBME describes the number as the percentage of the exam’s content you have mastered, adjusted so that scores on different forms mean the same thing (NBME Program Guide). It is not your raw count of right answers.
NBME does not set a pass mark. Your clerkship decides what counts as pass, high pass and honors, and NBME gives clerkship directors grading guidelines, reviewed with faculty every two to three years, to help them choose. Schools also get national norm tables that compare their students with a representative group from LCME schools at the same stage of training. That is where shelf percentiles come from, so the percentile that matters is the one your school uses.
- Ask your clerkship for its honors and pass cut-offs before the rotation starts; they differ between schools.
- Know your module length. A 90-question Core exam and a 110-question three-module exam give different timing pressure.
- Use the practice forms’ conversion. Each Clinical Science Mastery Series report includes a table converting your result to the approximate subject exam scale.
For how percentiles work across every shelf, see our guide to NBME shelf exam percentiles.
High-yield areas on the family medicine shelf
- Screening and prevention: who gets which cancer screening, at what age, and the adult and child vaccine schedules.
- Chronic disease in clinic: hypertension, diabetes, lipids, asthma and COPD, and when to step treatment up.
- Musculoskeletal complaints: back, knee and shoulder pain, and when imaging is needed, especially if your school adds the Musculoskeletal module.
- Common skin problems, at 3–7% of the exam.
- Depression and anxiety screening and first-line treatment, under behavioral health.
- Biostatistics: sensitivity, specificity and reading a study, since NBME lists the medical literature on this exam.
- Communication, ethics and patient safety, a larger share (5–10%) than on most shelves.
A closer look at prevention and chronic care
Prevention. At 20–25% of the exam, health maintenance is the single most reliable source of points. Learn screening by age and risk, check it against USPSTF recommendations, and learn the vaccine schedule from the CDC rather than memorising old tables.
Chronic care. Questions often show a patient whose blood pressure, sugar or breathing is not controlled and ask for the next change. Learn the order in which treatments are added and when to refer.
Common mistakes on the family medicine shelf
- Ordering tests the patient does not need. Many questions reward doing less, or starting with lifestyle change.
- Getting screening ages and intervals wrong, which costs points across the 20–25% prevention share.
- Studying like an inpatient exam. Every question is set in clinic.
- Skipping biostatistics because it is small; screening questions often depend on it.
- Forgetting to check which modules your school uses, which changes the exam length and the musculoskeletal share.
Test-day tips for the family medicine shelf
- Ask what the patient is due for today, not only what is wrong.
- Prefer the least invasive correct answer when the patient is well.
- Match screening to age, sex and risk factors given in the stem.
- Pace yourself for your school's module length.
How to study for the family medicine shelf during the rotation
Family medicine clinic sends you a new problem every fifteen minutes, which matches the exam. We turn each clinic day into a short list of topics, from the preventive care due for each patient to the chronic disease you adjusted, and work questions on those that evening.
We cover screening and prevention early because of their weight, then chronic disease, then musculoskeletal and skin. Before the exam we confirm your school's modules and finish with timed blocks at the right length.
A sample week of family medicine shelf prep with us
- Early in the week: screening and vaccines by age group, built into one table.
- Midweek: chronic disease follow-up, from blood pressure to diabetes.
- Later: musculoskeletal and skin complaints, adjusted to your school's modules.
- Weekend: a timed block at your exam's real length, plus biostatistics questions.
After each family medicine practice form, ask
- Did I get screening ages and intervals right?
- Did I order a test the patient did not need?
- Did I start with lifestyle change when that was the answer?
- Did biostatistics or ethics cost me points?
- Did I practise at the length of my school's modules?
Where the family medicine shelf leads
Prevention and chronic disease run through Step 2 CK and COMLEX Level 2-CE. On NBOME's Level 2-CE blueprint, community health and patient presentations related to wellness are set at a minimum of 12%, and that is the heart of family medicine.
The screening table you build for this shelf is worth keeping. Prevention questions come back on every later licensing exam, and you will have already done the work.
Study resources for the family medicine shelf
Family medicine practice forms are available from NBME's Clinical Science Mastery Series, at 50 questions and $21 per form. Because prevention is such a large share, we pull every screening miss from those forms into a single review list.
Screening questions follow the US Preventive Services Task Force recommendations, and vaccine questions follow the CDC immunization schedules. If biostatistics is a weak spot, our monthly Biostatistics group class with Alexandra is available on the Services page.
Divine Intervention, UWorld and other third-party resources
Students ask most about three kinds of outside resource. Each has a place, and none replaces timed questions:
- Divine Intervention podcast episodes on the family medicine shelf work as audio review on the drive to clinic. Listen after you have done questions on a topic, so the episode fills gaps rather than introducing material.
- A question bank such as UWorld is the core of the month. Filter to ambulatory and family medicine questions early, then mix in internal medicine, pediatrics and OB/GYN questions set in clinic.
- Video or text review courses such as OnlineMedEd help when a whole area is new, for example musculoskeletal exams or contraception counselling. Use them for the topics your questions say you are missing, not front to back.
Whatever you use, check screening and vaccine answers against the USPSTF and CDC sources above. Third-party summaries can lag a guideline change, and the exam follows the current guideline.
Who tutors the family medicine shelf
Family medicine shelf prep is led by Dr. Shauhin “Sean” Moazezi, DO.
From a student we tutored through clerkships
“He helped me make a plan, pass on my first attempt, got me then through all my clinical rotations to pass my Shelf exams on the first try, got me a good Step 2 score”
Tim S., Step 1, shelf exams and Step 2 CK
One-on-one family medicine shelf tutoring with The Boards Professor costs $349 per 50-minute session, online by live video (Zoom or Google Meet). Book a free intro consult to start.