Interesting topic. I agree that the shelf exam is a standardized test that we are unlikely to change. At the same time, if the exam covers very different material from what we experience on the rotation, it seems that there is a problem somewhere. Either the family medicine experience at UVA is not what students around the country experience, or the test itself is not a fair test of family medicine knowledge. In either case, I think this is a problem that warrants some investigation.