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Help! How Long To Add 20-40 To My USMLE Step 1? 4 Step 1 Experiences (Including a 45-Point Jump from 1st NBME Practice Exam)



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NBME UWSA Score Graph USMLE Step 1

Most of us assume that more time studying for the USMLE Step 1, Step 2 CK, or Step 3 exams would lead to higher NBME scores.  But what if they could be rising even faster?  And what if your NBME scores are plateauing…or are even lower?

Here’s a question I received recently, which is like many questions I get from awesome medical students like you (emphasis mine):

Dear Alec,

I stumbled upon your website somehow after doing relatively poorly on an NBME today. My goal is 250+, and my last NBME (taken about 1.5-2 weeks ago), I scored a decent 234. However, today’s score was 224, and my test is in 5 days. It’s pretty disheartening knowing that I regressed in performance over a period of a couple weeks, but also alerts me to the fact that I’m not studying smart. I plan on delaying my exam after reading about your strategy, but my question is how much time do you think is ample enough to raise my score say about 20-30 points? I downloaded Anki and it looks like an amazing tool I would love to use, although I’m just a tad bit concerned about how long it will take to not only generate cards, but review them as well. FYI I’ve already done usmleworld questions one time through, and read first aid numerous times. I know your plate is probably full as it is, but do you have any suggestions/studyplans/schedule for a 3-4 week period for a guy who has already put in a few months of work? Just thought I would shoot for the stars with this email, because I’m really tired of studying hard and not getting results. I can’t begin to thank you enough for all the time and effort you’ve taken to help other people through your hard work, and you should know that its people like you who EMPOWER other people. Anyways, hopefully this reaches you at a time of minimal stress, and hopefully we can chat soon.

All the best, A

Like this student, two questions you may be asking yourself are:

  1. How long will it take to increase my NBME scores by (20-40+) points?

  2. Is it possible to start Anki/the Yousmle Method at any time, even if I am well into my USMLE studying?

Don’t worry, to help you plan your test-taking strategy, I will share 4 USMLE Step 1 experiences (including my own) of students who have used the methods I describe on this site.  And as a free offer, I’ve outlined the strategy I and every student I tutor use to raise their NBME scores.

How long do I study for to raise my NBME/USMLE scores by 20-40 points?

For many medical students, a 20-40 point bump is a good jump in score for their entire studying period.  It’s a question I’ve wrestled with for some time, so I decided to dig a bit deeper and look at exactly how long it took to raise my score from 236 to 270, a jump of 34 points.   These were my NBME and UWSA scores graphed over time:

NBME UWSA Score Graph USMLE Step 1

Here is the same data in tabular form:

Date 3-Digit Score Form
3/28 236 NBME 3
4/17 259 NBME 6
5/1 257 NBME 11
5/22 264 NBME 12
5/29 265 UWSA #1
5/29 265 UWSA #2
6/5 270 Step 1


The largest jump I took was within the first 3 weeks, from 236 to 259 (23 points).  I suspect that several things played a role in this.  First of all, while I had been using the Kaplan QBank sporadically during my second year, I had only finished roughly 25% of the question bank (around 500 questions) by the time I took my first NBME.  When I began my studies in earnest, however, I was doing between 1-2 blocks of questions per day for the first 4 weeks, then 125 questions/day thereafter.  Thus, after the first several weeks, I was much more familiar with the test format, and so part of my score increase can likely be attributed to familiarity. Secondly, I intentionally started out by doing fewer questions, to give myself more time each day to study topics I was particularly weak on.  For example, for the first week, I did one 46-question block a day, but studied many of my weakest subjects, including embryology.

However, you’ll notice that my NBME scores, including the UWSAs, appear to trend upward until the day of my test.

What about the results of students who switched to Anki/Yousmle Method for their Step 1 studies?

One question I had when I started USMLE tutoring was, “could medical students adapt these methods if they had used different methods prior to their Step 1 studies?”  It’s one thing to use Anki to make pathogenesis to presentation cards throughout your first year or two of medical school, but how well can these methods be adapted to someone who’s used a completely different method?  Can they find similar success, and how long would it take?

The good news: the fact that I’ve been a USMLE Step 1 tutor for the past several years means we have a wealth of data from which to draw.

The short answer: students can adapt the Yousmle method effectively, regardless of whether they’ve been using Anki or not prior to studying for Step 1. Let’s look at some examples from three of my most recent students who have taken Step 1.

Student #1: How long to go from 230 to 261?

Here is a student who came to me with a goal of breaking 260.  As you would imagine, with a baseline score of 230, he already had a strong knowledge base, and in this case, Anki simply facilitated the process of shoring up weak areas, which included neuroanatomy and pharmacology. The timeline is deceptively long, since he had taken the baseline NBME with his school in early December, a month prior to beginning his Step 1 studies in early January.  We worked together for about 7.5 weeks starting the end of January. NBME 230 to USMLE Step 1 of 261   The same in tabular form:

Date 3-Digit Score Form
12/10 230 School NBME
2/9 242 NBME 11
3/10 254 NBME 15
3/14 258 NBME 16
3/20 261 Step 1


Unlike me, his NBME score increases actually appear to accelerate at the end of his studies.  I want to address this in a future article, but having worked with students and seen how they read QBank and NBME questions, I’m convinced there are often as many mistakes in interpretation as there are in actual knowledge/retention.  In other words, simply learning the facts is insufficient, and you can raise your score significantly, even in 2-3 weeks, simply by interpreting the question stem better. Again, it’s hard to assess his baseline, as his NBME was a month before he began studying, but even if you take the NBME he took a month after he began studying as his true baseline, he was able to raise his score 19 points in 5.5 weeks, and 31 points in 2.5 months.

Student #2: How long to go from 200 to 245?

This student came to me with a goal of breaking 230, from a baseline of 200.  She began studying on January 6, and worked with me for about 2.5 months, over which she raised her score 45 points.  Over the final 2 months, she raised her score 25 points.

NBME 200 to USMLE Step 1 of 245

NBME/UWSA results in tabular form:

Date 3-Digit Score Form
12/10 200 School Exam
1/25 221 NBME 7
2/17 219 NBME 11
3/2 232 UWSA 1
3/2 238 UWSA 2
3/10 232 NBME 12
3/18 241 NBME 15
3/24 237 NBME 16
3/28 245 Step 1


It is interesting to note that for this student and for myself, the UWSA exams were in fact an underestimate of our final scores.  A sample size of n=2 is obviously too small to make any judgements, and I have seen the UWSA both underestimate and overestimate scores, but in general, I wonder if the supposed overestimation of the USMLE World Self-Assessments is a bit overblown.

For those of you keeping score at home, is her 45 point improvement more impressive than the 31 point improvement seen in the previous example?  Depends on how you look at it.  Certainly, anyone would be thrilled to have such a large jump, but most people would agree that it is harder to go from 230 to 260 than 200 to 230. Regardless, both students did fantastic, and I am so proud of what they were able to accomplish!

Student #3: What if I’ve failed my USMLE Step 1?  Will these methods work for me?

Here is a scenario many medical students are loathe to contemplate, but happens far too often, particularly to those who a) memorize, and b) use passive learning strategies over active ones.  This is a graph of this student’s performance prior to working with me:

Prior to working with me, this student studied 6+ months using predominantly passive learning (videos from a top commercial prep organization), and failed her USMLE Step 1

NBME Plateau and Failed USMLE Step 1


We began working together shortly after this student found out they had failed their Step 1 exam.  Using her previous failed Step 1 score as her new baseline, here were our results together:

Failed USMLE Step 1 to Pass


Here are the scores in tabular form:

Date 3-Digit Score Form
6/22 170 NBME 11
7/12 191 NBME 15
7/19 191 NBME 7
7/24 187 Step 1 (failed)
9/7 196 NBME 6
10/1 203 NBME 12
10/13 214 NBME 13
10/16 198 NBME 5
10/24 216 Step 1 (Passed!)


Two reflections on this student’s data.

  1. Fatigue is real: this student had taken NBME 5 after a very long day of studying, and it shows in the score (198, from 214 previously).  Thankfully it was just a blip, and they recovered for the exam.
  2. This was strong validation that anyone can adapt to the Yousmle Method and continue to improve their scores.

What have we learned?

Reflecting on my experiences, as well as these 3 students, 4 things stand out:

1. ANYONE can adapt these methods at ANY stage of their USMLE preparations

No matter if you are starting your first year/summer of medical school, at the beginning of your USMLE preparations, or if you’ve failed your exam and need to bring your score up, I have seen this method work time and time again for students aiming simply to pass to students aiming for 260+.

Having tutored dozens of students in their USMLE preparations, one thing is clear: it is never too late to stop the cycle of mindless memorization and passive learning.

2. If you’re looking for a 20-30 point increase, it is reasonable to expect at least 3-4 weeks (and possibly more)

While obviously the results varied in these 4 cases (and your results will vary), a 20-30 point increase is substantial, and will likely take at least 3-4 weeks.  Again, it is a personal decision whether and how much to delay one’s exam.  If it were me, if I had the time, I would probably spend even longer to make sure that I was scoring above my target score (probably in the 4-6 week range).  And if I wanted to target a higher increase, I would likely give myself even more time (6-8 weeks, at least).

You might find yourself improving at a much faster rate (I have a student now whose NBMEs have improved by over 70 points in ~2 months), but those are very atypical cases.  As such, I wouldn’t plan on having such success, and would give myself as much time to accomplish my goals as I could.

3. Using the Yousmle Method (detailed below) can help raise your score if you’ve reached an apparent plateau or have even failed your exam

Student #3 was a clear illustration that these methods could be adapted even after someone had reached an apparent plateau and has even failed their exam.  So many medical students follow this pattern: they never find an effective learning strategy, and so rely on memorization.  Even after two years of following this dead-end strategy, I’ve seen numerous students improve their scores substantially by following the continuous cycle of 1) learning for understanding, 2) making sure to never forget the information, and 3) learning how to apply it to USMLE questions.

4. Your score “plateau” will likely be much higher (and may not even exist at all)

Looking at the trends of these students, as well as other students I’ve worked with, it is clear that few if any really reach a score “plateau” as is so often described by other students.  Why might that be?

Most students describe hitting a “plateau” in their score when they feel that the amount of knowledge they gain every day is balanced by the amount of knowledge they forget.  The beauty of using Anki effectively is that you can constantly add to your knowledge while making sure you don’t forget anything old.

This sounds great in theory, but as we can see in these 4 examples, none of us really reaches a “plateau,” in the sense that many students describe.  We CAN see this illustrated by Student #3 using more traditional methods prior to working with me.  She reaches a plateau, and actually have a slightly lower Step 1 than predicted.

However, we can see the exact same student breeze past her supposed plateau, and raise her score nearly 30 points after supposedly “peaking.”

These methods are powerful, and I want to make sure you can implement them effectively, in the least amount of time necessary.

FREE: Instant Access to the Strategic Pillars and QBank Strategy My Students Have Used to Average Nearly a 40 Point Increase

I’m constantly seeking out ways to improve as an educator, and I’m proud of the fact that, over the past 12 months, first-time test-takers working with me have averaged nearly a 40 point increase in their score (39.4 to be exact).  After years of helping students with their exam, I want to share with you the strategic pillars every single one of these students has successfully implemented, as well as the question bank settings that I use most commonly (random vs. subject-specific, timed vs. tutor vs. untimed).

What is the best way to start late in the game?

As a thank you for your support, click on one of the buttons below to receive instant access to the strategic pillars, including the QBank settings I recommend for my students.

What is the best way to start late in the game?

But what are the best ways to adapt these methods to improve your own scores?  In general, as I have advised in other places, the goal is NOT to turn all of First Aid into Anki cards, particularly before you do any QBank questions.  It would take too much time to make the cards let alone actually do them, and that is time that you are taking away from doing other essential activities (namely QBanks).  Instead, I and the many students I have tutored have found great success in the use of QBank questions as a “diagnostic” tool of what we are weak on, followed by intense study of that subject to ensure that we never get another question wrong on that area and making Anki cards to never forget that subject.

The approach looks like this:

USMLE Step 1 Study Cycle

Anki cards to never make the same mistake twice

I had a 34 point improvement by making plenty of mistakes on QBank questions, and focusing my learning and Anki card-making on never making the same mistake twice.

A huge time-saver for me was, instead of trying to learn everything first, and then taking the question banks as a sort of proving ground, I improved my score by 34 points by making plenty of mistakes on QBank questions, and focusing my learning and Anki card-making on never making the same mistake twice.

What do most students try to do?  Most students waste time by trying to make all of First Aid/other resources into Anki cards BEFORE they do the bulk of their questions.  Why is this a waste of time?

  1. It takes too long to turn all of First Aid into Anki, especially if you have less than 2-3 months to go
  2. Even if you could turn all of First Aid into Anki, you would never have time to review all of your cards
  3. Even if by some miracle you could complete 1. + 2., you would spend your entire day on doing Anki cards, and never actually do a QBank

Instead, use QBank questions to diagnose your weakest areas, make sure you learn them well by focusing on pathogenesis to presentation, and make Anki cards that test your ability to connect/apply information so you never forget it.  Then rinse and repeat!

What Question Bank settings do you recommend for USMLE World, Kaplan, etc.?

Many of you have asked me whether I studied subject-specific, and timed/tutor/untimed.  I always did random, because I felt that doing subject-specific made it too easy to eliminate certain wrong answers (e.g. if I’m studying renal, I know that all of the cardio-specific answers will most likely be wrong), and wasn’t as representative of how the real test would be.  For the first month, I studied using tutor mode, to give myself time to improve my ability to read/interpret questions, but then spent the last month doing random, timed.  I felt that this was a good approach, and it is one that I recommend to students I work with.

However, for some students, particularly those who are scoring well below the passing threshold (e.g. 180 or below), I have used a subject-specific approach for about 4-6 weeks first.  Why?  Step 1 studying is overwhelming to everyone, given the huge amount of information, if students have not learned the preclinical material as well as they’d hoped, then it can feel particularly hopeless.

It’s not!

We can convince ourselves of this by learning one organ block at a time in such a way that we never have to go back and review that organ block.  For example, we would start with our weakest topic (e.g. cardiology), learn that well for 3-5 days using the strategy outlined above, make sure we never forget it, and then move on to another topic (e.g. renal).

If you do it correct, you should see a bump in your QBank percentages for that block.  Because you’ve made effective Anki cards, you should be able to keep those gains, and even build on them, after you’ve moved on to the next block.

In this way, we can move through the entire body, make sure we learn it well and make effective Anki cards so we never have to go back for intensive review of that topic.

What to do next?

  1. If you haven’t already, familiarize yourself with my guide to writing effective basic Anki cards
  2. If you feel comfortable with the basics, read about more advanced techniques for making Anki cards here, here, and here.
  3. Still have questions?  Check out my Anki FAQ.
  4. Interested in Step 1, Step 2CK, or COMLEX tutoring?  Check out the tutoring page here.
  5. Want to read about the right and wrong approaches to using First Aid?  Read this article here.
  6. Check out the Resources page to see what I used to efficiently boost my Step 1 score.

One final thought

When I first heard of spaced repetition, it sounded too good to be true.  After many hours studying, mistakes made, dozens of students tutored, and a Step 1 score of 270, I am convinced that ANYONE can reap steady gains in their USMLE scores.

Are these results really too good to be true?  Do they seem attainable?  Does this seem like a reasonable approach?

What have you struggled with, and what, if anything, has helped you to break through when your NBME scores aren’t rising?

Let us know in the comments!


  • Forup Loading


    Okay… so I think I’m doing something wrong, or am reading this post incorrectly. I’ve been doing the questions, and then based on the individual questions I get wrong, I go and review that topic (for instance if I missed something on renal, I’ll go that part about renal). Is that how I should NOT be doing it? I feel like I’m spending way too much time on doing that ,and it’s getting cumbersome to finish reviewing exams.

    Please clarify your suggestion, if you don’t mind. Do you mean, do the QBank, random-setting, and if say embryology seems horribly weak, go go do a full day on Embryo??? With Anki cards? Thanks!

    • Yousmle

      Great question!  Typically I recommend “random” then say I get a particular question wrong in embryo, like on cleft lip pathogenesis, I would then study cleft lip and palate from First Aid, searching through the First Aid for all instances of cleft lip/palate, using the question bank as the context.  I would focus on pathogenesis to presentation learning, then make specific Anki cards on that information, to make sure I never forgot it.

      Embryology would be a bit too broad – I typically would just focus on the particular topic within that broad subject that I didn’t know, make sure I knew it well, then make sure I had Anki cards so I never forgot it.

      Make sense?  Fantastic question.

  • Usmleprepper

    Hey there, your blog is absolutely great! I regret that I found it this late in my prep. I have a question for you. I took NBME 11 today (the first one I’ve ever taken) and did disappointingly bad: a meager 209/410. My goal is for something above 235 so this was definitely a huge blow to my study prep.

    What makes it worse is that I’ve done Kaplan material once (except for Anatomy for which I used HY), FA 3 times, UWorld once (annotated key points to FA) with a cum of 78%, and Pathoma once (in february). I plan to take the exam in October but don’t know how should I go about. I clearly know that my study technique is not working (given the low score.) I’m starting UWorld review from tomorrow (2 blocks a day) along with reading my weak topics from FA and hopefully creating some Anki cards. I’ll also review Pathoma again as I think I’ve forgotten a lot of the stuff (even after having annotated key points in FA). Do you think reviewing Pathoma is a good choice or should I switch over to Goljan?

    I’ve done around 1075 q’s (40%) of UsmeRx and I will continue doing that whenever I get the time.

    I’m planning to give another NBME (12) on the 20th of July and UWSA by the 4th of August.

    Then I plan to do DIT in August along with my 4th read of FA and give an NBME after that.

    Would you suggest I do anything differently apart from making cards? adding an extra qbank like Kaplan? using other sources?

    Thanks a ton!

    • Yousmle


      Wow – it sounds like you’ve been doing a TON of work. I can understand how disappointed you must feel, since it probably doesn’t feel like your score is commensurate with the amount of work you’ve put in. While it’s hard for me to comment on why exactly your score hasn’t gone up, the pattern I’ve seen in many students I’ve worked with is that while we can indeed put a ton of TIME into our studying, we tend to recall less information, and be able to use it less if our methods are more passive. In other words, I found that while reading through First Aid, I could convince myself that I was “covering” more material, I often found when it came to actually doing questions, I would really struggle to apply that information, even though I had just studied that section!

      Instead, what I found helpful is to do questions first, which helped me identify my weakest areas to focus on, and then to use other resources (Goljan/Pathoma, Costanzo, etc.) to fill in those gaps. Personally, I never found it super helpful to watch more videos, but if you’re one of those rare individuals who can retain everything they watch/read, and know how to apply that information, then by all means!

  • Usmleprepper

    Thank you for your reply. Do you think it’s realistic to go from a 209 to 235> in 3-4 months? I will only devote to doing UWorld the 2nd time and going through Firecracker and doing a review of Pathoma.

    • Yousmle

      Great question.  For the typical student I’ve worked with, that should be plenty of time.  However, note that I’ve found the most important variable in the equation isn’t the number of days studying, but rather how effectively one uses their time. Specifically, how effectively one identifies their weaknesses, how well one learns the pathogenesis to presentation of each subject, and finally how well one can apply their knowledge to each question.

      Hope this helps!

  • Usmleprepper

    Thanks a lot! Do you offer any particular tips/courses to help out students?

    I’ve started using Anki with UWorld for the tough topics (as I’ve already annotated UWorld into FA), and you’re right, it rocks!

    • Yousmle

      Thanks so much for your message. As a USMLE tutor, I share some of my best tips, as well as most popular lessons, on this website in the form of articles and cheat sheets. I don’t currently offer a particular course, per se, but that’s a great idea that I will certainly consider!

  • Rie

    Thank you for all the great tips! I need some advice though. I have my step in 200 for both Step 1 and Step 2CK. I took an NBME last week and got a 170 =( Is there anyway I can achieve this goal in 4 weeks? Thanks so much!

    • Yousmle

      Dear Rie,

      Thank you so much for your message.  Sounds like a very promising situation from a connections standpoint, although I think your intuition is good that getting such an increase from your current NBME will not be easy.  Generally, a 30 point jump in <4 weeks, even when I've tutored students one-on-one for Step 1/Step 2CK material, is not typical.  Looking through results of past students I've worked with, the higher jumps in NBME Practice Exams has been ~30 points (one person had a jump of 53 points in a month, but that was an exceptional student).  As far as what I've found that has helped distinguish the students who have improved their score more than others, it is 1) an ability to learn the material well, 2) making GOOD Anki cards (without drowning in needless/low-yield facts that they memorize), and 3) learning how to apply it to QBank questions.

      Note, though, that this is for Step 1.  I'm sure it's been done, but it is not typical to have to do both Step 1 and Step 2CK in such a short period of time, with such a desired increase in score.

      Best of luck!  Please let me know how else I may be able to help.


  • marco

    Hi Alec

    I was reading your site and found it very helpful in refreshing for USMLE prep. I saw that you recommended a book for Immuno and I just bought it on Amazon and are finding it VERY useful. Do you have a similar recommendation for genetics and molecular biology? These subjects are giving me great difficulty and would love your feed back

    Thank you

    • Yousmle

      Dear Marco,

      Thank you so much for your message – I absolutely LOVE the immunology book, and it continues to be one of the best books I read in medical school. Unfortunately, I don’t know of a similar resource for learning genetic/molecular biology. Honestly, those topics were difficult for me, mainly because most of the resources I could find were geared towards grad students/students not taking the USMLE.

      What I did instead, which worked but admittedly not as well as if I’d had someone amazing explain it all to me like the immunology book, is to do questions on that particular topic, then study from the internet/a good helping of Wikipedia to make sure I understood not only the answers, but also to understand exactly what they were explaining in the question stems.
      Hope this helps. If you find an amazing resource for learning genetics/molecular biology, we’d love it if you’d share it with us!

      Looking forward to hearing more from you!

      Take care,

  • T.O.

    Dear Alec,

    How are you? I would love to get your opinion about my situation and how best to proceed. I am currently a month and a half into my final semester of M2.

    I just took NBME 7 today and scored a 400, which according to the report translates to 207. We have quite a few chapters in systemic Path such as Repro, CNS, Breast, Skin and Msk yet to cover as well as Pharm for these systems. I also haven’t fully owned the Renal section we just covered and really need to work on my biostats and behavioral.

    Should I be worried? My uworld average on timed random mode (minus biostats) on all material covered since med1 to date is 77%. So needless to say, I was a little shocked by the score I got on NBME 7 today. My goal is a 260+. I know we have a while till December to complete M2 and obviously I have at least 8wks to review before Step 1. I just want to know if you think its possible to make that jump?

    I did review the questions I missed with a buddy who got 262 after I finished the exam, and I found that I actually knew the right answers to a bunch of questions I missed, but I guess I didn’t see the clinical picture clearly or conceptually get what was being presented. Any advice you have would be greatly appreciated.

    Thank you very much.

    kind regards

    Toju O

    • Yousmle

      Hi Toju,

      Thank you so much for your message. Congratulations on doing a practice exam so early. Honestly, I would say that there is no reason to worry. There is still a ton left for you to cover. I think most people in your shoes worry about where they might be projected to score, since we all want to do so well, and are trying to find ways that we can reassure ourselves that we are on the correct path. Truthfully, it’s hard to predict what your score will be given the fact that there is still a lot of material that you haven’t covered, and given the fact that while your knowledge is probably very good, that there is still a large amount that is difficult to apply in clinical scenarios. At least this is what I experienced, as well as the many students that I have tutored, in that applying the facts that we’ve learned to clinical scenarios is difficult, and a skill unto itself.

      My best advice is to continue to learn things well, particularly mechanisms and pathophysiology, and try to apply it as often as possible. Try not to worry too much about where you might be predicted to score, as that is more likely to drive you crazy that it is to help you achieve your goals.

      Best of luck! Thanks again for your feedback.



    How are you ? i’m a 2nd yr student here in mostly we start our medical course in sec 2yr ,and most of there books are hardly to understand due to there english..and i want to write uslme nest yr ..pls Alec can u help me with sm tips and advise and the best materials 2 use coz i want at 1st sitting i shld atlese flock 280..thank you sir ALEC

    • Yousmle


      Thank you so much for your message. Lucky for you, I have a list of some of my favorite resources for Step 1, right here:

      Best of luck with your studies!!

  • tnt81

    Hi ,how are you? I am IMG , I was doing ANKI for the past 3 months I had an improvement really good , but now no any more , I am worry , I am scoring 200 on nbme , no enough , I would like what I can do to improve those results

    • Yousmle


      Thank you so much for your message. This is something that a lot of people deal with, hitting a sort of plateau in their scores. My two popular articles on the subject deal with learningthings to a sufficient depth, since one of the biggest things that students struggle with in Step 1 is learning facts rather than improving the understanding. For best my advice on the topics, I suggest the following articles-

      USMLE World: Is Your Strategy Wrong? (And How I Scored 270 on Step 1 By Ignoring The Dogma)
      Nailing the USMLE Step 1 Fundamentals (#4 Helped Raise My Score to 270 from 236 First NBME Practice Exam)
      Another thing that I work on with students that I tutor is their ability to understand questions, and particularly in their interpretation. It’s hard to explain in writing without going over questions with students, but the main idea is that you should understand what every sentence means for every question, not just try and look for buzzwords.

      Best of luck!

  • K Singh

    Hi Alec,

    I purchased your step 1 Deck and and have gone through about 70 percent of them. They are concise, easy to learn and full of high yield information. They helped me grasp some of the most difficult concepts (EX: Bacterial Genetics for me, General Virology, Embryology and some conceptually challenging topics- ex pathogenesis to presentation for Endometriosis, Difference of mechanism between Staph and Strep pyogenes skin infections ).

    I have a few questions related to the deck :
    1. I am aware that they do not have notes/cards for each and every question on U world. How many/what percentage of questions do they cover? Uworld has a total of 2116 questions.
    2. About 2 weeks prior to the exam, I wish to create a filter deck and review all the cards (Cram mode)- Do you recommend that? Would appreciate any suggestions that you might have.


    • Yousmle

      Hi K,

      Thank you so much for your message, and for your kind feedback! It is honestly difficult to know what percentage of questions are covered, since honestly, just as important as knowledge is your ability to apply that knowledge when dealing with question banks. As far as doing cram mode, I never found it particularly useful, since the entire point of using spaced repetition is that you don’t have to cram. If, perhaps, you haven’t finished the entire deck, and have a couple hundred cards left, then it might be worthwhile, otherwise I think just sticking with your current schedule and doing your cards every day would suffice!

      Best of luck!


  • Kay

    Hi, Alec, I just stumbled upon your website and read through almost all your posts, it was really helpful. I
    was planning to take my exam in a month and have been preparing for USMLE Step 1 for a looong time. But while doing qbanks, I have realized I’m terrible at both integrating/applying knowledge and recall. Planning to
    delay my exam another month now. I downloaded a sample of your Step 1 Anki deck, and I found them very useful, it made me think about things I wont usually think of, made me connect the dots between a high yield fact and the background concept. However, I’m new to Anki and don’t really know how it works. And I’m worried that it might be too late for me to work with flashcards now, with two months left before I take Step 1. What do you think?
    Also, what else would you recommend, will doing more qbanks help? I find reading and re-reading FA quite boring, and I can never remember stuff. :(

    • Yousmle

      Hi Kay,

      Thank you so much for your message, and for your kind words! You wouldn’t believe the number of students who have been preparing for their exam for many months, only to be disappointed in the amount (or lack) of progress. Although it’s a difficult road, I have seen success in these situations, so don’t lose hope!

      Thank you, too, for your kind words about my Anki cards. The question is a good one, whether starting Anki so late in the game is a worthwhile investment of time. For the cards that you will make on your own, there is certainly a learning curve, although using a premade to deck can help both to give you a large number of cards to begin with, as well as to give you templates on how to best to make cards.

      If it were me, I would still use Anki, which I still recommend for students I begin working with when they have only 6 to 8 weeks left. You are quite likely to forget what you’ve learned after a week or two, and even just boosting your memory by 10 to 20% would be worth the added effort. I would certainly focus on topics that are easier to make cards on, like pharmacology, and if you’re serious, to use the premade deck I made for exactly this situation.

      For your other question, it’s hard to know exactly why your score is not improving as much as you would like. Without ever having worked with you, and going strictly based on my experiences with other students in similar situations, it’s likely a combination of not learning things from pathogenesis to presentation, forgetting a large amount of information, and not knowing how to apply the information to clinical vignettes. Focusing on these three areas is your best shot at improving your score. Question banks can certainly help, but you will likely have to go further than that to learn deeper information. You can check out the Resources page to see what books I used and recommend to gain greater depth and ability to make connections.

      Thank you again for your message. If you have any other questions, please let me know!


  • Drew

    Hello Alec, I have tried both Firecracker and Anki flash cards for USMLE
    Step 1. Firecracker has about 11,000 cards and the Anki deck I
    downloaded has over 16,000 cards (covers every line in First Aid); but
    they become overwhelming and frustrating. They help with retention. When
    I test myself on U World for the first time I scored well on a topic
    that I studied (80% correct), but very poor on areas that I have not
    studied or forgotten over time.

    I see that your decks for Step 1 contain just 1300+ and step 2 CK has 1100+ cards.

    frustration is the accumulating daily cards (300-400) from large decks
    of 16,000 cards. And the frustration get more since it slows my pace to
    move onto new topics. Some days I am not motivated to do 200 cards
    knowing I have to focus on reading new stuff; so its a continuous
    struggle of scheduling. I have 8 months to prepare for Step 1, Step 2 CS
    and Step 2 CK.

    Using large decks, I see that my knowledge is
    becoming like the isolated facts being tested, its becoming a fragmented
    memory as well and I am loosing the big picture or concept to use in
    the clinic as a to be physician.

    Please help

    • Yousmle

      Hi Drew,

      Thank you so much for your message. I think everyone that has tried either Firecracker or the numerous decks floating around on the Internet can relate to exactly how you feel. The focus is so much on retention of simple facts, that the number of cards balloons to a unmanageable number, which takes away time from other important things, like learning new subjects, as well as doing question bank questions.

      Your question is a fantastic one, which is what can we do to overcome the feeling of being buried in flashcards, particularly simple ones so that we don’t feel like we are fragmenting our knowledge. For me, I was unwilling to give up on spaced repetition, and as such, had to accept that a certain portion of my day would be spent doing cards. That said, typically I was doing it no more than 300 to 400 cards a day at the most, even at the time I was in my dedicated study period. The way that I was able to cut down on the number of cards that I did was making pathogenesis to presentation cards. If you turn a series of 10 simple facts into cards, you will end up with at least 10 cards. However, if you can connect multiple facts with each other, by making sense of how each is related to the other, you can dramatically cut down on the number of cards that you do. My best advice would be to work on connecting pathogenesis to presentation, which will allow you to be more efficient with your cards.

      You referenced the decks that I have on the website, which are now a little over 1400 cards for the Step 1 deck. The goal of this was to create templates of pathogenesis to presentation cards in some of the most difficult to understand subjects for students studying for their USMLE exams, as well as to provide examples of other basic cards. You can find numerous free samples on the website as well. My hope is that with the material you can find on that you can cut down on the number of cards that you have to do, both saving yourself time, helping you to apply information, as well as to free up time for other important activities.
      Best of luck with your preparations! It sounds like you have learned a great deal, so I wouldn’t recommend blowing up everything and starting over. Just focus on making connections where possible, and utilizing pathogenesis to presentation cards to cut down on the number of cards you have to make and review every day.

      Take care,


  • Aparajita Ray

    Hi ,
    I am trying to share it on my Facebook timeline to see blocked content but unfortunately even after sharing it on facebook I am unable to see the content.
    Can you help ?

    • Yousmle

      Hi Aparajita,

      Hmmm…sorry to hear the site hasn’t been working as expected for you. I just tried it, and it seems to be working. If you send me your e-mail I am happy send you the content. As far as the micro cards be sure to check your spam folder, and make sure you confirmed your registration for the newsletter.

      Thanks again for your feedback!

      • Aparajita Ray

        Thank you Alec.I tried that and it seemed to be working.

        • Yousmle

          Great, I’m glad to hear that it’s working!

  • Shinehigh M. Eman

    Hi Alec,

    I finished my first reading from kaplan and now I am in my second reading and doing FA and UW online , intending to give my exam mid June , how can I benefit from your method ? Can u help me plz

  • Matthew So

    hey alec,
    so what is the yousmle method exactly?
    i have all of your decks and stuff, but i need to get a significant increase in my scores. I don’t think listening to videos and reading notes is helping me, so I need to do flash cards all day. I am talking about 1000 flash cards a day. Everything else is a waste of my time, I am finding.

  • Rob

    Hi Alec,

    I hope you are well. I was hoping for some advice on how to attack my last 3 weeks of studying for the USMLE step 1 exam. I’ve consistently followed your method, and in addition have been using you anki deck, and my track record is as follows:

    baseline NBME 7 – 224. (2 months out)
    I used Kaplan + some uWorld and used your method for one month of pathogenesis to presentation cards into anki.

    NBME 11: 247 (5 weeks out)
    continued your method, in addition to reading through FA to high-light topics never seen (most of these are random terms that I’ve never heard of ie Brugada syndrome, Jod-basedow phenomenon, etc) or I am weak on and reviewing those and turning them into ANKI cards (which slightly slowed down my review of problems).

    NBME 12: 256 (4 weeks out)
    same thing, but my review of problems has focused more on details than on concepts, and I feel like I am forgetting concepts, even though I am keeping up with daily reviews of ANKI

    Today – NBME 15: 256 (3 weeks out)

    Currently, I am doing 92 problems / day (random, timed), and review them; however, I feel like my reading of FA has slowed me down, and I am over concerned with the details, as opposed to the concepts. In addition, now that I understand the concepts, my reading of Uworld questions focuses on nit picky details. Thus, I am not reviewing the problems, as I had before. Or, I feel as if I know the concept, and gloss over it.

    Do you have any recommendations or advice to continue improving, or at least maintain my score?

    Rob A

    • Yousmle

      Hi Rob,

      First off, congratulations on your improvement thus far. That’s a pretty big jump for just one month, and so you clearly are doing something right. Thank you also for your kind words about the website, and for the Step 1 Anki deck.

      My best advice for you right now without having worked with you, would be to focus on developing a consistent way of going through questions. Your knowledge must be quite good to be scoring so high, so now you want to focus on making sure that you understand exactly what each sentence is telling you in each of the clinical vignettes. Focus on reading through each question only once, and on simplifying the question so that instead of being a complex two-step reasoning question, that it becomes a simple straightforward question that could easily be put on a simple flash card.

      The key with this last point is to make sure that you understand what each question is asking you. One thing I found with myself, and in working with other high scorers, is that oftentimes the questions that we get wrong are not necessarily because of gaps in our knowledge, but rather because we misinterpret part of the question, or don’t understand what the question is actually asking us. By forcing ourselves to re-create the question as a simple fact recall kind of question, you can assess and improve your ability to understand what the question is actually asking you.

      Hope this helps. You are almost there, just remember that the NBMEs do not give you quite as accurate of results the higher your score is so you might be improving, even if your NBME might not show it.

      Best of luck! Please let me know how else I can help.


  • Borboh Mason

    Hi Alec . I am an IMG, graduating from med school about 4 years ago. I scored 164 in the practice NBME17 4months ago and just took NBME 13 ,scoring only 183. I feel very much discouraged. I have gone through the Uworld qbank once and First Aid twice and also used pathoma videos… Haven’t worked with flashcards or anything like that..My exam is in 12 days and i don’t know what to do. What would u kindly advise ?

    • Yousmle

      Hi Borboh,

      Thanks for your message. Unfortunately, you’re probably not in a place where you could comfortably take the exam. I’d suggest focusing on pathogenesis to presentation understanding, since that is usually one of the biggest reasons students don’t reach the passing threshold. You can learn more about it here:

      Best of luck!

  • carbdoc17

    I bought your cards and I am retaining more. I failed my
    test with 185. I want to take it in September. I am doing 40 new cards
    per day and review the others…how can I maximize reviewing the cards
    so I can finish before I take it again. How apart should I take NBME to see an improvement before I take the step.

    • Yousmle

      Hi Maria,

      Sorry to hear about not passing, and thank you for your question. There are ~1400 cards in the Step 1 deck, so if you do 40 new cards/day and review all your old cards, you should be able to finish by mid-September at least. As far as NBMEs, I’d recommend taking one every 2-3 weeks to check on your progress, to make sure your scores are improving.


  • Danisbel Viamontes

    Hi Alec, I’ve just read your page since I was looking for an answer for what happened today. You see, I took nbme 13 and scored 330 which is the equivalent for 192 :( I completed UW with 56 %, did my first nbme on july . At that time I did nbme 16 and 17 because I was hoping to do the real exam on september. I scored 194 on nbme 16 and 202 on 17. Someone I know advised me to pospone the exam and study harder. I did it or at least I thought I was doing it and now after going through UW Q bank for the second time and scoring 91 % average in all queston and 57% in my incorrects only I did the nbme 13 and got a much lower score like I said. I’ve been studying about 10 hours a day and I don’t know what to do.. I am kind of sad now because it seems like all my effort is for nothing. Do you have any advise for me? I’ve been studying for a year now.. :(
    Thank you in advance

    • Yousmle

      I’m so sorry to hear about your difficulties with studying. I worked with several students who is then in a similar situation. They studied for basically an entire year, without any improvement in their scores.

      The biggest thing I would suggest is to focus more on trying to understand disease processes rather than having a set number of pages in a particular book that you want to read. For example, most students typically focus on learning everything in a particular book, then moving on to another. Instead, I would focus on learning the disease process, and using whatever resources you have available to do that. That way you can structure your day in a more predictable manner, focusing on learning a particular number of diseases or topics during the day, rather than trying to read some predetermined number of pages.

      Keep your chin up. Just focus on one problem/disease at a time, don’t think about the number of pages of a book you’re supposedly supposed to read, or all of the crazy/misguided advice you will read online.

      • Danisbel Viamontes

        Thank you very much for your message. I will try to keep my chin up like you said. I did another nbme today and score 211. Not much but surely much better than yesterday. I will try to follow your method the next 4 weeks. Wish I could have you as a tutor but it is what it is.
        Where can I buy your anki decks? Thanks

        • Yousmle

          Thank you so much for your response, and congrats on the improvement. You can purchase the cards at . Best of luck!!

  • red

    hey yousmle, how much should an IMG aiming for to be atleast considered for IM residency? thanks

    • Yousmle

      The average non-US IMG score for matched IM applicants was 231 in 2014. The average for unmatched was 217.

  • Omid ziaee

    Hi I have a request and I would be very glad if you help me. My wife is preparing for the step 1 which is in 10 days. She finished the first round of UWORLD with 73%. Yesterday, she took NBME 16 and got 228 which is not good in her mind. She has a goal to take 250+. She studied a lot and she has a strong background. What do you suggest? Does she need to postpone the exam?

    • Yousmle

      Great question. Obviously, if a test is that soon, it’s highly unlikely that she could improve her score that much in that period of time. The most important question is what is more important, the chance at a particular score, or taking the test at a particular time? If the score is most important, then certainly delaying the test would make sense.

  • Karim Elkholy

    Hi ALEC,
    I Scored a 215 on NBME 15 2 weeks ago, 220 On NBME 13 today, my exam in 2 months, my target is to get 240+ what is the best strategy?

  • Mss.Sunday

    Good Afternoon

    My exam is in 3 weeks, ive been studying 12 hours a day from FA and Uwold which i just finished with a 60% yesterday i scored a 184 in nbme 15 im really scared and cant push my exam.

    What can i do?
    Thank you so much,

    • Yousmle

      Thank you so much for your message. I completely understand how secure you must feel, since you have a very small window of opportunity, and not a lot of room for error. Here is an article I wrote about this sort of situation:

      Is there a reason that you can’t push the exam back? Depending on what score you’re hoping for, that may be your best option, depending on the circumstances.


  • BobMitchell

    Hey Yousmle!
    First off I want to say thank you for all the posts and study tips. You have no idea how helpful and powerful these tips are, so I wanted to first thank you for that.

    So I have exactly 4 weeks before my exam, but my exam scores were seriously all over the place.
    NBME 11 -baseline Feb 14-220 (2 weeks into studying)
    School CBSE March 1- 257
    March 14 NBME 12 -232
    March 28 NBME 15- 260

    So my questions are:
    1.Where am I/What do my scores mean?
    -I guess with taking out my CBSE it shows an upward trend which is good. But is a 28 point jump in 2 weeks believable?
    2.What should I be striving for for my last month of studying?

    Thank you again for all your help!

    • Yousmle

      Wow, you’re right, very variable. I assume you’ve since taken other NBMEs, so have a better idea if the NBME 12 was an aberration. It’s not uncommon to see one NBME significantly below the others. Just like everything, there are no guarantees, but I’d tend to believe the majority of your NBMEs, whatever that might be.

  • Sooraj K

    Hey yousmle
    I’m an IMG from India. Graduated in march this year.I’ve been preparing mostly from First aid and am halfway through my qbank and pathoma. I wrote my first NBME exam on July 2nd and got a score of 220. I got a score of 217 in my uworld self assessment a week before that. I’ve already blocked my exam date for august 23rd. Ideally I would like to get a target of 250+ at the very least. Being a graduate my baseline knowledge is pretty solid or I’d like to think so anyway. And I’ve settled quite comfortably into a 14 hours/ day study cycle. I’d like your advice on how best to integrate the cards into my study plan and cut out the superfluous study material.
    Thanks ,

    • Yousmle

      Great question – I’ve explained the best way to integrate the cards into your studying in the follow-up e-mails you will receive after purchasing the cards. Best of luck, and good job on starting at such a high level!

  • joor

    hey I have read many of your blogs and I have a question I would like to ask you! I have two weeks left for my test (already postpone it, and can’t do so more since my rotations start soon) and I need to bump my score as much as possible. Idk if doing Anki cards this last two weeks is something you recommend? or something else. Right now I took NBME 16 and got 207 and next monday I will be taking another and the monday after that another. I just found out about your BLOG TODAY since I am really stressed the NBME scores are really predictive of the real thing and I have already postpone my exam as far back as I am allowed to by my school. what do you think I should do to make sure I won’t failed the real thing or get lower than 207 right now. I expect to increase in my next two NBME but I don’t know what to do to make it kind of quick (I know it takes 3-4 weeks) but maybe I can try something out of the ordinary. I am planning these two weeks to do 3 blocks of Uworld (I already finished it once) alternating in certain days with Kaplan.

    • Yousmle
      • joor

        Hey Alec,
        thank you for your immediate response. The link you gave me was the first post I read. and here is my thinking:

        Advice # 1: I would be comfortable with increasing my score in the NBME and on the REAL STEP at least 20 points = 227 (initially i wanted a higher score even before I started studying but being realistic I need more time and I already got all the time I could get and apparently wasn’t enough).

        Advice number 2) I would like to take 2 back to back exams to practice my endurance and also practice doing simulations with 2 blocks first, then break, 2 blocks, break, 1 block, break, 1 block, break, 1 block and done BUT the thing is that following my review source I made the mistake of trusting them and I already took UWSA 1 and 2. SO WHAT CAN I DO INSTEAD

        Advice # 3) I will be working to see if they can squeeze me in the only prometric test location in my area to take the practice exam.

        Advice # 4) That is what I had in mind given the limited days I have and I learn most from Q banks and cross referencing it to first Aid than only reading FA or any other material (videos)

        • Yousmle

          Great – best of luck!

          • joor

            Thanks- if i cant take two exams back to back what can i do? 8 blocks of questions for endurance?

          • Yousmle

            I usually recommend doing one UWSA/4 blocks of UW, followed by NBME.

  • wella li

    could you please help me .. i hate anatomy even though i got an A in my school exam but for the step 1 i dont know where & how to study it and what is important (high-yield and what is not ) please guid me

    • Yousmle

      Honestly one of the best ways is to use QBanks to identify gaps, then learn those particular topics that come up. There isn’t a one-stop resource that I’ve found that does a good job of highlighting all the high yield information.



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