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Step 1 Anki Deck

To score 270 on Step 1, I learned not only to integrate and apply my knowledge...but to never forget it!

Save Time AND Boost Your Step 1 Score!

Limited Time! Step 1 Anki Deck

1600+ of the USMLE Step 1 Anki cards I used to boost my score from 236 to 270

At the beginning of my study period, I went through a video review course for about 5 weeks, along ​with intermittent UWorld random timed sets that I’d annotate inefficiently into First Aid. After this, I took an NBME and got a 228. I knew at that point that I wasn’t reaching my goals and was clueless as to how to boost my score quickly, so I searched online looking for advice when I came across the site. Within 9 days, my next NBME score was a 249. I continued this process for another 5 weeks until all of Uworld was turned into pathophys-to-presentation cards.

- Johns Hopkins University Medical Student, Final Score 265

Download a free sample here

Top students are already mastering pathogenesis to presentation - what are you waiting for, get started now!

All high-scorers understand pathophysiologic mechanisms and how to apply them to clinical vignettes. If you've been trying to re-memorize First Aid for the nth time, been cramming for your classes praying for luck on test day, or thinking that "just one more time" through UWorld® will finally increase your NBME scores, stop wasting your time and start the hard work towards building the foundation towards your Step 1 dreams.

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Why the Step 1 Deck?

The keys to doing well on Step 1 are:

1) Mastering the pathophysiologic mechanisms of disease and learning how to apply it to clinical vignettes, and

2) Recalling as much of that information as possible on the day of your test.

The Anki cards were made with those goals in mind. I started with some of the most difficult and conceptual NBME and QBank questions that students consistently struggled with, and made pathogenesis to presentation cards specifically tailored to students' most common weaknesses. Then I supplemented it with key high-yield facts. With every student I work with, I update and add to these cards to create a growing list of the most pathogenesis to presentation cards you will find.

Use the leading spaced repetition program, Anki, to study on the bus, waiting in line, or at your computer.

I spent thousands of hours making Anki cards during medical school.  Save time and boost your score by using pre-made cards!

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Constant Improvements

The deck is constantly updated. Be sure to purchase here to receive the most up-to-date version!

It entirely depends on your timeline.  If you have > 2 months before your exam, I would recommend doing the entire deck prior to doing a question bank.  If you have only a couple weeks, I'd recommend doing QBank questions first, then searching the deck for cards pertaining to the topics you missed, saving you the time of searching for explanations/integrations.

What is the best way to use this deck?

How many cards are in the deck?

At the time of this writing, there were 1400+ cards in the deck.  I still tutor a great deal, and with every student, I help them craft expert, customized Anki cards to help them to integrate and apply their knowledge.  I use the best of these cards to constantly update the Anki deck, and will release updates in the future.

Just the (free) program Anki®.  To access the deck, download the Anki program here, and "Import" the Step 1 deck from within the Anki program.

Do I need anything special to use the deck?

Why Anki?

I've written extensively about the topic of Anki here, here, and here.  I wouldn't be where I am today without Anki, which is by far the best spaced repetition program available.

Will these cards save me time?

Absolutely!  I have spent thousands upon thousands of hours honing my Anki card-making skills, to create the kinds of integrated and applied cards that helped me score 270 on Step 1.  Add to your own Anki deck, or use these as the foundation for your own.  Of course, you can make all of your own pathogenesis-to-presentation Anki cards, or you can use some of mine!

When should I get the deck?

As early as possible. The benefits of spaced repetition are many, and the benefits are greatest the longer you've been practicing. All of the cards have been "tagged" by subject, meaning that even if you're in your 1st year, you can supplement your class learning by studying all of the "cardio," "renal," or other subjects, while saving the other subjects for later. Or if you're closer to your exam, you can study all of the cards, boosting your knowledge with cards and explanations you won't find anywhere else!

Do the cards cover all subjects?

Yes! There are over 1200+ cards (and counting), and have been conveniently tagged by subject, meaning that if you're reviewing cardiology, you can review only the "cardio" cards without having to study the others. That said, this deck was not created to be "all-inclusive" - in my experience decks/services attempting this overwhelm medical students by giving them 20,000+ fact stop cram into their heads. Instead, I've chosen only the highest-yield facts and explanations I've used with students, which I continue to update as I tutor more and more people.

Who is this deck intended for?

The cards have been created to accommodate medical students at all stages of training, from those in their 1st year, to someone a week before their exam. With "tags" for each card dividing them into subjects like cardiology, renal, respiratory, biochemistry, etc., you can study individual subjects along with your classes. Because there is a focus on high-yield concepts and facts, even someone with a week or two could get through all of the cards before their exam.

Can I study the cards by organ system?

Yes! Many students prefer to study by organ system, either during their classes, or during their dedicated Step 1 study period. The cards are conveniently tagged by organ system so you can beef up your knowledge in cardiology, renal, stats, biochemistry, or any other subject!

Unfortunately, given the nature of digital sales, all sales are final. To preview the deck, you can download sample cards here.

If I use your deck, should I stop using my own Anki cards? Will this prevent me from making my own cards?

Absolutely not! The entire goal of the high-yield decks was to focus on the concepts, explanations, and facts you are least likely to know...and that are most likely to be on your exam. Anki makes it easy to add your own cards to the deck itself and/or study another deck simultaneously. Everyone will have their own individual needs and weaknesses, so you are encouraged to make your own Anki cards as a tailored supplement.

Why should I get the pharmacology deck along with the Step 1 deck?

While it is true that the Step 1 deck has high yield pharmacology concepts in it, its focus is not trying to provide information on all of the drugs you might find on your USMLE exams.  The Pharmacology Deck is focused entirely on teaching you all of the most important Step 1 drugs, including the mechanism, use, and most important adverse effects, in the most efficient way possible.

What are "pathogenesis to presentation" cards?

Ask yourself, "who do I know that scored well on Step 1, and what was then common thread between all of them?" Of course they were hard-working and diligent, but there are thousands of students who study hard, but never see their scores increase. Instead, the "secret ingredient" common to all students who score high on Step 1 is their ability to understand pathophysiology mechanisms, and to apply them to clinical vignettes. The best students are masters of pathogenesis to presentation - so what are you waiting for?

OK, so I believe "pathogenesis to presentation" and spaced repetition are essential to Step 1 success - what about basic, high-yield facts I need to know?

We have you covered there, as well. While it's true that pathogenesis to presentation should form the basis of your approach to Step 1, it is also true that there are a number of high yield facts you need to know. This deck is constantly updated with the key facts you won't find in First Aid.

How did you make these cards?  Did you just turn First Aid into flashcards?

Most resources involving spaced repetition and Step 1 are based around the idea that if you cram more ideas into your head, you will do better on Step 1. In my experience, this is wrong! Instead of turning First Aid into 30,000 basic flashcards that will overwhelm and frustrate students and prevent them from applying their knowledge to QBank questions, I took a different approach. I started with the the most difficult and conceptual NBME and QBank questions that students consistently struggled with, and made pathogenesis to presentation cards specifically tailored to students' most common weaknesses. With every student I work with, I update and add to these cards to create a growing list of the most pathogenesis to presentation cards you will find.

I want to start using Anki, but don't know where to begin.

That's exactly how I felt when I began my journey with Anki. I knew deep down that spaced repetition could either bury me in a mound of mindless memorization or lead me to unfathomable recall and applications. I didn't have the benefit of a well-made, pre-made set of pathogenesis to presentation and basic cards, and had no idea of how many facts I would comfortably put on an Anki card. Over time, I learned through trial-and-error what made for a "good" card, and which ones were wasting my time. You can read more about those tips here. In my work as a USMLE tutor, where even students with less than 2 months before their exam have successfully integrated Anki into their studies, you can dramatically improve your learning curve and supercharge your ability to make connections with the well-made templates found in the Anki decks.

Can I get a refund?

You are one the first people I want to tell my score to. I just saw it 30 minutes ago and I got 266. I just wanna say thanks for the help and support.

- IMG, Final Score 266

I have to give Alec major credit for helping me beat my goal of a 260 on Step 1. First off, the Step 1 Deck was a phenomenal resource. I completed UWorld once, and then I used the deck while going through UWorld a second time, and it really helped. Not only did the concepts stick, but the way the cards are designed, they helped me improve pattern recognition and strengthen connections between related (and unrelated) topics! It was a great investment and I will out certainly be using the Step 2 Deck when the time comes!

I felt uncomfortable taking the time to learn to properly use Anki given the limited time I had before my exam, but the advice he provided on this website and in his emails were absolutely incredible and golden. This way of thinking helped me ace getting at the core of what each question was asking, which made the exam so much more manageable! I will definitely be incorporating Anki-based learning during the clinical phase of my education and beyond! Thank you so much for this incredible and well-crafted resource!

- Neil, Final Score 261

There is a huge advantage to having Alec's personalized deck. The explanations go beyond just the concept explained in UWorld and give you a holistic understanding of the patho-physiology associated. Even though the cards are made from concepts in UWorld, Alec presents them in a manner where you have to apply knowledge instead of strictly memorizing the cards and regurgitating information. Using these cards as an example is also a fantastic way to learn how to make your own Anki cards, which you can add to the deck and further improve your performance and retention.

Just wrote an NBME today and got a 243, 6 weeks out!

- MS2, who improved his score 30 points in just 1 month (with 6 weeks to go)

Not only is Alec extremely knowledgable, but he also has tremendous insight as to the study strategies and skills necessary to succeed on USMLE Step 1. With the demands of medical school, Alec understands the importance of studying efficiently and effectively and has truly transformed my approach to my coursework in the second year.

- MS2, who raised her score 72 points (175 to 247) in less than 2 months

I wish I could have gone to the Alec School of Medicine. As my husband says, "Alec is the best. He's really your guy." He's the best teacher I have ever had. I ended up raising my step 1 score by 29 points after failing it the first time and plan to work with him on some of my third year shelf exams.

- University of Washington student, who raised her score 29 points after failing Step 1 once

I first encountered your website three weeks ago, and now am both a strong ANKI proponent, as well as gratified to find that I am not the only advocate for using one's brain to solve mental puzzles, highly controversial though it may sound. ;)

- Asher, IMG

Just wanted to drop you a line and let you know I surpassed both of my step goals. My scores are listed out below. Thank you so much for all of your help! It really did make a difference.

- VCU MS2, who raised his score 53 points (from 190 to 243) in less than 2 months 

I like how the cards are organized into systems. I've been using them for a month now and when I am learning a particular system, I use the cards and they actually help me with how I go about learning the material. Instead of blunt memorization, I find myself thinking more about the why and how things are as they are. When I am answering QBank questions, I found that I am able to recall information much more efficiently since I understand rather than just know.

The spaced repetition, I believe, is superior to Firecracker. Firecracker just hasn't worked for me. I love the deck so far!


I'm a European trained doctor. I recently graduated and for family reasons I realized it would make sense to move to the USA. Naturally this meant taking the USMLE. As I started studying I realized how much of the basic sciences I'd forgotten or maybe never even learned correctly. I'm very lucky that I found, it's changed my thinking about studying and medicine. I really wish this resource had existed while I was in school. By focusing on mechanisms rather than facts, you create deep understanding of the material. This seems very obvious but somehow it eluded me while I was studying. 

I've been making my own Anki deck and this has greatly benefited me. I've also been using Alec's decks, they've been a great help to me. Alec has produced a very targeted efficient set of questions that reinforce the material you need to master. By using this mechanism based approach I've great results. I'm very confident that I'll score and match well. 

You've improved my score, and also just refreshed my love of learning. I feel more connected to medicine than I have in years.

- Dr. J, European IMG

I saw your website about one month before my exam when I was upset by studying a lot without significant improvement. My final score is 252, which is quite close to my aim score. Yousmle is an awesome website for preparing Step 1, especially when you have reached a plateau. The method is to switch from passive studying- low-efficient and painful memorizing to active studying- integrating, understanding and applying knowledge into clinical situations (AKA most Step 1 questions). When you know what you are studying for, you study well. Also it teaches you how to make the best use of the powerful tool Anki (I like the idea of reverse cards a lot). I would strongly recommend this!

- University of Nebraksa Medical Center Student, Final Score 252