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Tutoring FAQ

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Tutoring for the USMLE, COMLEX, or Shelf exams is a major investment in one’s education and future.  Here are some of the most common questions I receive about tutoring:

What exactly does the tutoring entail?

The general goal of tutoring is to help you to use your time as efficiently as possible – to help you craft a personalized plan to most effectively strengthen your weaknesses, to teach you the things that would take you exceedingly long to teach yourself, and to help you to learn how to approach questions to maximize your knowledge.

Why it is better than simply studying on my own?

In my experience, most students struggle with identifying their true weaknesses, and are even worse at addressing them. Thus, they focus their time and energy on tasks that are incredibly low-yield, like repeating USMLE World for the 3rd time, rather than focusing on their true weaknesses (e.g. the application of knowledge, their approach to questions, etc.)

Even in the rare instance when I find a student who has correctly identified the things holding them back and is actively working on it, that all still takes TIME. When you work with me, there are only two kinds of subjects: subjects you can teach yourself without help, and subjects that will take you a disproportionate amount of time to learn. My job, in addition to tailoring a plan to your individual needs and situation, is to teach you the subjects you struggle with the most, so that you can get back to doing the things that you’re good at.

What else could I possibly learn from tutoring that I haven't learned from the website?

You are too kind! While it is true that I created this website so I could share my years of experience to those who were preparing for the biggest exam(s) of their life, there are still things that I cannot convey well to a mass audience. An example would be how to approach clinical vignettes in questions. An article on how to read through questions, analyze the meaning of each sentence, and how to figure out what the question is actually asking would be limited, given that it would be filled with generalities, and without the ability to give specific feedback to where each student is.

How long are sessions?

Sessions are 2 hours long, which students have found to be the ideal length.

How many sessions do students typically need?

Again, it’s hard, since every student has individualized needs and abilities. I’ve worked with students as little as once every couple weeks, although this is more common for students who contact me during their 1st year of medical school, to get an extra boost in their studies to lay the groundwork for when they begin in earnest. I’ve also had students who have found the sessions so useful that they request sessions nearly every day. While every student is different, I would say “typically” I meet with students once every 1-2 weeks in the beginning, and space it out after that.

After I'm done with my test, then what? Will you forget about me? Will you return my calls??

Haha, that last one was a bit of a joke. But in all seriousness, I regularly get e-mails/calls from former students, asking for advice, extra tutoring, or just to let me know how they’re doing. And I know how valuable it is to get direct insight from those ahead of you. My high school had 3 counselors TOTAL, for all 1600+ students; getting advice, or even just a letter of recommendation for college, was a nightmare. I’ve also trained at some of the “elite” institutions of the world (Stanford, MGH, etc.), and realize just how valuable a mentor who cares for you can be. Mentoring students is one of my favorite parts of my work, and I will want to help you achieve success beyond your USMLE/COMLEX/Shelf exam!

Can tutoring help me beyond just my exam?

In one word, “yes!” I’ve seen students’ NBME scores jump by more than 10-20 points simply because they suddenly began to realize how to read questions. Every school I’ve ever seen (including Stanford and Harvard) focus on knowledge over application during preclinical years, and all students (including myself) struggle with applying that knowledge to clinical scenarios.

What has been most gratifying, though, is to hear from students after they’ve begun clerkships, many of whom really rock! Most students that memorize for their exam never learn how to properly analyze/interpret data, which hampers them for both Step 1, as well as clerkships. I knew a student who had scored >255 on Step 1, but who really struggled with presentations and getting asked questions on rounds, simply because they had put all of their efforts into answering multiple choice questions. Your ability to impress your attendings/residents on rounds (and thus your clinical grade) is directly related to your ability to analyze and interpret large amounts of data.

How you approach Step 1 can set you up for success or failure when you enter clerkships.

What do you mean by 'your approach can set you up for future success?' Can you give an example?

Literally 10 minutes after I wrote the previous section, I received this e-mail from a former student who is on her first clerkship of 3rd year, which also happens to be internal medicine (things like this make me so proud!).:

I wanna start working with you again ! Maybe 1x per week . Need help with pharmacology and dosing and just slowly starting to prep for step 2 .

Would it be possible to have a set date ? Like Saturday mornings or something like that ?

Pps literally killing rotations basically been offered jobs haha ! You trained me well 🙂

Let me know .

While I can’t guarantee job offers, I will say typically students feel very well-prepared for clerkships, as my teaching style is very similar to the style of teaching most commonly seen on wards, both for clerkships and residency.

Where does the tutoring take place? Do I have to travel to you?

99% of the time, I work with students via Skype, which the vast majority of students prefer – it allows us to share screens, for me to draw on the screen for demonstration purposes, and for us to conveniently work together while minimizing travel time. If you live in the Boston area, and would like to meet in person, I am also happy to accommodate requests to meet in person when possible.

Can I get a discounted rate?

There is a discounted rate for the first session, to give you an idea of what tutoring will be like, as well as for us to both assess for “fit.” After that, there are various discounts for pre-paying for hours.

What is a reasonable expectation of score increase over the time we work?

I’m very open about my students’ successes, which you can read about here.  I will say that typically, students who develop the habits for success on these exams earlier tend to do better; I’ve seen students with score increases of 70+, although the average is closer to 35-40.  As in all things, however, your miles may vary.

Question not answered on this page?

Feel free to e-mail me at with any other questions!


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  1. Moiuz says:

    Hello Alec,

    I have been in touch with you via email but I wanted to post here so everyone can be benefited from this.

    I saw that you offer Step 2 Anki deck. Can that be use for preparing for Step 3? I am scheduled to take my Step 3 in next month or so and feel like some sort of Anki cards can be helpful? Also, I know you might be inclined to say, “oh yea, Step 2 deck is great for step 3 because it’s your product” so any honest feedback would be greatly appreciated.


  2. jovana says:

    I am wondering if your Anki deck for step 2 ck involves “what to do next” for example if you chose a CT over MRI or when to do thoracentesis or thoracostomy etc.?

    Thank you.

  3. Andrea Kriss says:

    Hi Alec, I am an IMG hoping to get into the US for medical residency. Assuming one wants to apply for residency in September 2020 against Match in 2021. Can you create a hypothetical timeline to get usmle scores, lors and usce ready before the applications begin?

    What do you think about paid subscriptions like ambross, lecturio or boards n beyond?
    Will you recommend any one of them?

    Thank you.

  4. MLG says:

    Hey Alec,

    So I’m noticing that I’m able to get through all my Anki cards that are due each day…but my number of new cards has severely decreased. I haven’t been able to keep up the pacing of making them as I have going through…if that makes sense. Do you have advice? I’m averaging 10 new cards a day…but my review is anywhere from 150-175 a day. I am using the suggested questions from each lecture and then going back through notes I took during and making them…I feel like I’m doing it wrong. I’m also trying to add any UWorld cards, but those take me a long time to get through…I’m trying to make them more like the ones you’ve given.

    Also, I tend to get flustered speaking in front of everyone…I know by this point I should be so much better…but it’s something I’ve defiantly struggled with. Even when I know an answer, it doesn’t come out right. Do you have any advice on how to improve that?

    Thanks in advance!

    1. MLG says:

      Hey Alec, I have another one for you!

      I have a question about embryonic origins. I know there are some that are super important, is there a good way to approach this?

      I got a question about the embryonic origin of the spleen today, and of course UWorld listed everything that is derived from the ectoderm, mesoderm and endoderm. I know this may not be a high yield topic, but I figure it’s more of a “gimme” question. Any advice?

      Thanks, MLG

  5. Jasmin says:

    Hey Alec,

    Do you provide the questions we practice with in individual tutoring? Is there a practice nbme to track the progress of the sessions? Is there a preliminary nbme to determine direction for each session?

    As an individual tutor will I have access to your pre recorded lectures and the Facebook group like the group sessions? Are the weekly question interpretation sessions (4-12 hours total/month) so you can learn how to questions faster, with higher scores
    Recordings of ALL 40+ previous sessions, so you can watch what you want, when you want (more content added every month)
    I look forward to your response!

  6. Myrty Olivera says:

    Hi Alec! I was wondering if there is a way to change some of the cards to cloze in order to quiz myself better. Can you post how we can change those settings on your Anki deck? Thanks so much!

  7. MR says:

    I am currently studying for the Step 1 Exam which I hope to take before the end of May. However, I feel like I am having difficulty retaining everything. I have tried to use the free Anki decks I find online that people have made but I find that there are just too many cards to get through. I also don’t know how many cards I should be doing a day to make sure I get through everything. I guess I just need advice on how to use anki for the next four weeks and if your cards will be any better than what I have been using. Also, I think I understand the Pathophysiology behind most of the concepts presented, however, when it comes down to answering questions I just get bogged down with all the details and just end up missing the point. Overall, I just don’t think I am a good standardized test taker. I have noticed these shortcomings previously with MCAT and SAT exams I took earlier in my academic career. Do you have any advice on how to improve test taking skills for standardized exams?

  8. Badra says:

    Hi Alec,

    Yesterday when I did my Anki cards it said I didn’t have any new cards to do and only gave me 82 old cards to review. Today it only gave me 57 review cards and 30 new cards. I have my anki settings set based on the link you sent me. But I feel like I should be getting more cards per day? Is this normal or am I missing something?Also for some reason the immune system session #2 is not accessible on the website. It is listed and has the integration/application questions but the video isn’t there?

    1. Yousmle says:

      Hi Badra,

      Thanks for your message. I updated the Immune System link, and it should be working now. As for the cards, it’s strange that it would give you new cards one day and not the day before. Make sure you don’t have a “custom study session” open, which can take cards away from your normal reviews – if you do have custom study, you can just delete it and the cards will go back to the original decks. Otherwise, if you can give me a screenshot so I can see what you mean, I can help you better.


  9. Laraib Kiran says:

    Hey alec hope you are well .Can you guide me how to study mbbs effectively because I am a Pakistani student and want to know when will be the best to clear my usmle either after the mbbs with proper study or during the studies with different parts.The reason is this I am poor person but its my desires to go for study my specialization after mbbs from America .I will be very grateful to you if you guide me about this process of how to prepare .I am a second year mbbs student from KARACHI MEDICAL AND DENTAL COLLEGE and not want to appear for usmle part 1 within next year because of my financial situation and lack of preparation.Thank you

  10. Stefanie says:

    I was wondering if I could ask you a few questions regarding step studying? My exam is June 8th and I just wanted to quickly get your advice on studying outside of using your decks. I am currently doing 40 Kaplan questions per day and then making Anki cards based on the material in each question. I am attempting to incorporate material from FA, Sketchy, and Pathoma into my deck (not necessarily all on the same card). This is taking some time, and I am having to do it for all subjects as I did not start this process earlier in the year (for ex., we had our cardio block last semester and I did not study outside of material presented in lecture), but I feel that it’s helpful. I just wanted to get your opinion on this process as far as making my own cards, using yours, and doing questions. Additionally, I didn’t see anything on your site about Sketchy. Do you feel this is a good resource?

  11. Ali Assi says:

    Hi Alec,

    Just sent you an e-mail about tutoring services. Looking forward to your response!

  12. PrAsoON SaXeNa says:

    Sir can step 1 be given second time if not satisfied with the present scores.
    And sir are Kaplan notes good way for preparation along with the standard books that we prefer.

    1. Yousmle says:

      You cannot retake Step 1, unless you fail it. I’ve never used the Kaplan notes, so can’t really give you much insight there.

  13. Yoyo says:

    Hi Alec,.

    I’ve been using your decks for about 1.5wks on Neuro/Psych+its drugs and though it’s been very dense, it’s helping me to retain some difficult stuff that I wouldn’t have been able to without it.
    I do need some word of advice from you though Alec.

    I have about 50 days before Step1 my baseline score is below “passing” respectively.
    While your deck has been helpful, it does take quite long to work on the decks. Perhaps it’s b/c I’m working on some of the most dense decks, but I feel like I’m missing out on not filling in with other info from FA (which I know you’re not a big fan of it).
    Also, I feel like my pace with the deck is too slow esp with the new cards to fill each day’s quota on top of everything else.
    Considering the time I have left and the status of baseline, do you think I should just keep doing your cards plus cards I make from doing questions or do spend some time reviewing from FA?
    UWorld also is such a time consuming sucker…

    Could you please let me know of your thoughts? Thank you so so much and I appreciate your time.

    1. Yousmle says:

      Honestly, I’m not a huge fan of just reviewing straight from First Aid. It’s hard to know exactly what you should do given that I don’t know your baseline, nor have they seen which you are struggling with their what is preventing you from improving your score. Usually, though, it is a combination of understanding the information, and knowing how to apply it in vignettes. You should definitely spend as much time as possible on learning how to do question interpretation properly, and use the Yousmle cards to help you to understand and apply the information better.

  14. Ekata Tracy Omoegbele says:

    Hello Alec! I wanted to know how I can set my step 1 deck to reviewing all the card like if I just want to do all the cardio cards all at once instead of having to wait. How can I do that?

  15. Kiaara Sinha says:

    I am extremely overwhelmed to see the motivating and fruitful messages from you every week. I would be thankful to you if you could help me with my problem. I have heard people complete 2 blocks in a day. But, unfortunately I am not even able to do 1 block also. It is really distressing when I look at my slow speed. I am not even able to focus properly. I have done offline uworld (subject wise) once when I used to complete one subject from Kaplan LN. And, now I am doing online Uworld questions. Please help me and guide me how to increase my speed.

  16. inam says:

    Hi Alec,
    Does your step 1 deck include the microbio cards or do
    i have to download the free microbio cards on top of the step 1 deck

  17. belen says:

    Dear Alec, I write this email hoping you can help me. I am a Spanish pulmonologist. I finished my degree 10 years ago and now after 5 years working as pulmonologist I have decided to rescue an old dream and will try to go to USA to work. So I have left my current work to study the steps. I would like to pass the step 1 on first week of May. After I read tons of things in internet I don’t know exactly how to do it and how is the best way to start. I have some things clear, as I have purchased today your ankis deck (step 1 and step 2) and probably I will ask you to become my tutor. The second thing I have clear is I wouldn’t like to waste any minute or dollar since now.

    The second thing I have clear is I cannot wasted any single minute or dollar since now.
    I was thinking to make a kaplan course but the on-demand course is the only course I could make from here and I don’t know if it makes differences with using just the qbank.

    So I thought to do the next: to buy the kaplan books in internet and start studying Kaplan books combined with your anki cards while I learn to make my own anki cards (if necessary). I have first aid + costanzo + goljan as complementary material to kaplan books. Do you think is it right??or should I do something different?? the best thing is I could change program, because I have only two books (Gojlan and Fisrt aid), so I could change the things if you think I could make something better. I wanted to make a first lecture of all kaplan books and then start with the questions banks….talking about qbank, what do you think is better??kaplan qbank or Uworld?? Please I love the way you teach the things and Write your blogs and emails. Can you help me to select the right way to reach my aim??

    Thank you so much in advance for your time and your help.

    Have a nice day,


    1. Yousmle says:

      Thank you for your message. I’ve written about the subject here:

      As far as the Kaplan course, I’ve never used it specifically, but as you probably know, I’m not a huge fan of passive forms of learning, particularly sitting there while someone delivers a ton of information at you.

      Coincidentally, I may have another tutoring spot that just opened up, so if you are still interested, send me an email, since it is first come first serve.

      Hope all is well!


  18. Rhoda Franco-Noriega says:

    Hi Alec! I sent you a PM last night about your recommendation for anyone like me who had been out of med school for about 10 years now and still plan to take USMLE. My classmate had just started his residency this year in the US after working for years like me and his recommendation was to study just First Aid for step 1. However when I started trying to study it, I already feel overwhelmed. I think I have forgotten most of the nitty gritty details of basic sciences and I feel so inadequate. One of the suggestion was to go through the practice questions first to know your weak areas but I’d rather not. I think what I need is to go through the basic sciences again, like a major brush up before I venture to answering questions. Is it possible to do that? How much would it cost to do tutorials with you? I do not have a specific timeline yet but hopefully I can start residency within the next 2 years. Thank you!

    1. Yousmle says:

      Great question – I just sent you an e-mail.

    2. belen says:

      that is a good way to say it….overwhelmed!!that is how I felt first time I tried to read (and I am not saying studyng) First Aid book. I think is a great book but not to start with step 1 and not to study using that book, maybe I am wrong!

  19. Rahul Prasad says:

    I am in the final stretch (2nd year US Med student) before taking Step 1
    in early June and I was wondering if you have any advice for how to
    develop a focused schedule for studying?

    I find myself torn between how to balance using resources (Pathoma, First Aid), reviewing (Anki) and
    doing question banks in a progressive and organized manner i.e. do you have any suggestions on how to organize time to create Anki cards, review them, and doing relevant questions on a day to day basis?

    1. Alec Palmerton, MD says:

      Fantastic question. 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.

      Hope this helps!


    2. Yousmle says:

      I didn’t realize I never responded to this. But since we spoke subsequently, I hope I answered your questions!

      1. Rahul Prasad says:

        No worries! I have a few questions regarding the HHMI fellowship you participated in – would you be willing to communicate via email?

        1. Yousmle says:

          Absolutely – let me know.

          1. Rahul Prasad says:

            Send me an email via your preferred address?


          2. Yousmle says:

            Actually, I’m sure there are others that would be interested in our exchange – would you be willing to share your question here so others may benefit?

          3. Rahul Prasad says:

            Sure thing!

            My questions were regarding the proposal and essays – what approach/format did you take in writing them?

            For the proposal, did you follow the NIH proposal formats?

            For the essay, where you more creative in describing your inspiration for pursuing the fellowship or more cut and dry, outlining your career goals and past research experience?

          4. Yousmle says:

            Great questions. For the proposal, I don’t recall exactly, but my guess is I followed the proposal formats. I seem to recall that they are big sticklers for following their particular formats/rules, so I would recommend that. As for the essay, it was probably somewhere in the middle – I wasn’t particularly creative, but went into some detail regarding my passion for science/applied learning, etc.

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