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USMLE World: Is Your Strategy Wrong? (And How I Scored 270 on Step 1 By Ignoring The Dogma)



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Virtually every medical student who has prepared for Step 1, Step 2 CK, or Step 3 has used USMLE World.  “UWorld” (or just “UW”) is held in near-religious reverence for its questions that match the USMLE Step exams’ two-step reasoning process, with explanations that bring medical students to tears of joy and have cured several forms of cancer.

I jest, but when I was a preclinical medical student at Stanford nervously anticipating my USMLE Step 1, I bought everything I was told.  “Everyone” knew that all you had to do to destroy Step 1 was to read First Aid five times, and do USMLE World at least twice (and review your wrong answers another couple times for good measure).  Then and only then were you ready to brave the rite-of-passage exam.

So why did I ignore this advice?  And what did I do to eventually boost my score to 270?

NBME UWSA Score Graph USMLE Step 1

Here I deconstruct several of the most common beliefs surrounding the USMLE World Question Bank, and see whether they withstand rational scrutiny.  Know that as much as the “common knowledge” surrounding USMLE World is opinion, this is also my opinion, based on my experiences preparing for Step 1/Step 2 CK, as well as having tutored students for the USMLE Step and Shelf exams.

NOTE: I considered sifting through any of the number of anonymous USMLE forums to find examples of this advice, but to be honest, I still get pangs of anxiety whenever I look through those forums, with all of their distress and breathless dogma.  If you are one of the admirable, brave souls who can use those without getting palpitations, and find any such advice, share it in the comments and I will update this article (but I might not visit it myself =).

Claim #1: You must repeat USMLE World at least twice (even if it means not doing another QBank)

This is perhaps the most common advice I heard as a medical student, and one that I ignored.  What is the basis for this common medical student belief?  The main reason given is that, because USMLE World is such a fantastic resource (and it really is), that doing it MORE THAN ONCE will somehow boost your score even further.

This is one of the most common misconceptions I see among students preparing for Step 1: if something has helped you in the past, then somehow doing it infinitely more will increase your score indefinitely.

This sounds reasonable until you consider that it ignores the opportunity cost of spending weeks repeating USMLE World over and over.  In other words, every single time you repeat a USMLE World question, you are losing the opportunity to study a question from a different question bank, one that might help you grow your knowledge in other ways that USMLE World will not.

USMLE World is fantastic, but is by no means infallible.  There are definite strengths and weaknesses to USMLE World, and to ignore other valuable resources is to set yourself up for potential disappointment.  For example, it is excellent at making difficult two-step reasoning questions, although tends to be weaker on more recall-type questions that are also seen on USMLE Step 1.

Verdict: Fiction, although to get the most out of any question bank, make sure to use Anki to make sure you never make the same mistake again.

“So how many times would you recommend repeating USMLE World?”

USMLE World questions are as close to the real thing as possible. As such, I did NOT do USMLE World twice.

I considered, and still consider, USMLE World questions to be as close to the real thing as possible, and as such, I do NOT recommend doing USMLE World twice.  Why is this?

One of the most difficult things about the USMLE Step 1 is that you will see questions that you have never seen before, or even thought about.  My real secret to scoring 270 on Step 1 is this: knowing how to reason through questions that you’ve never seen before and arrive at the right answer differentiates people who are scoring <240 vs. 250-270.

How do you prepare well for questions you’ve never seen before?

By practicing questions that you haven’t seen before.

This might seem obvious, but I think that people mistake the fact that USMLE World is as close to the real thing as possible to making the mistake that every question on their USMLE Step 1 will be exactly like a question they’ve seen on UWorld.  This is not true, although the number of students who claim that their test was nothing like First Aid/USMLE World imply that the students making this mistake are numerous.

Full disclosure: I used Kaplan’s Question Bank first, then did USMLE World second, for a total of 2 question banks used.  I didn’t repeat either, and didn’t even go through my incorrect questions.

Claim #2: You should begin USMLE World at least a year before your exam

This advice falls under the category of “All you need is USMLE World and First Aid.”  In this school of thought, the only things Step 1 will test you on are found in these two resources, and so all you need to do is to drink from their never-ending fount of knowledge as early and as much as possible to arrive at USMLE High Score Paradise.

Doing well on the USMLEs (and Step 1 in particular) involves having as much integrated, applied knowledge of the human body as possible, and knowing how to apply it to clinical scenarios.  While I agree that introducing a QBank into your studies early in your second year or even late in your first year is useful, this definitely does NOT have to be USMLE World (I would even argue that this is a waste of the USMLE World questions).

As I’ve stated numerous times, I scored 270 on Step 1 NOT because I had more knowledge than 99.9% of other medical students, but rather because I got really good at applying pathophysiologic principles to questions I had never seen before.  By constantly practicing my ability to apply knowledge to novel clinical scenarios, I vastly improved my Step 1 score.

The two times I had repeated wrong questions (once by accident, and once by curiosity), I found that since I was using Anki, I could remember not only what the right answer was, but also what the flaw in my reasoning had been when I first saw the question.  And while I may have improved my knowledge slightly by repeating the question, I found that I learned much less in 30 minutes of work than if I had simply done 30 minutes of the Kaplan QBank.

Verdict: Fiction, although if you plan on only completing a single QBank once, then I would recommend using USMLE World

Claim #3: USMLE World is the most similar to the real exam

As much as one can mimic a test that specializes in showing you questions you’ve never seen before, USMLE World does the best job.  Having been a medical school tutor for years, and worked with dozens of students, I can say that the difference in quality between Kaplan and USMLE World isn’t all that vast, although if I were to do only one question bank, I would still choose USMLE World.

Verdict: Fact (see caveats above re: best uses)

Claim #4: The more times you repeat USMLE World, the higher your NBME exams / USMLE score will be

This is an example of good advice that has gotten mangled by our over-anxious medical student minds.  Everyone likes to see a positive trend on their NBME exams, and so when we see our NBME exams going up after doing 20 blocks of USMLE World questions, we think that our scores will go up an equal or greater amount if we do 20 blocks more.  This may be true to an extent, but we tend to forget the diminishing marginal returns.

As we discussed previously, I do not believe that repeating USMLE World questions is good practice for seeing questions we haven’t encountered before, which will happen on your test day.  I’ve often wondered why there are so many students who take the test who come out saying that it was nothing like what they’d prepared for, and wasn’t at all like their USMLE World questions, while there are others (including myself) who claim it was very similar to what they’d expected.

Why is there such a difference?  Having worked with multiple students who have failed Step 1 prior to coming to me, I believe that the difference in these two groups’ experiences stems from what they believed the test to be.  The first group often feels that the exam is simply a test of facts, facts that they will accumulate by doing USMLE World questions over and over while reading through First Aid until they fall asleep with drool running down the pages.  The second group knows that they can’t possibly learn every bit of knowledge on the test, but that the point of the exam isn’t knowledge so much as your ability to apply principles.  They recognize that memorization itself is insufficient – they must learn how to apply that knowledge to interpret the test questions correctly.

The latter group sees the QBank merely as a means to an end, a practice ground to hone their reasoning skills for the day of the test, and in my experience as a USMLE tutor, this group tends to do much better.

Verdict: Fiction, at least in my experience and the experience of most of my friends/students

Claim #5: You must use USMLE World in your USMLE preparations

This is a no-brainer.  I completely agree.

Verdict: Definite fact.

Claim #6: USMLE World should be the last question bank you use before taking Step 1/Step 2 CK/Step 3.

Again, like many of these pieces of dogma, the answer will depend on what you believe the test to be.  If you believe it to be a test of knowledge, then doing USMLE World right before your exam may or may not be as important.  However, if you believe that the USMLEs are in fact a test of your ability to apply knowledge to questions you’ve never seen before, then you will likely want to use USMLE World as the final question bank before you take your test, as this is the best QBank I’ve found that mimics the real test conditions.

If it isn’t already abundantly clear, I fall in the latter camp – those that believe QBanks are a learning tool, to learn critical information as well as how to apply it to novel situations.

Verdict: Fact (depending on what you believe). 

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Concluding thoughts

While I am sure there is going to be disagreement, my goal with this blog post was to challenge the dogma surrounding the use of USMLE World.  While it is no doubt an extremely useful question bank, it is by no means the holy grail of USMLE Step 1 preparation as it is so often held to be.

Ultimately, your preparations and how you use these resources will depend on what you believe the test to be about, and what you believe it takes to get a high score.  As a medical student and USMLE tutor, I worked under the assumption that Step 1 wouldn’t be a receptacle for me to regurgitate UWorld/First Aid knowledge, but rather a series of carefully constructed questions that would test my ability to integrate and apply pathophysiologic principles.

You are free to disagree (and I welcome your thoughts in the comments)!  Remember that there isn’t only one way to approach using USMLE World, and that there are plenty of viable, rational alternatives!

What to do next?

  1. Curious to know how I prepared for the exam?  Check out the table of contents.
  2. Check out the resources page to see what other resources I used to improve my Step 1 score.
  3. Worried this is only a single voice in the wild?  Check out these students’ experiences and see that there is a rational, measured approach to improve your Step 1 scores.
  4. Planning on doing more than one QBank?  Check out Kaplan’s Step 1 QBank.
  5. Know the worst mistake I see students make using First Aid for the USMLE Step 1?  Check out this article here.
  6. Interested in Step 1, Step 2CK, or COMLEX tutoring?  Check out the tutoring page here?

BONUS: FREE sample Anki cards I made based on my USMLE World QBank studying.  Just support the site below for instant access!

I get lots of questions from students asking exactly how I made Anki cards based on USMLE World questions.  Hint: I did NOT make abnormally long cards, and made sure to focus only on the critical information from each question.  If you want samples of cards I made, support the site below.

Here are your free cards!

What do you think?  Are you still planning to repeat USMLE World twice?  Other thoughts?  Let us know in the comments!

  • Sidney

    Just took my Step 1. I wish I had done spaced repetition earlier; only started doing it after I read your blog. Do you think you could do a blog post on how you studied (books used, etc) during clinicals for the shelfs and step 2ck/cs? Thanks.

    • Yousmle

      Hey Sidney – congrats!! Regardless of how the test itself felt, I’m sure it felt nice to be done and move on with your life!

      You read my mind re: future plans on blog posts – using Anki/spaced repetition is certainly useful for clerkships, and I would love to add more articles re: how best to balance studying w/ life w/ clerkships. Thus, thank you for your comment, as the more interest I can see in such articles, the more I want to write!

      In the meantime while I prepare future articles/get ready for the start of the new year, I can say that I carried over my general approach to doing questions first (usually UW), then studying off of the explanations later. For Step 1, some people make all of their cards based on FA/other resources FIRST, then do questions later, but they quickly find on clerkships that this is untenable. It is virtually impossible to make all of those cards before getting through a reasonable number of questions before you have to take your shelf. Instead, I just did questions first, then studied the things I got wrong, and made cards to make sure I never made the same mistake twice – basically, the same approach as with Step 1.

      Hope this helps! You always have such thoughtful contributions, and love to hear from you!

      Take care,

      • K. R

        Hi Alec

        First I’d like to say what a great site! It’s fantastic to see a past medical student giving as much valuable information as you are.

        I’m a UK clinical student just starting my clerkship. Really looking forward to your upcoming article on this. How did seeing patients fit in with your learning for shelf exams? I’m currently choosing a condition a day, using different resources to understand it and trying to examine specific patients then having a power Sunday of creating anki cards that I review everyday. I think I prefer the Do questions, read, make cards though instead, seems more interesting.

        Also I’m assuming any qbank would suffice. I think our Oxford clinical handbook is similar to first aid.

        Thanks very much

        K. R

        • K. R

          Just to clarfify, I don’t intend on sitting any Step exams. This is just for my first year clinical shelf exams. Struggling to find a parallel UK Qbank with explanations as good as the USMLE World Qbank!

          • Yousmle

            Hi KR,

            Thank you so much for your message! It’s hard for me to know exactly what the best QBank would be, since I went through the American medical system. However, the strategy of doing questions, reviewing them, making cards so you never forget them, and doing your cards works regardless of the question bank. I did this with more than just USMLE World, and used it for every other question bank I used, with similar results.

            Best of luck!


          • K. R

            Thanks for getting back to me with the sound advice :)

            Following on from this, let’s say I do a question r.e. a specific diagnostic test for ‘disease X’. Would I then study this particular diagnostic test only or would I study the whole of ‘disease X’ including presentation, management etc. in my textbook?

            Sorry if this seems really picky but it will make a big difference time-wise. Shall I just trust in my question bank that it will cover all aspects of the key diseases?

            I also noticed on your Facebook page that you have some new content to those on your newsletter. Unfortunately I have only just signed up to the newsletter. Was it by any chance on the topic of clerkships or work/life balance? – Both 2 interesting topics that I’ve noticed you have in the pipeline.

            Thanks very much again for your help, fantastic work.


          • Yousmle

            Thank you so much for your kind words. You will likely drive yourself crazy if you try to learn everything about every single disease you study. Instead, I suggest that you use First Aid as a target of the information that you need to understand. First Aid will let you know what knowledge you need to have, and the goal is for you to understand the why’s and the how’s of those diseases and the information. Best of luck!

  • Mihir Shah

    First of all, thanks a ton for the articles and the blog. Its awesome !
    I had a question – Did you make cards out of the Educational points in U World and Kaplan QBank both or just U World ?

    • Yousmle

      Thanks for the feedback!  Great question – I made cards for both QBanks, mainly because they tended to focus on different information, and one gave better explanations for some conditions than others, and vice-versa.

  • Jordan Sparks

    hi !!
    ur blog is amazing,
    all myths busted!! i was looking for help when i stumbled upon your blog,
    u r an angel!! your advice helped me significantly advance my preparation&
    use my grey neurons & application skills like never before,
    i can see the results instantly!!
    thank you soooo much for doing all this, i really mean it,
    im also eagerly waiting for your future posts…
    send you my heartfelt best wishes…
    have an awessome life !!

    • Yousmle

      Hi Jordan – thank you so much for your message! I really appreciate you taking the time to write and share your thoughts with the community. It really is quite amazing when you can actually FEEL yourself improving, particularly in your ability to understand and explain the human body. I look forward to hearing more feedback about the site!

      Take care,

  • Jordan Sparks

    hi !! alec

    the anki decks on micro-virology & jaundice are amazing !! absolutely indispensable !!
    thanx a lot….im also going through micro book

    “How the Immune SystemWorks”, its really cool,
    wraps up stuff pretty amazingly!
    your post on “Could You Connect Conjugate Vaccines and ABO Incompatibility for the USMLE Step 1?”
    is really eye opening especially the clarity it gave regarding

    A B antigens=carbohydrate, so IgM& Rh=protein = IgG” is really great
    (i always knew it was IgM & IgG butdidn’t know why)…
    since im an IMG….. theres not whole lot of time for me to do immunology,

    so i’m just wondering if you could
    upload decks on entire immunology…it would be of immense help.
    thanks in advance .
    good day!!

    • Yousmle

      Dear Jordan,

      Thank you so much for your clear, and fantastic feedback! I’m thrilled to hear that you found the USMLE Step 1 Cheat Sheets useful, particularly the one on conjugate vaccines, as well the Anki decks.

      I’m always looking for more ways to help, and I will definitely try to include more Immuno cards in my next giveaway!

      Thanks again for the feedback – I look forward to hearing from you again in the future!

      Take care,

  • Stylish JiuJitsu

    Hey there!

    Outstanding blog, seriously! And very useful advice as well. I was wondering if you can share the copy of your study schedule for Step 1 ?

    • Yousmle

      Hi Stylish – thank you so much for your kind words and fantastic question.  I hope to write an article about this at some point, but in the meantime, here are my thoughts:

      I made a schedule, but never really following it.  I never really did subject-specific days, as I mentioned previously, but instead used random blocks of question bank questions to make sure that I knew the whys/hows of the conditions in the questions.

      Hope this helps, and I look forward to hearing from you more in the future!

  • Forever Estudying


    Great post, I am taking your advice and getting through more questions via integration and application v. passive reading/”active” memorizing. How many times were you able to get through First Aid during your study preparation? I was unsure how beneficial questions would be v. numerous FA read throughs? I will be able to finish it 1-2 times MAX… maybe 1.5x. I am not sure how to most efficiently manage my time, my exam is in 3 weeks. Thanks!

    • Forever Estudying

      To be more specific. I have been through UWORLD once and I have been through FA once… now I need to balance between re-doing UWORLD, using my KAPLAN Qbank, and re-reading FA thoroughly (# of times would depend on my question strategy). I would appreciate any advice you have!

      • Yousmle

        Hi Forever,

        Thank you so much for your great feedback and fantastic question. I actually am finishing up an article that I wrote in response to your question, but it’s not done. I did, however, want to respond ASAP given your short timeline. I actually never finished First Aid even once, and definitely didn’t read through it multiple times. My goal was to make sure that I learned it well enough the first time that I never had to go back to re-learn those things. When I had 2-3 weeks left, I was still focused on learning fewer subjects well, rather than trying to cover as much material as broadly as possible. Information without much depth never seemed to help me much, as well as students I have tutored.

        Hope this helps! I’ll be sure to update this when I finish the upcoming article (sorry, residency doesn’t lend itself to updating this blog a ton other than responding to comments, haha).


      • Yousmle

        Hi Forever,

        Just wanted to update you: I just published the new blog post here . Thanks again for your question, and I look forward to hearing your feedback on the new article!


  • Heather

    Hi Alec,
    Thanks for all the helpful information. I am taking my STEP1 in less than 6 weeks and was wondering what you think about doing Qbank blocks on random vs by topic? I have been going back and forth on which approach to use as I feel like sometimes on random I am not able to really learn the information as well. However, I know that I am not really testing “what I know” if I am sticking to a specific topic every time I do a block and then not coming back to that topic for a while.
    Any advice is appreciated!

    • yousmle

      Hi Heather,

      Thank you so much for your kind words and question. In general, I exclusively did questions on random, for the reasons you stated – it is more realistic to the real test, as I found that I could just eliminate particular answers just because they weren’t in the right block (e.g. eliminating pulmonary hypertension as an answer simply because I was doing a cardio block).

      That said, my philosophy has shifted over time as I’ve been working with students who are at varying points in their studying. If I could go back, and if I had a lot of gaps in my knowledge, particularly if those gaps were concentrated in a handful of subjects (e.g. if I didn’t know a ton of cardio, neuro, and renal topics well, but was comfortable with most of the others) I would probably recommend to do subject-specific blocks in those weak topics, since I would be immediately testing myself on gaps that I’d filled, as opposed to waiting around for similar questions to come up again in a random block. I would just make sure that 2-3 weeks out, I was doing random blocks again.

      Ideally, assuming you’re using USMLE World right now, if you were to do subject-specific blocks in a particular subjects, I would probably use Kaplan blocks, so as not to “imbalance” the blocks that I have remaining. This is a personal preference, but I would hate to do all of my cardio questions, only to switch back to doing mixed blocks and not see any cardio questions after I’d spent all of that time learning it. Plus, Kaplan is convenient since they give you the First Aid pages, and don’t block copy/paste when you’re doing it, which is nice if you’re making/editing Anki cards.

      Hope this helps!

  • usmleusmleusmle

    Hi Alec, I’ve read a few of your blog posts but can’t seem to figure out your general timeline of balancing coursework and board studying. I recently started my 2nd year and am thinking of switching over to dedicating the first half of my school’s 3 week test cycle on First Aid, DIT, Pathoma, question bank, etc, then looking at my school’s lecture slides to study for the school exam. Then a few months out to Step 1 in June focus more on Step 1 materials. Or did you focus on courses only, then started studying a lot for Step 1 in March, as that is when you took your first practice test? Thank you all this great information on your site!

    • Yousmle


      Thank you very much for your message. I did not use DIT, and Pathos was not a known resource when I took Step 1, so really I just focused on my coursework for the majority of the time, and made sure that I UNDERSTOOD as much as possible from First Aid as I went along. I think that it is sufficient to begin your studies for Step 1 during your dedicated study period, as this is what I and many others that I know did. The most important thing is is that you take the time to improve your ability to APPLY that knowledge during your dedicated studying, not simply focusing on facts.

      Hope this helps!


  • tamara postigo anchante

    Hi yousmle, this blog is amazing… How I can get your complete set of anki’ cards???

    • Yousmle

      Hi Tamara, thank you so much for your message! I have to Anki decks for sale, which you can purchase from the links at the top right of the website! Thank you again!

  • Matt

    Hi Alec, thanks for putting together the website. It’s great! I’m going to start my first year of med school soon and would like to hear what advice you have for me on preparing for the step 1? What do you recommend for first year students? Should we do UWorld questions as we cover different subjects in class? Make anki cards for each class so when it comes around for our dedicated study time, we have more time to do qbank questions? Thanks!Matt

    • Yousmle

      Hi Matt,

      Thank you so much for your message, and for your kind words. In general, I do not recommend doing question banks during your first year. I know that a lot of people will tell you that doing Q banks early is critical etc., but in my experience these are also people that do not use spaced repetition, or at least do not use it effectively. If you use spaced repetition well, you should only have to go through a question bank one time.

      Some of your approach will depend on how important your class ranking is, since the more important it is the more I would focus on your class work. That said, I still focused a lot on my coursework, even though Stanford is pass fail throughout the preclinical years.

      My best advice to you is to use your coursework as a supplement to your studying for Step 1. One of the most difficult tasks during the first two years of medical school if you figure out what is most important to study. It’s easy to say that you should learn the fundamentals, make connections, and learn things in as much depth as you can. It’s a completely different thing to put that into practice, though. To do this, I would use First Aid as a target for the information that you need to know. Use your classes to understand the First Aid material well, since FA won’t give you much depth or mechanisms, but will give you a good idea of the kinds of information that you will be tested on for your Step 1.

      Also, remember to take a deep breath, and relax. Medical school is one of the most challenging times, but can also be greatly rewarding. You are in for quite a ride. If there’s anything I can do to help, please contact me again on the website, and I will be happy to help in any way possible!


      • Matt

        Thanks Alec for the response! I will keep in touch. Good luck in your future studies and endeavors!

        • Yousmle

          Sounds fantastic. I definitely look forward to hearing from you more as you progress through your career!

  • Matthew So

    hey alec,
    how do you recommend using the q – banks? i’ve been using them by discipline – ie neurology, etc. but ia lways do timed. should we do more mixed mode stuff?

    • Yousmle

      Great question. It really depends on whether you are scoring well already, whether you are close your exam, and what your overall goals are. If you’re scoring above 200 or 210 on your NBME practice exams, I would recommend doing mixed blocks. If not, particularly if you have more than a month until your exam, it might be better to do subject specific so you can hit your weak areas in a more concentrated fashion.

      Best of luck!


  • d ily

    Alec, thank you for all your insights. It’s definitely a breath of fresh air! I just have some concerns over doing the UWorld- review book approach for Step 2 CK…. I’m using Master the Boards and I find that it’s a bit more confusing to do questions first before looking them up. Would you recommend using another review book for your method? Like FA for Step 2 CK? Thank you so much!

    • Yousmle

      Thanks so much for your message! I personally used UWorld for Step 2CK, doing questions and studying from them, and have known many people who have successfully done that strategy. If you find yourself needing more foundation, I used First Aid for Step 2 CK as a reference, which I found to be useful.

      Hope this helps!

  • Hugo

    I’ve always had a hard time passing steps. i’m studying for step 3 right now. I’m scoring about 50% correct each time I do 44 timed question blocks. That puts me at the 5th percentile. Do you know how that compares to an actual Step 3 score?

    I know there isn’t a 1:1 translation between UWorld and a predicted true score but I was hoping you could give some insight as to what a passing score on Step 3 and what kind of percentages/percentiles I should be seeing on Uworld.

    Any insight would be super helpful.


    • Yousmle

      Hi Hugo!

      Thank you so much for your message. Unfortunately, there is no perfect way to predict what your score will be particularly when using question banks. The best thing to do is to use an NBME practice exam (for Step 3 I believe they are “Comprehensive Clinical Medicine”), which should give you a good idea of where you would score if you take the test now.

      Best of luck!


  • Matthew So

    Hope all is well.
    I’m getting mroe intot he Anki game, but it’s sort of tough to really master it.

    My first quesiton is how many anki questions do you do a day? How many new ones do you do a day?
    And, how do you interpret U-world scores?

    I’m scoring pretty low right now. I’m probably averaging 40-50%.

    I also don’t know how ot use the q- bank. I basically was doing it by systems, and now I am slowly reverting to mixed blocks.

    I’ve discovered that i learn best with pathoma/firecracker, but the anki stuff is almost getting excessive. I am trying to do what you did with your pathogenesis to presentation cards, but I don’t know what’s a realistic goal to set.

    I basically outlined all of pathoma into an excel file and iam going to import it into anki.
    Any thoughts?


    • Yousmle

      At the peak, I did about 300 to 400 cards in a day of old reviews, and roughly 40 new cards in a day. I don’t put much stock in UWorld scores, and go more by NBME scores. If you are scoring below passing, I would still study by system. Honestly, it sounds like you are trying to do too much, and should probably pare down some of your resources. I would not do both Firecracker and Anki, and would choose one or the other, otherwise you risk overwhelming yourself by trying to chase way too many rabbits.

  • Matthew So

    hey alec, thanks for the reply., my problem right now is that as I am typing things into anki, I recognize that my time might be better spent by basically putting everything from first aid into anki;
    there are other decks and flash-card services like USMLE flash rx that offer that service. so is there any benefit to doing this? keep in mind i only have 3 months so it’s not like i have a lot of time to spare.

  • H.B

    Hi Alec,

    I wasn’t quite sure where to post this. I was wondering do you have answer keys and explanations for NBME 15, 16, 17? Or any reliable sources you would recommend? Im trying to go through the exams and for things I’m unsure about there are a lot of contradicting answer keys and discussions online.

    Thank you

    – H

    • Yousmle

      I don’t, unfortunately. Typically I go over this with students that I tutor, to help them to understand any issues they are having with interpretation of the questions themselves. I don’t know of any resource like what you’re asking for, however, presumably because it would likely break certain copyright laws.

  • Shane

    Hi Alec,

    My Step 1 exam is 13 days away and unable to push it back any further. In light of this, I had two questions:

    1. Would I likely gain any benefit from your ANKI cards at this stage? Certainly, my big weakness I feel is applying basic pathophysiological principles to new questions.

    2. I know that U world is supposedly the best question bank to use but haven’t gone through it already, I wonder would I be better off getting Kaplan because at this stage I feel I’m just recognising answers without having to really think about it.

    Any help or advice would be much appreciated.


    • Yousmle

      Sorry for the delayed response – hope your test went well! Studying pathogenesis to presentation at any stage should help, as should spaced repetition, although in general the longer the timeframe, these will be even more useful.

      Hope your exam went well!


  • Craig

    Hi Alec, I’m sitting at 11 days away from my Step 1 and looking for advice on tackling the last week. I will be finishing DIT with 9 days to go. I still have 1500 questions left to go through on UWorld. In my last week I was hoping to get through First Aid (80 pgs/day), Pathoma/SketchyMicro (4 hours a night), and 80 UWorld questions per morning. Would I be better off scrapping First Aid and Just doing UWorld Questions from 8 AM – 4 PM each day. (on average I can get through 20 questions/hour). *I’ve never felt like I could just read and comprehend. So any extra time each day would maybe be spent on a topic I feel the weakest on.

    • Yousmle

      Hey! I hope your exam went well. This may be late, but in general, when you are that close to your exam, typically it’s best to do more questions rather than passive learning. I hope this can help you for your preparations for self exams and for Step 2!

  • Angie

    Hey Alec–

    Any suggestions on how to tackle
    Step2 CK as far as if I should do uworld questions as random sets of 44 or by subjects? Any advice is greatly appreciated!


  • Angie

    Hey Alec–

    I’m getting ready to take step 2 ck and was wondering if you had advice regarding doing the UWORLD questions. Would you recommended doing random sets of 44 or Taylor them by subject?? Any advice would be greatly appreciated.


    • Yousmle

      Typically I’d recommend random, unless you’re scoring very low (NBMEs < 200) and you absolutely need to review by topic.

  • Sarah

    Hi Alec,

    this is great advice, thank you! I was wondering if you could tell me, how exactly do you reason through the question? I have been doing sooo many question banks and I have studied A LOT but I just see no improvement on my NBME’s. I must be lacking the integration and application skills or I may just not have understood the connections well …
    Would you have any tips?

    Thank you

    • Yousmle

      Hi Sarah,

      Thank you so much for your question. Certainly, a lack of integration and application can certainly trip you up, and to prevent you from improving your scores. My best advice is to both slow down when you are learning topics, so you give yourself enough time to learn them appropriately, as well as to make it your mission to understand what each sentence means in every NBME or question that you do. You won’t be perfect, but if you improve a little bit every day, you can certainly make a lot of progress.

      Hope this helps!


  • Jose D Medina Esquilin

    Hi Alec,

    I’m in the later part of my first year in med school and my goal is to complete one kaplan qbank and one lap of UW qbank. I wanted to know how many questions should I be doing per day or week or month?

    • Yousmle

      Honestly, I’m not a huge fan of doing too many questions that early. You could do both in a 2 month period (this is what I did), so I wouldn’t worry too much about doing too much early.

  • Zaydoon

    hello doc.
    i have a serious problem, I’m an IMG and my Step-1 is in less than 3 months
    I’m doing Uworld for the 1st time and first aid 3rd time along with flash cards
    I keep on getting 65-45% on every system-wise block that i do
    I’m starting to panic and feeling down and
    my friend is preparing with me and his Uworld is 90-75%
    i feel like I’m doing something wrong. I’m afraid to take NBME because if i fail i’ll be frustrated

    • Yousmle

      The best thing to do is to take an NBME now, to see where you are, to get an idea of whether you are improving your scores are not, which would let you know how effective your studying is.

  • david cruz

    Alec, I Appreciate Yourselflessness. I Believe You Have Been A Blessing To All The Students of Medicine. This is why I am reaching out to you today. My Question for You Sir : What should i go over now that i am to take USMLE STEP 1 Dec. 30 2015? In 2 days I will finish Uworld. I Have done DIT 288 videos and the ANKI card you recommended.

    • Yousmle

      Thank you so much for your kind words, and question. I hope that my advice is not reaching you too late. I best advice is to do more questions, and to learn the topics that you are weakest at, but focusing on a manageable amount of information every day.

  • Nishant Tiwari

    hello Dr.Alec
    i just finished my 2nd year in an Indian Med school.I am planning to give step 1 in 6 months..that much time i have for preperation…
    i am going to use following books
    1.Rapid review pathology
    2.CMMRS for micro
    3.High yield series for anatomy
    4.BRS physio
    5.Kaplan lectures notes and lectures for Pharmac and biochemistry
    i am confused about which source is best for behaviuoral sience?
    i am also thinking to buy ANKI deck from you….should i get that after i finish single reading or it would be wise to get it now…and use it from initial phase of preperation?
    also should i buy UWORLD 6 months subscription and use it from initial phase for learning purpose or after i finish single reading?
    I really appreciate you taking time reading this!
    please help me!

    • Yousmle

      Honestly, spaced repetition is best if you get it earlier. If you plan and getting the Anki deck, I would get it as soon as you can, so that you can benefit from the greatly improved retention, particularly since you have such a long time frame.

      As far as UWorld, I would honestly probably wait to use it until you are closer to your exam. I am not a fan of doing it twice or more like some people have recommended, mainly because I think the benefit of using it is mainly in practicing doing questions for the first time, since that is exactly what it will feel like on the day of your exam. If you want to do any questions early on to get a sense of the test, I would recommend doing the Kaplan question bank.


      • Nishant Tiwari

        Thanks a lot for your reply
        Do you think my review material is correct? anythin you would like to add/subtract
        i will let you know about Anki cards soon

        • Yousmle

          I’ve never used HY for anatomy, so can’t comment on it, and I prefer Costanzo to BRS phys if you’re going to use it as a reference (this is a minor point, they are the same author), but otherwise those look solid!

          • Nishant Tiwari

            Thanks a lot!! :)

          • Yousmle

            Absolutely – best of luck!!

  • Sunny

    I’m using the your step 2 CK deck..I used your step 1 deck too and I liked it..Is there any suggestions for preparing for step 2 ck? Most of your email seems to be relevant to step 1. Thank you.

    • Yousmle

      Great question, and thank you for your kind words about the Step 1 deck. Honestly, the approach is very similar for learning Step 2 material. I would recommend spending more time on question banks, and focusing on learning appropriate interpretation of clinical symptoms and signs. Step 1 is more difficult for the knowledge and being able to make connections, while Step 2 is difficult in differentiating between similar diseases that give similar presentations.

  • Usmle Max

    I liked your page and i agree with you completely ,,,,i think the test depend on how you improve your strategy to deal with the question more than the solid memorization which is unfortunately what i learned in my medical school in Iraq..anyhow ,,,do you agree with the fact that Uworld is completely a learning tool and thus should never be used as estimation for your score in exam ?

    • Yousmle

      Thank you so much for your assessment, and your comments! In general I would agree, that generally UWorld is better as a learning tool, and should not be used as an estimate of your score. How many times have you seen people in USMLE forums say that they had a very high average on their question bank blocks, only to have a very disappointing USMLE score?

  • Jesus

    Hi, my name is Jesus from Mexico city, im an IMG and I want to get into radiology. I have extended my elegibility period for april-june 2016 for my step 1 because I made the nbme 13 and a u wolrd self assesment last week and I got 215 and 219 respectively, so, what do you recomend me to do to get a 240+, I have readed all the Kaplan books once, finished the uwolrd twice and have Readed the first aid 2015 twice.

    Thank you.

  • Rachel

    Hi Alec!

    I’ve been using your cards for a couple days now, and have already begun appreciating how understanding the WHY can really help both understanding and retention!

    I had a question regarding how I should use QBank along with the Anki cards. I’ve been doing the Anki cards by system, and doing UWorld along with system as well. (I have already completed UWorld in its entirety in random/tutor mode, but had to push back my exam as I wasn’t scoring well on NBMEs).

    Would you recommend doing cards and questions by system as the best way to go if I need to bolster my knowledge of concepts?

    I do feel it’s helping me make sure I have the concepts down, but at the same time, I can’t help but think that doing UWorld randomly is better to simulate the exam!

  • Sainandan Reddy

    Hello, how can I purchase or download the anki flashcards? It sounds like they could be a wonderful tool for ny step 1 prep…

    • Yousmle

  • Imran

    Hey whats up? Thanks for taking time to read this. Could you please guide me in taking USMLE Step 1. I am confused due to the amount of resources there are. I am an IMG, but my school is not USMLE oriented, so the bulk of my studies comes from reading sources. What would you recommend i should do. I am a 4th year medical student and I am in a 6 year MD program in Europe. I was thinking of taking the exam next year(2017) in September. I am thinking of reviewing all my BRS books and FA. But that will take too long and Idk if its worth the effort of investing that much time into this review. I would really appreciate if you properly guide me in this. Thanking you in advance.:)

    • Yousmle

      You can find some of my general advice on the topic in the table of contents:

      If you’d like individual/group instruction, you can e-mail me at alec at

  • A Haji Datoo

    Hey !!!
    Heard about your site from a Youtuber. Wondering if you have cards specifically for Physiology, Neuroscience Immunology and Genetics. Thank you!

    -A. Haji Datoo

    • Yousmle

      I do indeed! The physiology cards are all spread out in the different organ system blocks, but neuroscience, immunology, and genetics all have their own sections. I ask which YouTuber you heard about the site from?



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