How I scored 263 – IMG USMLE Step 1 Experience 2021

IMG USMLE Step 1 Experience Score 263

This experience of Abdelrahman Mostafa Ibrahim IMG medical students from Egypt.

Hey everyone,

I want to share my experience studying, the sources and methods I used, and any mistakes I made, and things I could have done better. This write-up is, more or less, my personal experience and endorsement for the use of Anki. 

Firstly, I’m a graduate of Alexandria University in Egypt. I finished my 12th and final semester in November 2019. I began preparing for the USMLE Step 1 starting February/March after that, which coincided with the beginning of my internship year (which ends in March 2021).

How long did it take to prepare for Usmle Step 1?

My total study period was ten months, from February of 2020, until my exam date on the 17th of December, 2020. I received my score report on the 6th of January, 2021 (3 weeks later).

My primary and only source of “studying” was Anki. By now, I’m sure most of you have heard of it, but for those who haven’t: Anki is a flashcard program that uses spaced repetition for maximal long-term memory retention of information. I did not use any textbooks whatsoever, nor did I take any notes or otherwise. Once again, I only used Anki, in addition to questions solving (Uworld, and a bit of AMBOSS, but I’ll get to that later).

Before I move forward, this Youtube channel is your friend regarding Anki and related USMLE decks:

I highly recommend going through Anki 101 Basic Skills playlist before reading the rest of this, as I’m going to use some terminology related to Anki moving forward.

The deck I used was the AnKing Step 1 Overhaul. At the time, it was version 3. Right now, it has been updated to version 8 and contains some 32000 flashcards. I finished almost all of the flashcards in the AnKing Overhaul deck, except for maybe 1000-2000 cards that I decided were not relevant or otherwise duplicated.

I used other sources: Boards and Beyond, Pathoma, Sketchy, Uworld Step 1 Qbank, and about 500 questions of AMBOSS towards the end.

I would watch a specific video, whether from Boards and Beyond or Pathoma, then I would unsuspend all of the flashcards for that video. I used to do about 100-150 new cards/day, and I upped that to around 200 new cards/day towards the end as I was getting impatient (I do not recommend this, I will come to it later). Needless to say, I did all of my review cards every single day, and I rarely let reviews pile up into the next day.

I then started solving Uworld questions towards the 2nd half of my study period, so around June or July. However, I do not recommend this (I will come to it later).

Download Complete Uworld Qbank 2020 For USMLE Step 1

Lastly, I did an NBME when I was around halfway through Uworld and then decided to finish the rest of Uworld before finishing all other NBMEs, one after the other.

My NBMEs Scores VS Actual USMLE Score:

These were my NBME scores:

17 – 252 (31-10)

18 – 261 (11-12)

19 – 244 (30-11)

20 – 257 (06-12)

21 – 249 (08-12)

22 – 252 (09-12)

UWSA1 – 275 (13-12)

Free 120 – 92% (13-12)

Predicted score: 258 (95% CI lower limit: 249, upper limit: 266)

Actual score: 263

Download ALL NBMEs Self Assessment

Recommendations for study:

1- Anki is by far the strongest tool I’ve come across regarding memory retention of information, and medical education specifically. I studied throughout my entire medical education using textbooks as I did not this application existed. However, I was introduced to it by my cousin in early 2020. Initially, of course, I was very skeptical. After studying my whole life using a specific way, how are you supposed to change your studying entirely? However, as I started digging deeper into what Anki is and how people have been using it to study medicine for years now, I started changing my mind. I understood what Anki meant and how it adheres to the two most important learning principles and retaining learned information: practice testing and distributed practice. I then used the AnKingMed Youtube channel to orient myself regarding Anki and the AnKing Overhaul deck. I then downloaded the deck and adhered to a year-long routine from there. After finishing my reviews, I started my day, then I watched a video, then I unsuspended the flashcards related to that specific video.

2- Start solving questions early. Do not use Uworld just yet. I wish I had used another question bank during studying because I felt I had “wasted” Uworld by solving it during the study and then solving it again random timed. After all, I had seen a lot of questions before, and I felt that my Uworld percentage was therefore inflated. The main issue here is that I thought it eroded my confidence going into the exam. While my Uworld percentage was around 91%, there was a part of me that was doubting it because I wasn’t sure how many questions I was getting right just because I had seen them before. So what’s the problem with all of this? It’s not a huge problem/issue, in my opinion. But I think there’s a real benefit in doing the entire 3400 or so question, 100% random timed, and having a percentage at the end that you can reliably believe. There is no better predictor of your exam performance than doing some 80 blocks in exam-like conditions and having a percentage to back it up. Therefore, if I were to do it again, I would have probably used a question bank like AMBOSS while studying chapter by chapter, and then when I was finished with studying, I would do Uworld from start to finish in random timed mode.

Download AMBOSS Qbanks 2020 For USMLE Step 1

3- Even though Anki is a fantastic tool to learn and retain information, it is not without its faults. A significant problem I was falling into while studying is that I was memorizing how a flashcard looked instead of really understanding/internalizing the information that the flashcard was trying to test me on. I also ignored the “Extra” portion of flashcards for some three months of my study because I was fed up with doing reviews. I paid for this when I did questions later because I realized I was making a lot of mistakes because I was simply memorizing the way a flashcard looks and even ignoring relevant information in the “Extra” portion of flashcards that allow the information to be integrated with your mind in a testable way. So, what’s the solution? TAKE YOUR TIME while doing flashcards, and ALWAYS look at the extra portion. Make sure you understand the flashcard 100% before moving on to the next one. It might seem hard, but believe me, you will know or have a “feeling” when you’re studying a flashcard, and you don’t understand what you just memorized, nor do you know where it fits into the bigger picture. Once again, the AnKing Overhaul deck is the best deck available, and this won’t be a problem if you take your time doing your flashcards.

4- Do NOT do more than 100-150 new cards a day. The reviews pile up extremely quickly, and it won’t be easy doing more than 600 reviews a day. Even though the reviews themselves may not take very long, but they are very demanding. I made the mistake of doing 200 new cards/day, sometimes even 250 or 300 for around a month or two, and I paid the price of doing 1000+ reviews a day, which is something that I do NOT recommend AT ALL. Your time is better spent taking care of your mental health by doing less than 500-600 reviews a day, and doing questions if you feel like you have extra time during your day.

5- This is super important: making your own flashcards for questions you get wrong when you start doing question banks. If using Anki to study is 50% of the process, then properly solving and LEARNING from your mistakes is the other 50%. Whenever you solve a question and get it wrong, you have to ask yourself first: why did I get this question wrong?

If the answer is A) deficiency of information. Then ask yourself, what was the information that I needed to get the question right? Make a flashcard for that extra piece of information.

B) Confusion between 2 answer choices, and picked the wrong one. Then make a flashcard that differentiates between the two answer choices.

C) Carelessness while solving and reading the question wrong. This is the easiest to fix: use the highlight function, and go slower, and make sure you highlight the question at the end of the question stem, so you go through it very carefully, making sure you don’t answer based on “decreased” instead of “increased” for example.

There are other reasons you can get a question wrong, but I’ve listed the ones that got the most wrongs for me. Once again, it is just as important to ask yourself WHY you got a question wrong and then proceeding to fix that problem to make sure that it doesn’t happen again. This is progress.

I think that about sums everything up. If anyone has any questions, I’ll be glad to answer them, and I’ll update this post with any questions and answers.


I studied exclusively using Anki, and nothing else. I used the AnKing Overhaul deck. I used B&B, Pathoma, Sketchy. I solved Uworld and 500 questions of AMBOSS. I then made my own flashcards for mistakes that I made while solving questions.