My personal opinion (from taking Step I back in 1998--oy, I've dated myself) was that the website alone was enough. Of course, I liked pathology, and paid attention to the classes when I was taking them during my basic science years, but when it came to studying for the boards, I leaned VERY heavily on this website--I had great Step I scores, and my pathology ranking was off the chart. I definitely reviewed all the images, and did the tutorials and exams they had available. I've taught medical students during my pathology residency, and recommended the site strongly. The feedback I got was that the website alone was quite sufficient.