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Basic Anki Card Creation: The Complete Guide for Med School and the USMLE Step Exams

 

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How did I remember nearly everything I learned in medical school, so that I could score a 270 on the USMLE Step 1 and receive honors on all of my 3rd year shelf exams?  By building a strong foundation of knowledge that I never forgot, which I put into Anki flashcards, which to this day I still review.  Here I share the method of making cards that can be the difference between toiling away for hours in frustration with little to show for it vs. scoring a 270+ on the USMLE Step 1.

3 key principles (and 4 mistakes to avoid) for Anki success

While I am a strong proponent of using Anki for more than just memorizing flashcards, the way that I recommend most people to start is to treat it as a basic flashcard program.  Here, I lay out 3 simple rules for making BASIC flashcards, along with the 4 most common roadblocks that delay people reaching their full potential.

USMLE Step 1 Anki Cards

Rule #1: Keep the amount of information on a card to a minimum (ideally 1-3 unrelated facts)

By far the most common mistake that people make when they start out using Anki cards is that their cards contain way too much information.  This point is worth repeating, because making cards that are too long hurts you twice: once, because you will have to repeat these cards many more times, which wastes your time as you repeat facts unnecessarily; and twice, because we won’t remember the information as clearly.

Let me give you a real-life example:

On the front, this student had as the question:

Differentiate the infections by the causative agent and describe the rashes in their locations direction of spread. Also describe unique findings.

Rubella 
Erythema infectiosum 
Roseola infantosum 
Hand/foot/mouth dz 
Scarlet fever 

And as the answer:

Rubella (rubella virus) head to trunk to extremities, cervical LAD
Erythema infectiosum (5th dz, Parvo B19) – Red rash on cheeks (slapped cheeks), lacelike rash on trunk/extremities
Roseola infantosum (6th dz, HHV 6) –   rash from trunk to periphery
Hand/foot/mouth dz (coxsakievirus type A) – vesicular rash on palms and soles, ulcers on tongue/oral mucosa
Scarlet fever (Group A strep) – rash with small papules (sandpaper like)

Mistake #1: cards that include too much information waste time, and help minimally with recall

This card is clearly well-intentioned – s/he is studying the viral red rashes of childhood, and wants to try and connect the information, to not fragment the information.  Sadly, however, by making a card so long, they will have to repeat a lot of information unnecessarily.  For example, let’s say they could miraculously recall all of the information from the first 4, but forgot the causal organism of Scarlet Fever.  If they wanted to make sure they could recall that fact, which is important, they would need to repeat the entire card.  Second, for anyone who has made a card like this (and I have made lots), whenever it comes up for review, the desire to pass it at all costs so we don’t have to repeat it is quite strong.  Thus, we let our standards slip for how well we have to know the information to hit “good” or even “hard.”  However, this makes the cards worthless for the exact thing we are using them for , since we will continue to “pass” the card despite not knowing the information solidly.

For cards that are too long, the simplest thing to do is to separate the facts into separate cards

This may go without saying, but the best way to recall this information, while minimizing repeating facts we already know well, is to make separate cards out of the facts.  One example would be:

Rubella – Identify the causative agent and describe the rashes in their locations direction of spread.

Answer:
Rubella virus – head to trunk to extremities, cervical LAD

You could then do the same thing for the other diseases.  This makes reviewing the card much faster, improves recall for the few facts (as opposed to cursory recall of many facts) and cuts down on unnecessary repetition of information I already know.

“But don’t you have to make more cards this way?”

Yes, you do, but ultimately, I’ve found that making more cards with less information on each card actually cuts down on the total amount of time spent reviewing your cards.

“How do I know if my cards are generally the right length?”

This may vary person-to-person, but as a rough approximation, it should take you roughly 1 hr to review 100 “old” cards (cards you have reviewed previously).  If they are “new” cards, I would expect it to take anywhere between 1-2 minutes per card, as it may take multiple reviews for the information to stick.  So, to review 200 old cards, and 35 new cards in a day should take you roughly 2.5-3 hours.

Rule #2: Have a question for which there is a single, unambiguous answer

This encompasses the next two most common mistakes I see people make.  The first is illustrated below:

Question:

Oral hairy leukoplakia

Answer:

EBV

Blank Stare USMLE Step 1 Anki

Mistake #2: Unclear/ambiguous question

This is relatively simple, and most people will catch this eventually, usually after they’ve reviewed the card several times and can’t remember their thought process when they originally wrote it.  The solution to this is also relatively clear: simply clarify your question.  Something like,

“What is the infectious cause of oral hairy leukoplakia?”

A related mistake is exemplified below:

Hyperventilation would cause what kind of alkalosis?

Back:

Respiratory alkalosis

Mistake #3: Giving away too much information in the question

If I was trying to remember what hyperventilation would cause, I would want to remember not only that it would be a respiratory and not metabolic (I probably could have guessed this), but I would also want to remember that it would cause an alkalosis.  While this is a relatively obvious example, it happens all too often: I will write a question, only to find out later when I’m reviewing it that the information I really wanted to recall was already given away in the question itself.

Rule #3: For information you want to recall, test it explicitly in a question

Finally, I wanted to highlight one final mistake that I made constantly when I began to use Anki – a mistake I would like you to avoid.  It is a variant of the first mistake (too much information), in which I put a lot of information into the answer and expect to remember it all.  This was one of my first cards, and I keep it in my deck as a reminder of how far I’ve come with my cards (and how far ahead you will be with your cards!):

Question:

Parainfluenza virus vs. RSV – What are the major syndromes they cause?  BONUS: What surface proteins are associated with each?

Answer:

Both PARAMYXOVIRIDAE.
Parainfluenza – CROUP (laryngotracheobronchitis) – gradual onset, fever, barking cough, inspiratory stridor (wheezing sound), hoarse voice, variable progression.  Has mixed neuraminidase and hemagluttinin, so can agglutinate RBCs.
RSV – BRONCHIOLITIS – variable course: tachynpea, grunting & flaring, indrawing & wheezing, cyanosis, apnea in some.  NO HEMAGLUTTININ, so do not agglutinate RBCs.  Has F (fusion) and G (attachment) proteins – F protein mediates creation of SYNCYTIUM.

Mistake #4: Expecting to know information in the answer that wasn’t explicitly tested

As you can tell, it clearly is too much information.  What’s worse, when I made this card, the only place I had the information that croup and bronchiolitis were caused by parainfluenza and RSV was on this card.  Do you think I remembered these facts when they counted?  Nope.  And why?  Because I had this misguided thought that if I just saw the information a certain number of times, at the right spaced intervals, I would remember it all.

Remember: the only information you will recall is the information that you specifically ask yourself to recall.

“But wait!  What if I didn’t want to test myself actively on this information, but I might find it useful in the future?”

While not really an exception to the above point (you still won’t remember the information if you don’t test yourself on it actively), you CAN leave information for yourself hidden in cards, in case you want to reference it later, but are unsure if you want to test yourself actively on it.

There you have it!  Here are the 3 rules for writing basic flashcard-type cards, and the 4 mistakes to avoid:

  • Rule #1: Keep the amount of information on a card to a minimum (ideally 1-3 unrelated facts)
  • Rule #2: Have a question for which there is a single, unambiguous answer
  • Rule #3: For information you want to recall, test it explicitly in a question
  • Mistake #1: cards that include too much information waste time, and help minimally with recall
  • Mistake #2: Unclear/ambiguous question
  • Mistake #3: Giving away too much information in the question
  • Mistake #4: Expecting to know information in the answer that wasn’t explicitly tested

What to do next?

  1. Get started!  Download Anki if you haven’t, and make some flashcards!
  2. When reviewing, note how long your reviews are taking.  It should take you roughly 1 hr to review 100 old cards, and 1-2 minutes per new card.  If it’s taking longer, re-evaluate your cards: they are likely breaking one of the 3 rules (usually Rule #1: too much information).
  3. Subscribe to YOUSMLE below, to get some of the highest-yield Anki cards that I used to get a 270 on the USMLE Step 1!
  4. Check out the Resources page for everything I used and recommend for using your time most efficiently.
  5. Once you have made basic cards for about a week and feel comfortable with the process, challenge yourself with more advanced card-making skills here.

Photos by Sean MacEntee and Andrew Malone.

  • Enki

    You website is great, and as a foreign medical
    student thinking of taking the USMLE reading the experiences of others
    like you is invaluable, since I can’t exactly ask my older colleagues.

    I have used Anki to great success for some classes, but I
    never had the discipline to review everyday. It is a shame, because I
    absolutely aced the subjects for each I used Anki, and nowadays
    everything seems to slip from my memory while I study (and zero remains
    after the exams).

    I guess I have to start toughening up and reviewing everyday if I want to take the USMLE.

    To scratch my own itches I wrote a series of addons, some of which are public.
    You might be interested in the Image Occlusion 2.0 addon, which in my opinion is the only practical way to generate image occlusion cards in Anki (https://ankiweb.net/shared/info/282798835). I hope you like it!

    I wonder if you would mind sharing your Anki usage
    statistics so that I might get a better quantitative understanding of
    what it will take and plan my time accordingly.

    Thanks for everything,

    Tiago

  • Yousmle

    Fantastic question – thank you so much for your contribution to the community!

    As far as my usage statistics, I would say that at my peak, I was doing around 350ish cards a day, adding maybe 30-40 new cards a day. I would split my Anki review into two chunks of time, typically, and I think it was taking around 3.5-4 hrs a day. Of course, the number of reviews you do in a day will definitely depend on how many questions you make a day, how many new cards you allow yourself to see, and how long you’ve been making cards.
    It’s a substantial investment of time, but when you consider what you’re able to accomplish – reviewing the majority of the relevant information you’ve learned over the course of months/years that you’re most likely to forget on that particular day, then it’s definitely worth it!

  • Jose Ting

    Hi Alec,

    Thank you for contributing so much to the medical student community. I have read a lot of your articles and find them extremely interesting. I did have a few questions that I was hoping you could answer. I am currently an MS1 ending my first year, and I was wondering how to go about studying for STEP 1 throughout my second year.

    1)Should I be making Anki cards for my courses? If so, how do I review the older material after I begin a new block? I don’t see how I can feasibly make cards for the current block, review them each day, and also review old cards for previous blocks so that I can retain all of the material.

    2)Should I be using FA beginning my second year in cohesion with my classes? How exactly should I be using it if I am not supposed to just read through it?

    3)I know you mentioned that you started with Kaplan Q bank, and tested yourself on your knowledge, and used Anki cards to retain the pathogenesis to presentation so that you would remember the underlying concept, so as not to get a question wrong on the concept in the future. Should I start using Kaplan Q bank starting the beginning of my second year, even if I haven’t covered all of the material yet (for example my MS2 yr covers path, pharm, behavioral science, etc)? If not, when exactly should I start using Q banks to do what you did?

    4)Over this coming Summer, I was planning to devote an hour a day reviewing your STEP 1 Anki deck. Should I review the cards that I have not yet covered in class? Or should I just review the subjects that I have already covered my first year (e.g. micro, immuno, etc), and wait until I cover the other subjects during my school year?

    I would really appreciate any tips you might have for me,

    Thanks!

    Jose

    • Yousmle

      These are fantastic questions. I apologize for the delayed response, as we just celebrated the birth of our first child, so things up and pretty hectic. I started to compose a response here, but it became longer and longer (it was combined with other questions, some of which were also from you). You can see the article here:

      https://www.yousmle.com/first-year-medical-school-usmle-step-1-studying/

      Hope all is well!
      Alec

      • Jose Ting

        Alec, Congratulations on the baby!!! And also thank you very much for your response. If I come up with more questions I will let you know.

        • Yousmle

          Thank you so much!

  • DonDraper

    Hi Alec,

    I also appreciate the advice on this website. I’m looking for the most productive strategy for using your Step 1 Anki deck. I’ve read some of your articles and you recommend using 2 decks (pharm and non-pharm) and changing the settings to 40 new cards/day and 9999 maximum reviews/day.

    However, I’m looking at your step 1 deck right now and see that the content has been separated into many small decks by subject. I’m wondering what my Anki settings and daily goals should be given my personal situation. To give you an idea of where I’m at in school, we’ve covered behavioral, genetics, biochem, histology, micro, immuno, etc. ​Is there a way to merge the small subject decks for the classes I’ve already covered and work on those? Is that a good idea or should I do something else?

    Thanks!

    • Yousmle

      You can certainly move the cards from the individual decks so that they are into one large deck. However, if you just click on the overall deck, you should be able to study all of the cards that are due in all of the individual sub decks.

  • Lewis

    Hi Alec, love your website!
    I want to share an advice: I use a lot cloze deletions on Anki, and this allows me to be tested on little pieces of information and at the same time to have a general overview of the associated information (in the image I give an example with a table about the management of pulmonary embolism). I think it is much better than separating related pieces of information into different cards. What do you think?
    .

    • Yousmle

      Very interesting. I personally never used cloze, just because I found myself memorizing the information based off of the context, and not really retaining the information when I really needed it most. If it works for you, though, I think your system looks very good!

  • Jose Ting

    Alec, I was studying your micro cards and I came across this one:

    Most important cause of arbovirus-associated viral CNS infections? Virus family?West Nile Virus

    Flavivirus

    MC what?

    What is MC?

    • Yousmle

      Most common.

  • Jy

    Hi Alec, i hope you re doing great. I spent the last few days making my own pharmacology anki cards based on the principles you discussed in “Mastering Pharmacology cards over a glass of Wine” where you mentioned an example of Hydralazine and making around 6 cards for each drug. I followed similar principles and made my own anki cards for the pharmacology part at the end of some of the organ systems in First Aid (So far imhave made CV section -211 cards, Hematology and Oncology -160cards, GI – 86). I had a couple of questions that were bothering me for some time now and i will be grateful if you can help me out. I seem to have made the cards but i m not sure on how to start studying them.

    1.From your experience with Anki, first aid, and students, Is the number of the cards under each section enough, or are they too many? I covered every drug mentioned in First Aid. I tried linking and making sense out of the toxicities of some of the drugs, and their clinical uses but couldnt do that for each of them, so i just made forward and reverse cards for those parts. I also wished to ask you, for a list such as this, what will be the most effective way of making an Anki card? For instance, this is what i did…
    Front card: HMG-CoA reductase inhibitors examples?
    Reverse card: (lovastatin, pravastatin,
    simvastatin,
    atorvastatin,
    rosuvastatin)
    what class of drugs?

    Is this how it can be most effectively done? Also, some drugs have numerous clinical uses(apprently, with no obvious connections that can make remembering easy), and when i make cards for that, it also comes off as some list…

    2. You also mentioned that we should set the number of new cards to 40 per day. how exactly does it work? While i was making the cards, the default number was set at 20, but i was making around 100 cards a day. Shouldnt Anki have blocked me from adding new cards when i reached 20? Also, what exactly does setting the number of reviews/day to 9999 mean? Assuming i m studying my Cardiovascular deck with 211 cards, how will that work?

    3.After completing my Cardiovascular deck, i tried testing my cards by trying “Study Deck”, but for some reason, none of the reverse cards was showing. However, when i browse through my deck, I do see card 1 and card 2 for each of the reverse cards i made. Are they stacked in the end of the deck? I was also wondering should i study it that way,(the cards appear in the order i added them, which is the order in first aid) or should it be random?

    4. In the end, i wished to ask you how do i most effectively begin studying my decks, such as my cardiovascular pharmacology deck…assuming i wish to study pharmacolgy anki cards for just one hour in the morning each day? Do i need to do any settings in my Anki software?(i have them on my Android phone)
    Also, i plan to start making my Uworld anki card deck, which i plan to study in the evenings, (pharma decks in the morning). will it possible to do that simultaneously on the same device, or will i have to study them on another device’s Anki software?

    Thanks for everything. 🙂

    • Jy

      I think i figured the answer to question 2, 40 is the number of new cards out of the whole deck to display each day. 🙂

      • Yousmle

        Hi Jy,

        Wow, lots of questions.

        1) I would recommend this article: https://www.yousmle.com/how-to-master-pharmacology-for-the-usmle-step-1-over-a-glass-of-wine/

        2) That is correct!

        3) Assuming you made the reverse cards, I’m honestly not sure why. You can always ask the Anki support people, who are much better at these kinds of questions.

        4) You can make cards on multiple devices, just make sure to sync the cards whenever you are finished, so that there is only one version of the cards.

        Alec

        • Jy

          Thanks so much for the reply. I have now figured out most of the things that kept on confusing me. You made mention of trying as much as possible to make pathogenesis to presentation cards. Can you please recommend some websites/resources that you find useful in this regard? Was wikipedia the only major one?What’s your thought on using medical dictionaries and stuff like Medscape? I’m sorry to be bothering. You have been the nicest and most helpful person that i have found so far and i appreciate all the help.

          • Yousmle

            Thank you for your kind words. Honestly, for making my own deck, I used every source I could find – many of the things I got from lectures, from discussions with professors, from “pearls” I heard on rounds/morning report. I would try and verify everything I learned by some other source, ideally a primary source if possible. Wikipedia is fine, as is Medscape – the key is to find the best explanations that really seem to make sense.

  • Jose Ting

    Hey Alec,

    I have run into the situation where I am making more new Anki cards than I am reviewing a day (I set my limit to 40). The problem is that say for example, if I have 120 new cards made at the beginning of the day, I will only review 40 of those 120 in one day, but Anki seemingly keeps showing me the NEWEST cards I make. In other words, I am not really covering the “old” new cards. But my cards kind of build on each other, so the “old” new cards contain knowledge that is helpful for answering the “new” new cards. I don’t know if that makes sense to you. I will elaborate below.

    Say I make 60 new cards on day 1 (we will call those cards 1-60). Then on day 2 I make 60 more new cards (so I have 61-120). On day 2 I will review 40 new cards, but Anki seems to be showing me cards 81-120, so I reviewed some of those new cards, but only the newest. Then on day 3, I still have cards 1-80 that I have not seen, but I will make 60 cards again (1-80, 121-180), but Anki will only show me the newest ones (141-180). So you can see that if I continue making more new cards than I learn each day, it appears that I will never learn those “old” new cards (1-80).

    Eventually, I will catch up if I stop making new cards, but currently I am getting closer to exams, so that is why I am making more cards each day than I learn.

    Main question: Is there a way to get Anki to show me the new cards (mixed in w/ the ones I am reviewing) in the order that I make them? i.e. can I learn cards 1-40 before they show me cards 81-120? Sorry if this seems very confusing…

    • Yousmle

      Hi Jose,

      Great question! This is something that I have tried to think of myself, but unfortunately, I don’t think there is an option to do this. You can either do the new cards that you created in a random order, or in the order that you made them.

      One alternative is that you can manually force the new cards you want to see into reviews. For instructions on this, see my article here: https://www.yousmle.com/how-to-force-anki-to-review-particular-cards-without-waiting-for-them-to-show-up/

      Alec

      • Jose Ting

        Alec, I came across this on the Anki guide:

        “Order controls whether Anki should add new cards into the deck randomly, or in order. When you change this option, Anki will re-sort the decks using the current option group. One caveat with random order mode: if you review many of your new cards and then add more new cards, the newly added material is statistically more likely to appear than the previously remaining cards. To correct this, you can change the order to ordered mode and back again to force a re-sort.”

        Just wanted to share that.

        • Yousmle

          Awesome – thanks for the info!!

  • Becky

    hi Alec,

    i’m having problem pasting on my Anki, any solution.

    • Yousmle

      Hey! I responded to your e-mail a while ago – I hope that this resolved your issue!

  • disqus_Kx3X0ACpUi

    Hi Alec,

    Your website is very informative and I am in the process of trying to establish anki cards for MCAT. If you could give me your opinion, that would be great.

    I know that I shouldn’t make lists for anki flashcards, but how would you use Anki to memorize stages of something? As of right now I am making one flashcard for the stages, and each individual one for the definition of the stage, for example:

    Erikson’s ten stages??

    • Yousmle

      Good question. Typically, it doesn’t work to put so much information into one card, which I think you understand. I might try making double-sided cards, something like the following, for efficiency:

      Front: Trust vs. mistrust – age?

      Can I trust the world?

      Back: 0-1 year

      What Erikson Stage? What existential question?

 

ROCK MICROBIOLOGY, even if you SUCK AT MEMORIZING!

With the FREE micro deck of more than 130+ Anki cards you will be practically BEGGING to get as many micro questions on your exam as possible.

it's free!
100% privacy guaranteed, no messin' around