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Anki for Med School: Why Is It So Hard to Do (and Why That’s Good)

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by Alec Palmerton, MD in Anki, Plan

What if you could learn anything well – never forget it – and learn how to apply it? What would your test scores be? How much easier would it be to answer questions on rounds or care for patients? How much more time would you have in the day? If you’ve pondered these questions seriously, you may have heard of Anki in med school.

Anki – and spaced repetition broadly – holds immense promise. Who wouldn’t want to remember anything forever? And to do it in the most efficient manner possible? Sounds too good to be true.

When I heard about Anki during my first year at Stanford, I was intrigued and skeptical. 13 years later, after a residency at Harvard-MGH, I’m still doing my cards daily. It was a struggle early on, and I made many mistakes. Yes, I moved through new material slower than my classmates and felt odd not cramming for tests. And yes, I had to be diligent and do it every day, even on my wedding day.

But, the benefits have been remarkable. Consider that I:

  • Have made 19,000+ cards and can remember virtually all of them,
  • Can learn any new topic much faster and more efficiently because I can relate it to everything I’ve learned in the past,
  • Scored in the 99.9%ile on Step 1 before it was pass-fail,
  • Honored every third-year shelf exam, and
  • Didn’t have to learn anything new in the weeks leading up to the Board exams (Step 2 CK, Step 3, and anesthesia written exams) I took since Step 1

How much do I study daily to retain everything important I have committed to remembering since my first year at Stanford?

30-60 minutes/day.

Intrigued? Read on.

Table of Contents

Med School Anki: The Promise and the Challenge

What would YOU instead do:

  • Cover material 3x faster, OR
  • Retain what you’ve learned 20x better?

Theoretically, we would all choose to 20x our retention. Practically, though, this isn’t easy to follow through on. There is a technique (spaced repetition) that can 100x how much you can remember. Yet paradoxically, most people don’t use it effectively – or at all.

How Do Spaced Repetition and Med School Anki Work?

You probably have already heard of spaced repetition and/or Anki. If you haven’t, the general idea is that you can maximize how much you retain by reviewing it before you forget it. And since the rate of forgetting decreases with every review, we can memorize an ever-increasing amount of information. Spaced repetition programs like Anki exist to remove our need to calculate when we need to do our reviews.

For more on using Anki in med school, see this article.

Why Is Retention So Hard?

Why do most people not take the time to learn spaced repetition properly and stick with it? Three reasons stand out:

  • There aren’t effective models for how to make cards that aren’t just regurgitation of facts (e.g., Zanki, Brosencephalon, Anking, etc.);
  • We’re wired for survival, not success; and
  • Learning something new is more straightforward to measure than not forgetting something old

Med School Anki Models Make People Go Crazy

It’s hard to beat free, especially when it promises to do most of the work for you. As such, many popular pre-made Anki decks are floating around the interwebs. Every year new decks come out, like Zanki and Brosencephalon.

The premise is simple: they turn all the high- and (sometimes) medium-yield information into Anki cards. All you have to do is to learn them, and you’ll remember them forever.

Sounds great, right?

In theory, yes. However, many students complain about the rote memorization-heavy approach. Do we need to memorize the genetic inheritance pattern of every single disease? Wouldn’t it be easier to learn the general concept/mechanism behind genetic inheritance patterns and then apply it to most conditions?

Regurgitation of Facts is OK for Flashcards, but Poor Preparation for the USMLEs/Life

Regurgitation of facts would be ok if that were what it took to be a good doctor or score well on the USMLEs. However, that is far from the truth.

Ana de Armas was supposedly in an English-language movie (War Dogs) before speaking English. To learn her lines, she memorized them each phonetically. It was okay (albeit much work) until some lines had to be re-worked.

Memorizing her lines without understanding their deeper meaning meant she couldn’t adapt. Eventually, she learned English “because [her] life depended on it.”

Memorizing facts is no different for the USMLEs. It may be slow and inefficient, but it works as long as the circumstances don’t change. However, the process falls apart when the details change – which they inevitably do with patients and the USMLEs. Our ability to adapt is compromised, and we get confused by the deluge of clinical information in the vignettes or charts.

We’re Wired for Survival, Not Success

Re: our evolutionary wiring, it isn’t easy to adapt to anything new. For myself, the inevitable ups and downs when trying a new thing will set off my fight-flight response. I’ve realized more and more that I justify not taking a particular action because I am afraid of rejection or making mistakes.

I’m not alone. How often do we allow doubt to paralyze us into continuing on the path we’ve always been on, even when what we’re doing isn’t working? Or let the discomfort of trying something new and failing get in the way of learning something that could change our lives?

Learning Something New Feels Like Real Progress; Not Forgetting Something Does Not

In addition, retention is problematic because it is harder to measure. If I cover ten pages in First Aid, I FEEL accomplished, even if I forgot ten pages of different topics. If I retain 100 pages, I feel much less accomplished. Even though the net change in my knowledge is vastly more in the latter scenario, my PERCEIVED change is less. As such, it is much harder to focus on retention.

But Med School Anki Can Change Your Life

When I started Anki in med school, I knew I would likely fail many times. And I did. I made horrible cards. I got suckered into the apparent speed of memorizing lots of information. And I spent lots of time having to learn how to make better and better Anki cards.

It was painful, and I considered giving up.

But by persevering, my life changed. Instead of relearning everything for every Board exam, I could take the knowledge I’d already acquired and pass, often doing much better. For example, I scored in the top 10% of the anesthesiology residents on our first national written exam. All I did was remember my med school knowledge and supplement it along the way.

And as time went along, my review time decreased. Initially, when I was learning more, I would have to spend 3-4 hours to remember everything I’d learned. However, with each review, your recall improved; I would study less with every passing week. When I entered clerkships, I only needed to review roughly an hour daily to remember everything. And by the time I was a resident, it was down to approximately 45 minutes/day.

How Different Would Medical Training Be If You Never Forget What You Learned?

It’s hard to overstate the benefits of learning something well and never forgetting it. Learning medicine is like studying a structure as you descend a spiral staircase. You will see the same information repeatedly but at different depths.

For example, there is little on Step 1 that won’t appear again on Step 2 CK. The organ systems – cardiology, renal, respiratory, etc. – will appear again in most of the subjects in Step 2. Even things like biochemistry, genetics, and immunology show up in pediatrics. By learning and remembering them well the first time, you will be able to gain even greater mastery faster when you see them again.

And consider how much time we spend re-learning something we’ve forgotten. Let’s say it took me an hour to learn something the first time. If I forget it and have to re-learn it, it might take a little less time, maybe 50 minutes. However, if I review something I already know, the time required is much less.

Plus, by knowing more, learning new things becomes so much easier. If you know cardiology well, would you believe it would be faster and easier to learn most things in the lungs and kidneys? And if you understood biochemistry at a deep level, wouldn’t it make studying GI and endocrinology much more productive?

Concluding Thoughts: Med School Anki Is Hard…Which is Good?

So learning how to use Anki in med school is hard. You’ll fail, feel discouraged, and move through new material slower than your friends. Its benefits aren’t immediately apparent, and you’ll have to live with the costs daily.

And that’s great!

If everyone did Anki (well) in med school, there’d be little benefit to using it if you only use it to stand out from the crowd. You’d have to do it to keep up with everyone else. It’d be the equivalent of standing in a crowded theater – the first person to do it would stand out, but once everyone else stood up, we’d all be in the same position as where we started. But is that the point? You want to be a physician and the best doctor you can be. Remembering and mastering concepts, data, and information will serve you well as a clinician, researcher, and medical professional. If everyone is doing it, so be it. All the better for medicine, generally.

But it’s hard to use, which is why few people use it well. Even fewer people stick with it. And that creates an opportunity for those brave individuals who are resilient, can move away from the herd, and will be knowledgeable and flexible enough to apply their skills in many different medical situations.

Want to learn more about this remarkable technique? Schedule a consultation to see how you can turn this challenging technique into something that may change your life.

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.