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Med School Anki: Make (or Find) USMLE-Crushing Flashcards

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by Alec Palmerton, MD in Beginners
Med School Anki Theory vs. Practice

Most students will have tried Anki in med school. There is a good reason: spaced repetition helps you remember anything, forever. I can still remember (and use) the majority of things I’ve made into cards since my first year at Stanford. I scored 270 on the USMLE Step 1 and received honors on all my 3rd-year shelf exams. As a resident at Harvard-MGH, my ability to help actual patients improved dramatically.

But for every story like mine, there are dozens of students who never use Anki effectively. Instead of Anki improving their understanding, they are stuck memorizing tedium. They’re buried under a mountain of mindless flashcards, some of which they made. Or maybe they cram details from Zanki, Brosencephalon, or other pre-made decks.

Often, students cramming details will find limited success on Boards and in the Match. When faced with real patients, their buzzword knowledge will fail them.

So how can Anki be so effective in some cases, but so awful in others? As an amusing attending once noted: “it’s the wizard, not the wand.”

In other words, even the best tool in the world will fail unless you use it effectively. Anki is no different. Memorize random facts, and you won’t magically apply key concepts on an exam. However, Anki can help you reinforce things you’ve already learned and understood.

In this article, we will discuss:

  • Why (good) Anki cards are among the strongest evidence-based study techniques
  • Five principles to make better Anki cards to improve your understanding and scores
  • The most common mistakes people make when making (or choosing) Anki cards
  • Real-life examples of excellent and bad Anki cards
  • How to spot good (and bad) pre-made Anki decks
  • Much more

Table of Contents

Med School Anki: What’s the Evidence?

You may be contemplating using Anki in med school. You may have heard of successful (or unsuccessful) students who used it. But, before you take the Anki plunge, what is the evidence behind it?

Studies have looked at Anki in med school. They often compare med students’ Anki use vs. “typical” practice. (Med students who use spaced repetition typically do better). However, proving something is BETTER is different from showing something is the BEST.

Instead, there are excellent reviews on the best educational techniques. I’ve adapted one such study, which looked at the learning techniques with the most robust evidence.

Evidence-Based Techniques to Maximize Learning

SummarizationWriting summaries (of various lengths) of to-be-learned textsLow
Highlighting/underliningMarking potentially important portions of to-be-learned materials while readingLow
Keyword mnemonicUsing keywords and mental imagery to associate verbal materialsLow
Imagery for textAttempting to form mental images of text materials while reading or listeningLow
RereadingRestudying text material again after an initial readingLow
Elaborative interrogationGenerating an explanation for why an explicitly stated fact or concept is trueModerate
Self-explanationExplaining how new information is related to known information, or explaining steps taken during problem solvingModerate
Interleaved practiceImplementing a schedule of practice that mixes different kinds of problems, or a schedule of study that mixes different kinds of material, within a single study sessionModerate
Practice testingSelf-testing or taking practice tests over to-be-learned materialHigh
Distributed practiceImplementing a schedule of practice that spreads out study activities over timeHigh
Adapted from: Dunlosky, John et al. “Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology.” Psychological science in the public interest: a journal of the American Psychological Society 14 1 (2013): 4-58.
Med School Anki: Combining the Strongest Evidence-Based Learning Techniques

What do you notice about the most evidence-based learning techniques? Specifically, of your typical day, how much is spent doing “low” vs. “high” utility techniques?

Most medical students spend most of their time on low-utility techniques:

  • Taking notes (summarizing your textbooks/lectures; “low” utility)
  • Re-reading / re-watching old material (“low” utility)
  • Highlighting / underlining notes/books (“low” utility)
  • Creating / using mnemonics (“low” utility)

If you’re not using Anki in med school, little of your day may involve:

  • Practice testing (“high” utility)
  • Distributed practice (“high” utility)
  • Elaborative interrogation (“moderate” utility)
  • Self-explanation (“moderate” utility)
Med School Anki Theory vs. Practice

Most med students do techniques that are “low” utility. (Good) med school Anki cards utilize most of the techniques with the most robust evidence base.

“Low” Utility Methods Are More Dangerous Than Useless Ones

I can already hear the indignation: “but my note-taking technique works!” “Mnemonics are better than the placebo!” “I got a question right on my last test because I re-watched ____ video!”

Yes, I’m sure those are true. The “low” utility techniques aren’t useless. However, less useful methods are much more dangerous than useless ones. Why? Because we would never waste our time if there were no benefit from something. Would you watch the TV program “The Office” to study medicine? No, of course not – because it clearly would not help you learn medicine. Instead, what holds us back are things that give us some benefit.

Re-reading or summarizing a textbook/lecture isn’t BAD. It won’t cause you to forget something. And therein lies the problem. It’s useful enough that it will convince you not to try something new. Something like using Anki in med school.

(To read The Key to Success in Medical School (and Life), click here).

Anki: Why It Combines Many of the Most Useful Learning Techniques

If appropriately used, Anki for med students combines many of the best study methods. How?

First, instead of re-reading information, you are tested on it. (Practice testing). Because of the spaced repetition algorithm, you have distributed practice.

The best cards also force you to use other essential study techniques:

  • Elaborative interrogation, explaining “why” something is (rather than just memorizing it)
  • Self-explanation, connecting something you’ve learned with another fact

Note that many Anki cards do NOT follow these evidence-based practices. As we’ll discuss later, many Anki cards are “flashcards” that are less useful for Boards mastery.

The Five Rules to Make Boards-Crushing Med School Anki Cards

Next, we will discuss my five rules for making Boards-crushing Anki cards. The first three will help you create basic cards. The last two will make your cards particularly useful for Boards. (And your future clinical practice).

Even if you decide you don’t want to make your own cards, it’s important to know the rules for making good Anki cards. Why? Because if you choose one of the many pre-made Anki decks, you want to choose the best ones.

Here are the five rules behind Boards-crushing med school Anki cards.

Rule #1: Minimize Unrelated Information (1-3 Unconnected Facts)

What’s the common mistake that people make when they start out using Anki cards? Their cards contain way too much information. 

Making cards that are too long hurts you twice:

  • First, because you will have to repeat these cards many more times and repeating cards wastes your time as you review facts unnecessarily; and
  • Second, because you won’t remember the information as clearly

Let me give you a real-life example:

On the front of the card, this student had as the question:

Differentiate the infections by the causative agent and describe the rashes’ location/direction of spread. Also explain unique findings. 

    • Rubella 
    • Erythema infectiosum 
    • Roseola infantosum 
    • Hand/foot/mouth disease 
    • Scarlet fever 

And as the answer:

    • Rubella (rubella virus) head to trunk to extremities, cervical LAD
    • Erythema infectiosum (5th disease, Parvo B19) – Red rash on cheeks (slapped cheeks), lacelike rash on trunk/extremities
    • Roseola infantosum (6th disease, HHV 6) – rash from trunk to periphery
    • Hand/foot/mouth disease (coxsackievirus 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: Long Cards Waste Time and Hurt Recall

The above card is well-intentioned. We’ve all been there. We’re studying the viral red rashes of childhood, and want to connect the information. We like seeing everything together without fragmenting it.

Trust me, I get it. However, by making such long cards, we will waste a lot of time repeating information we know already.

For example, let’s say they could recall everything about the first four diseases. Not only did we know the condition, but also the causal agent and its presentation. But what if we forgot the information for Scarlet Fever? If we wanted to ensure we could remember the last disease, we would need to repeat the entire card. We would review 80% of the information we knew well, just to remember the 20% we forgot.

Repeating Things You Know = Waste of Time

Reviewing what you know well already is a waste of time. Imagine you knew 80% of a textbook, but didn’t understand 20%. Would you want to re-read the entire book, just to get the final 20%? Of course not. Then why would you do that with your Anki cards? By making shorter cards, you ensure if you repeat a card, most of the information will be things you didn’t know.

Second, with such long cards, the desire to move on so we don’t have to repeat it is quite strong. Maybe you understood 60% of the card, and you feel time-pressure. It’s easy to lie to convince ourselves and say we know the card when we should really review it again. Thus, we let our standards slip for how well we have to understand the information to hit “good” or even “hard.”

Break Up Long Cards Into Shorter Reviews

The best way to recall information-dense topics is to make separate cards out of the facts. One example would be:

Rubella – Identify the causative agent and describe the location/direction of spread.


Rubella virus – head to trunk to extremities, cervical LAD

You could then do the same thing for the other diseases. Making more, but shorter cards:

  • Speeds up reviews
  • Improves recall for the few facts (as opposed to a cursory recall of many facts) and
  • Minimizes unnecessary repetition of information I already know
“But don’t you have to make more cards this way?”

Making shorter cards will increase the number of cards you make. But what really matters isn’t the number of cards, but how long your reviews take. Making more – but shorter – cards actually reduces the review time.

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

This may vary person-to-person. As a rough approximation, it should take you roughly:

  • 1 hour to review 100 “old” cards. (Cards you have studied previously).
  • 1-2 minutes per “new” card (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: Each Question Should Have a Single, Unambiguous Answer

Try this sometime: think of a popular song. (E.g., Mary Had a Little Lamb). Now, instead of using the actual tune, tap the rhythm out on the table with your hand. Then get someone to try and guess what song you’re tapping out.

What happens? The person will have no idea what you’re tapping, but you’ll think it is so obvious! Why? Because what is in your head isn’t communicated to the listener.

The same is true when you make flashcards. You’ll make a card and know EXACTLY what you mean. It’ll be so obvious to you what you’re asking. Except that in a couple weeks, you’ll look at the card, and have no idea what you’re asking.

Instead, make a clear question with a single unambiguous answer. Doing this will help you avoid the next two most common med school Anki mistakes.

If your cards don’t have a clear question, you’ll look at it with a blank stare later.

Blank Stare USMLE Step 1 Anki

If you make a question without a single, unambiguous answer, you’ll end up staring at it blankly

Mistake #2: Unclear/Ambiguous Question

Here’s a sample card that does NOT have a single, unambiguous answer.


Oral hairy leukoplakia



To you, it might seem obvious that it is a bad question. However, in reality, I see this problem all the time! Why? Because we assume “future us” will know the answer.

Make Clearer Questions for Better Med School Anki Cards

Like most Anki mistakes, most people will realize their errors eventually. You’ll see the card in a month, and think, “huh, what is this asking?” The solution to ambiguous questions is clear: make clear questions! Instead of asking, “oral hairy leukoplakia” like the question above, try something like,

“Oral hairy leukoplakia – what is the infectious cause?”

Note, however, that you can make questions too obvious. So obvious, in fact, that they take away the difficulty in testing yourself.

Mistake #3: Giving Away too Much Information in the Question

Here is an example of a question that gives away too much information:

Hyperventilation would cause what kind of alkalosis?


Respiratory alkalosis

Let’s say I was trying to remember the effects of hyperventilation. I would want to remember not only that it would be respiratory and not metabolic. I would also want to remember that it would cause an alkalosis.

While this is an obvious example, it happens too often. I will write a question, only to review it later and find I’d given away the answer!

Instead of the question above, ask:


Hyperventilation – has what effect on acid-base status? Why?


Respiratory alkalosis. Hyperventilation → CO2 exhalation ↑ → PaCO2 ↓ (respiratory alkalosis)

Notice how I am testing myself on:

  • What kind of acid-base change it is
  • Whether it is metabolic or respiratory

The more you’re forced to recall, the more you’ll remember. This brings us to our next rule.

Rule #3: Test Information Explicitly If You Want to Remember It

Finally, I wanted to highlight one common mistake that I made when I began to use Anki. It is a variant of the first mistake (too much information). Specifically, I would cram everything into the answer and expect to remember it all.

This was one of my first cards. (I cringe when I look at it).


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


Both PARAMYXOVIRIDAE. Parainfluenza – CROUP (laryngotracheobronchitis) – gradual onset, fever, barking cough, inspiratory stridor (wheezing sound), hoarse voice, variable progression. Has mixed neuraminidase and hemagglutinin, 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 Recall Something That Wasn’t Tested

The above card has way too much information. What’s worse, this was the only card I had that listed the viral causes of croup/bronchiolitis.

Do you think I remembered these facts when they counted? Nope. And why? Because I had this misguided thought that if I saw something enough, I wouldn’t forget it.

Remember: you will only remember what you 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?”

Let’s say you find a fact that is interesting, but not interesting enough to try and remember. You CAN leave information for yourself in cards, in case you want to reference it later. Just don’t expect to remember it in the future!

Rule #4: Ask, “Why?”

USMLE questions ask you to apply essential concepts. They minimize questions about specific facts. (You can read about the NBME’s question writer’s guide if you don’t believe me).

So what does that mean for your med school Anki cards? That you should ask, “why?” as much as possible. Not only is asking “why?” one of the evidence-based study techniques listed above. It will also help you get a higher Boards score.

Let’s take a simple example from women’s health: syncytiotrophoblasts. (Syncytiotrophoblasts are the cells that cover the chorionic villi in the developing embryo).

A simple card that didn’t ask, “why?” might be something like this:


Syncytiotrophoblasts – what are they? Where are they located?


Layer of epithelial cells that surround the chorionic villi in developing embryo

This card isn’t BAD. There’s a clear question, without too much information. It follows the basic med school Anki card-writing rules.

However, do you really understand syncytiotrophoblasts from this card? Is this likely to help you answer Boards questions? Probably not.

Asking, “Why?” Deepens Your Understanding

Instead, let’s see what happens when we ask, “why?”


Syncytiotrophoblasts – what are they? Where are they located? Why?


Layer of epithelial cells that surround the chorionic villi in developing embryo

These cells form a syncytium. (Essentially one long giant cell. “Syn” = together, “cyto” = cell, so syncytium literally = “together cell”). Because the cells have fused together to form a giant cell, there are no intercellular gaps. This lack of gaps is what creates the “blood placenta barrier.” Thus, maternal immune cells can’t cross the placenta to attack the developing baby.

What do you notice when you ask, “why?” You finally start to understand! Yes, it might take you longer to make/review this card. However, the payoff for your retention, Boards scores, and clinical practice is immense.

This leads us to our final med school Anki card rule: make connections between concepts.

Rule #5: Make Connections Between Concepts

One reason that learning medicine is so tricky is that everything is related. (It’s also why learning medicine is fascinating). Understanding cardiology before you’ve learned about the lungs is difficult. Yet that’s precisely what a first-/second-year med student must do!

As discussed above, one way to improve our learning is to make connections. The fancy term for this is “self-explanation.” It means that you relate something new you’ve learned with something you already know.

So how can we connect syncytiotrophoblasts with something we already know? By tweaking the previous card to relate it to immunology.


Syncytiotrophoblasts – use what they are to explain their location. Specifically, explain how they would interact with the maternal immune system.


Layer of epithelial cells that surround the chorionic villi in developing embryo

These cells form a syncytium. (Essentially one long giant cell. “Syn” = together, “cyto” = cell, so syncytium literally = “together cell”). Because the cells have fused together to form a giant cell, there are no intercellular gaps. (Recall that immune cells migrate BETWEEN cells in a process called diapedesis).

This lack of gaps is what creates the “blood placenta barrier.” Thus, maternal immune cells can’t cross the placenta to attack the developing baby.

How often do you try and relate one topic to another? If you’re like most med students, you don’t see the connections enough. And it’s not your fault! Too few med school lectures explain the “why.” Instead, our professors focus on the “what.”

To read more about how to learn why something is, I recommend:

(To read UWorld + First Aid: 4 Keys to Mastery (#4 Bumped Me to 270 from 236), click here).

Pre-Made Decks: How to Spot Winners?

One med school Anki theme is how hard it is to make your own cards. Even to make basic cards – without asking “why?” or making connections – is difficult. Finding the explanations, then turning them into good Anki cards, is time-consuming.

So it’s tempting to use pre-made Anki decks. I totally understand! You may have heard of Zanki, Brosencephalon, or any number of med student-made Anki decks. Before you use them, however, I caution you to think about the most effective study techniques.

Most med student-made Anki cards are what I call “flashcards.” They are simple and follow the basic med school Anki card-making rules. They’ll have a simple, fact-based question. Here’s a typical example of a pre-made card from one of the above decks on syncytiotrophoblast:

Typical Zanki Card on Syncytiotrophoblasts

Here is a typical pre-made med school Anki card. Notice how it will help you memorize a fact, but do little else.

Is there anything wrong with this card? No. There may be a question that asks you about choriocarcinoma and hCG. (Although again, such a simple question is unlikely to be on your test). The problem is that it does not help with making connections.

Pre-Made Med School Anki Cards Ignore Connections and Don't Ask Why

Most Pre-Made Med School Anki Cards Ignore Connections and Don’t Ask, “Why?”

Pre-Made Cards Would Be Better if They Asked, “Why?”

But what does the typical pre-made card NOT do? It doesn’t tell you WHY. There is no connection!

A better, evidence-based card would give you an explanation and a connection. Something like:


Choriocarcinoma – use what cells it is derived from to explain what hormone is elevated. Why would it make sense that these cells would secrete this hormone in the first place?


hCG is elevated

Derived from trophoblastic tissue (including syncytiotrophoblasts). Syncytiotrophoblasts secrete hCG to prevent loss of the corpus luteum. Thus this tumor is associated with elevated hCG.

Syncytiotrophoblasts invade the endometrium. Their successful invasion depends on progesterone/estrogen. During the first trimester, progesterone and estrogen are secreted by the corpus luteum. Thus, it makes sense that syncytiotrophoblasts (and choriocarcinomas) secrete hCG.

What do you notice? First, the second card is longer. That might seem like a disadvantage at first. I mean, it is so much SIMPLER just to memorize a fact. And there are some facts you will need to remember.

However, like most things in life, you get what you put in. If you memorize details, don’t expect to understand USMLE vignettes magically. Instead, given the USMLE’s emphasis on mastery, take the time to learn it well the first time. Because the worst studying is studying you’ll repeat since you didn’t learn it well the first time.

Pre-Made Anki Cards with Explanations and Connections

Are you overwhelmed with the idea of making your own Anki cards that explain “why” and not just “what”? Use the Yousmle Cards. Master explanations and connections to maximize your Boards score in the shortest time.

Want to Learn the Right Way From Day 1?

Does this sound familiar? You’ve poured time, energy, and money learning everything only to realize you didn’t learn it right the first time. You ask yourself, “what do I do now? Take more time that I didn’t have in the first place to learn it all again?”

No one wants to be panicked and cramming during their USMLE dedicated study. Yet that’s what happens every year.

What if I told you there is a better way to master the material once – and never forget it?

In the Yousmle Online Course, you’ll learn how to save time, get higher scores, and open the door to more impressive residencies. How? By learning the right way from Day 1.

The Online Course allows you to not only master the most Boards-critical knowledge but gives you the skills to learn anything and remember it forever. The earlier you start the better! If you were training for a marathon and wanted to be at the top would you wait until the last month to get a coach? No! You would start at the beginning with a coach who has the knowledge, experience, and passion to give you the highest possible outcome. Having the right techniques to study smarter and not harder from the beginning is a life-changing opportunity.

To be steps ahead of the competition and master more in less time – sign up for the Online Course today.


There you have it!  Here are the five rules for making (or finding) Boards-crushing med school Anki cards:

  1. Minimize Unrelated Information (1-3 Unconnected Facts)
  2. Each Question Should Have a Single, Unambiguous Answer
  3. Test Information Explicitly If You Want to Remember It
  4. Ask, “Why?”
  5. Make Connections Between Concepts

Concluding Thoughts

One of the most common mistakes med students make is they are in a rush. Everyone feels behind. Instead of mastering information, they’ll try to cover it quickly.

Using Anki in med school is no different. Most students will balk at taking the time to understand material and using Anki as a way to remember it. Instead, they’ll take short-cuts. Instead of mastering the material, they’ll try for multiple “passes” of the material. And there are tons of pre-made Anki cards that will cater to this memorization-crowd.

Instead, remember that the best studying you can do is the studying you won’t have to repeat again. Whether you decide to make your own cards – or use a pre-made deck – be sure to make cards that ask, “why?” Even better, try and make connections between concepts. Not only will you learn the material better, you’ll set yourself up for much higher Boards scores.

Photo by Andrew Malone.

  1. Mackenzie says:

    Former student here. I am now in
    residency and having a hard time turning our study guides for the in training exam into anki cards. Any suggestions? I want them to be meaningful, but am having trouble making them right amount of information

    1. Yousmle says:

      Hi Mackenzie! Great to hear from you – fantastic question. The best advice I can give without seeing the actual cards / information is that you should try and make connections. Things like, “TTP – use the pathophysiology and severity to explain the treatment,” the answer being “Fundamentally it is an autoantibody disease – and a relatively severe one – so it would make sense that you would use a technique to remove those antibodies asap to prevent further damage, like plasmapheresis”

      You COULD make a card that just said, “TTP – what is the treatment?” but it’d be harder to remember, and less likely to help you with other topics.

      Hope this helps!

      Dr. P

  2. Nidhi Jain says:

    Hi Alec, I’ve been following your blogs since I started my prep., gone through all them now and even read your book on USMLE Step1 prep. It feels like you are speaking directly to me and each point you say adds alot of value and encouragement.
    I’m trying to design my Anki cards, however am getting confused with the advice given on 2 blogs – UWorld + Anki (where it is suggested to make lengthy but meaningful pathogenesis-presentation and less no. of cards for a topic) v/s this blog (here encouraged to make straight forward, short and multiple cards for a topic).
    Which one is to be followed? It would be very helpful if you could please shed some light on this.

  3. Bharat Rawlley says:

    Just purchased your 3 decks, You have any opinion on the intervals we should keep? like the graduating and easy interval is 4 days by default. Do you recommend anything else? Thanks!

  4. Keith says:

    Hey Alec.

    Im only a few days into the program. I have to say its exhausting and even though I am very used to anki and doing questions, your strategy requires patience, recall, and focused work on weak areas which most of us tend to ignore while studying things we enjoy.

    My Step1 exam was scheduled just over 2 weeks from today before I begin my first clinical rotation but I decided to postpone the date. Thankfully I have more time after this rotation because progress flatlined for 3 weeks and I did not know what to do. I can name a number of reasons why I knew it was the right thing to do as I am sure you probably already knew. What really made me stop and think was all of my extrinsic motivations that you mentioned in the videos. They were all wrong causing anxiety and zapping my confidence if a score wasn’t what I thought it should be or if I missed a question I knew the answer to. I started beating myself up instead of learning from my mistakes which is really what medical school is all about. On top of that I’m packing to move again and for the first time I will be away from my wife and 2 kids for 8 weeks during this clinical. The timing was completely wrong and I knew this because it was difficult to focus.

    Ultimately I want to become a better student and a better doctor. I hope you can offer some advice as I transition into this rotation that will not only help me with new challenges and material but also with my Step 1 exam later this year.

    Thank you for all the help.


  5. Karlee Kirkpatrick (IL CCOM 21 says:

    Dr. Palmerton,

    I liked your Cardio Starter Deck so much that I bought the Step 1
    Deck. I really wish I had known about these as a First Year!
    Obviously, I already started on the Cardio Starter Deck. Should I
    switch to the Cardio deck in Step 1? What is the difference between
    the two?

    Have a great rest of your day

  6. Busola Olabiran says:

    Really great post! As you have amazing anki cards already and I’m starting step 1 prep very earlier (one could argue too early) would it be better to teach myself the relevant content, using the resources you’ve highlighted and then use the cards you have already created to consolidate my knowledge? Or should I attempt to create my own? Or perhaps a mixture of both? Creating new cards to fill in any gaps that I’m taught in uni that way I’m preparing for the steps whilst preparing for exams from uni

    1. Yousmle says:

      Ideally both – I’d start by using the Step 1 and Pharmacology cards, but then once you get the hang of how to use it, how to best make cards, then I’d make cards of your own, since you are starting so early and have the time to make/do more cards than are just in those two decks.

  7. disqus_Kx3X0ACpUi says:

    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??

    1. Yousmle says:

      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?

  8. Becky says:

    hi Alec,

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

    1. Yousmle says:

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

  9. Jose Ting says:

    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…

    1. Yousmle says:

      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:


      1. Jose Ting says:

        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.

        1. Yousmle says:

          Awesome – thanks for the info!!

  10. Jy says:

    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,
    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. 🙂

    1. Jy says:

      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. 🙂

      1. Yousmle says:

        Hi Jy,

        Wow, lots of questions.

        1) I would recommend this article:

        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.


        1. Jy says:

          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.

          1. Yousmle says:

            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.

  11. Jose Ting says:

    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


    MC what?

    What is MC?

    1. Yousmle says:

      Most common.

  12. Lewis says:

    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?

    1. Yousmle says:

      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!

  13. DonDraper says:

    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?


    1. Yousmle says:

      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.

  14. Jose Ting says:

    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,



    1. Yousmle says:

      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:

      Hope all is well!

      1. Jose Ting says:

        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.

        1. Yousmle says:

          Thank you so much!

  15. Yousmle says:

    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!

  16. Enki says:

    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 ( 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,


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