Anki Sketchy

Sketchy is a powerful visual learning platform designed to retain and apply content for mastering learning material. The Sketchy Method is based on the 'method of loci' – an effective technique proven to increase learning. Really, it's a fancy way of saying you'll be a modern memory champion before you know it.

I'm telling you, Anki = long term memory. The cards in this deck contain small, Sketchy Flashcards cropped portions of the overall sketch – these force you to focus on all of the small details of each sketchy are cards for which I added my own memory hook. Sketchy Microbiology and Sketchy. We would like to show you a description here but the site won't allow us. Sketchy is a powerful visual learning platform designed to retain and apply content for mastering learning material. The Sketchy Method is based on the 'method of loci' – an effective technique proven to increase learning. Really, it's a fancy way of saying you'll be a modern memory champion before you know it. Anki Nicolet Sketchy Flashcards USMLE. Created by Nicolet, who took high scores USMLE. Thanks for making these flashcards on Anki. Sketchy Flashcards are very useful for everyone.

A trend in med school is using pre-made Anki decks with 20,000+ cards that promise to cover 'everything' on Step 1. These include Zanki, Brosencephalon, and a host of others.

The allure is obvious. 'Memorize a gazillion facts, and you'll do great on Step 1!' However, there are many hidden costs (and questionable assumptions) underlying this approach. Here Adam Nessim describes why he started using Zanki – and why he stopped.

Here is Adam Nessim:

How I Came to Use Zanki

When I first came to medical school, I heard about Anki. It uses spaced repetition so you can memorize enormous amounts of information. You'd do well in your classes and ultimately the USMLE Step 1. However, the devil is in the details.

Anki sounded like a great idea, so I started to use it here and there to memorize a bunch of facts before each of my tests. It helped in the short term. However, I never ended up continuing to review these cards after the tests. Not studying the cards meant I forget them. This defeated the purpose of long-term spaced repetition altogether!

A few months later I started using the Brosencephalon deck. Many medical students claim to have found success with it in the past to prepare for Step 1. This deck covers most of the facts in First Aid but not everything. I actually liked this deck and was able to get through the cards fast.

The one qualm I had is I found myself memorizing the card more than learning the facts themselves. For example, I often knew the answer after reading only 3 words of the question! I could tell this blind memorization wouldn't translate to boards-style problems.

Towards the end of the year, I heard of this 'amazing' new deck called 'Zanki' which was 26,000+ cards. It promised to cover everything you need to know. Its sources included First Aid, Pathoma, Sketchy, and Kaplan. I then made what I now feel was a bad decision, and switched to the Zanki deck.

I thought to myself 'If I can just learn every single fact in that deck, I must be able to crush Step 1!'

This idea was wrong for 3 main reasons.

(Disclaimer: this post is my opinion. Many claim to use Zanki – and Brosencephalon – with good effect. However, their use conflicted with my study principles. A high Step 1 score is about mastery of the material. For me, mastery of material involves more than memorizing 26,000+ individual facts.)

1. It Was Unsustainable and Driving Me Nuts!

In theory, it sounds great that Zanki has 26,000 cards, and covers everything. However, I quickly realized doing all those cards sucked up all my time.

Over the summer of my first year, I was catching up on topics I had recently done. This included autonomic pharmacology drugs and renal. It wasn't too bad at first as I knew most of the material already. However, to get through these sections, I was adding 150-200 new cards a day to my Anki deck. Translation: I was adding 150-200 cards I needed to review the next day, the day after that, and so forth.

When I came back for second year, I started my neuro course which was an absolute beast. Before I knew it, I had accumulated almost 4,000 cards that went unreviewed.

Goodbye, spaced repetition!

You see, the entire point of Anki is that you do each card on the day that it is supposed to be reviewed. Otherwise, it defeats the whole point. So if I were supposed to review a renal card in 15 days, then for spaced repetition to work, I would need to see it in 15 days! The problem was, with such a backlog of cards to review, I was never seeing the reviews I needed to. I was only seeing the last day or two worth of cards and forgetting the rest.

Ultimately, this quantity of cards was too much for only having a year to go before Step 1. A year sounds like a long time, but not when you are trying to go through such an enormous number of cards and actually review them all. (Even for students who start early, it's not uncommon to hear they study 800+ cards per day.) I was burning out from doing Anki cards, and it was causing me stress that was counterproductive.

2. My Memory Was Too Fragmented

A conventional method for making Anki cards is to break down concepts into short flashcards. Zanki does the same. However, I found that Zanki's way of breaking down content had severe limitations.

By memorizing many little pieces, at best I could recall a specific card. I couldn't piece it all together. For example, I knew whether minimal change disease was nephrotic or nephritic syndrome. (It's nephrotic). I could do this for all the other renal glomerular disorders. However, if you were to ask me what the 5 main nephrotic syndromes were, I'd struggle to create a differential. I also couldn't tell you what the classic presentation for minimal change disease was.

My memory was becoming fragmented. I wasn't able to group content together which is a proven way of helping memorization. And unless a Boards question asked the exact fact on one of the cards, I was afraid I wouldn't be able to answer it.

3. It Didn't Translate Into Mastery of the Material

Memorizing tons of facts does not allow you to think at the level needed to do well on the boards and as a practicing clinician. Yes, I memorized a ton of information. But I couldn't connect it to disease presentation, pathogenesis, and algorithmic treatment approaches.

Don't get me wrong, memorizing is still very important to do well in medical school. It's impossible to make connections when you do not have the basic facts down. However, true mastery of material goes well beyond that. Spending my entire day memorizing facts prevented me from attaining mastery.

Three Changes I Made Since Stopping Zanki

Since stopping using the Zanki deck, I have changed my approach to using Anki. Here are the three significant changes.

1. Reviews First, New Cards Second

First, I am committed to not going too fast with new cards. If it is a decision between finishing my reviews for the day or doing the number of new cards I had planned on doing, then reviews come first. To enforce this, I set my Anki so that all reviews are shown first before I can do new cards. I have come to terms with the fact that I am not going to memorize every single little fact using Anki.

Anki is a great way to supplement your studies, but it should not be the end all be all. Not doing 150-200 new cards a day has given me tremendous amounts of time. I have used this time to do questions from USMLE RX. As I write this, it is November of my second year. My school has covered the basic sciences, immuno, renal, neuro, endocrine, and repro. I do 20 questions a day on these subjects with a thorough review. However, I am by no means consistent with this. Starting January, I will be sure to increase the number of questions I do a day.

2. Cards That Make Connections

My second change is to create cards that force me to make connections. I have been trying to stay away from simple memorization cards. As discussed above, I often memorized the Zanki card itself rather than the information.

Now, I try to connect pieces of information together. For example, a single card may say 'what is the presentation of abruptio placentae? What are possible causes?' My answer might be 'abrupt, painful bleeding in the third trimester. Possible DIC, maternal shock, and fetal distress.' These longer answers take time to get through, and I have seen my speed decrease by about 33%. However, my understanding and ability to make connections has definitely increased.

I learned the importance of cards that force you to make connections and understand disease presentations. Dr. Palmerton from yousmle.com, calls this understanding the pathogenesis to presentation. Dr. Palmerton has examples of these types of cards on his site and even offers a Step 1 deck which I have been using.

3. Decks That Reinforce Other Resources

Lastly, I have been using the pepper Sketchy micro and pharm decks which I love. Sketchy Medical uses cartoons as mind palaces. This allows you to memorize pharmacology and microbiology better. However, as good as these sketches are, without spaced repetition I eventually forget them. Thus, I have been using these pepper decks which incorporate all the videos from sketchy, so that I won't forget them.

I have also been using a random deck based on high yield facts from Boards and Beyond. I love the boards and beyond videos as they are a great way to provide context to First Aid. But again, I need to make Anki cards to help me memorize the information. Some of these pre-made cards are good, but I also like to supplement it with making my own cards.

Concluding Thoughts

Are you like me and do NOT have a photographic memory? If so, then spaced repetition is a must when it comes to reviewing for big exams such as the USMLE Step 1. A great way to incorporate spaced repetition into your studying is by using Anki. However, you must use it the right way!

My grades suffered by not using Anki correctly. Like others, I was memorizing tons of facts at a time. And I still do not think I have mastered the use of Anki. However, I am always trying to improve my study habits. As a medical student, you will find that this is half the battle.

Everyone is different. Many students have done well using a variety of study techniques. Don't be alarmed if your approach is drastically different than mine. I hope through sharing my experience you can take away some valuable information. Maybe you can learn from my own mistakes. Perhaps you've never heard of Anki before and are now willing to give it a try! Either way, I wish anyone who is reading this the best of luck with their studies. Please feel free to reach out with any questions.

Adam Nessim is an MD Candidate at the Albert Einstein College of Medicine in the Bronx, New York. He graduated from Cornell University with a Bachelors of Science with High Distinction where he majored in Human Biology, Health, and Society, and minored in health policy. He blogs at All Things Healthcare. He also shares his journey as a medical student on his instagram @allthingshealthcare.

Latest Update: 20 July 2020.

This short guide pertains directly to the use of Anki with pre-clinical coursework, although some principles may apply to medical training more broadly. This guide also assumes some working familiarity with Anki. If you are looking for a primer on Anki, please access this guide before proceeding further.

Table of Contents

• Principles
• Utilizing Anki for Lecture Content
• Utilizing Anki for Early Step Studying
• Principles for Anki
• Recommended Add-Ons
• Additional Resources

Principles

The use of Anki during pre-clinical training depends entirely on one's study objective, which can be conceived of as lying along a spectrum:

At one end, the priority is placed entirely on studying for Step 1 and shelf exams, while on the other end, learning lecture material is the sole focus. (Increasingly, fewer medical school curricula 'teach to the test' and thus may omit several topics that are relevant for board examinations from lectures.)

The majority of pre-clinical students likely find themselves in the middle of this spectrum, aiming to establish a good grasp on lecture content while also steadily preparing for Step (see Approach 3 below).

Approach 1: Early Step Studying

You are already planning on pursuing a competitive speciality; you are particularly Type A and like being 'ahead of the curve;' you enjoy standardized examinations and are comfortable with less-than-perfect performance on pre-clinical assessments

• Learn content from a comprehensive commercial resource (listed in 'Resources' below) in conjunction with First Aid.
• Study using the pre-made AnKing deck (increasingly the gold standard), unsuspending cards from tags as supplemental videos are viewed (see 'Utilizing Anki for Early Step Studying' below).
  • Fill in gaps, as needed, using your preferred comprehensive resource.
• Test yourself with a commercial question bank (listed in 'Resources' below)
• Reinforce the material by consistently reviewing your Anki cards and watching lectures provided by your medical school, taking notes on any material not covered in the above comprehensive resources.
  • To save on time, I recommended not making your own Anki cards for any lecture material not found in the AnKing deck. You might instead utilize short-term memory before assessments by reviewing/cramming your notes.

Approach 2: Learning Lecture Material

You are not currently planning to pursue a competitive speciality; you are not currently too focused on standardized exams; you want to focus on learning material rather than just being 'taught to the test,' which might bring on some undue stressand not bode well for performance on pre-clinical quizzes and exams

• Learn content from lectures provided by your medical school, taking diligent notes
• Study by creating all of your own Anki cards (absolutely not recommended) or searching the AnKing deck for cards that align with lecture content in addition to making your own cards for material not covered in AnKing (see 'Utilizing Anki for Lecture Content' below)
• Test yourself with the study objectives provided by lecturers, if available, as well as a commercial question bank, if desired.
• Reinforce the material by consistently reviewing your Anki cards and reviewing your notes, if helpful

Approach 3: Middle Ground Between Step and Lecture

You are considering a somewhat competitive speciality; you don't want the stress of studying for Step years in advance or the stress of having to catch up during the Dedicated period by not chipping away at some of the material now

• Learn content from lectures provided by your medical school, taking diligent notes
• Studyby unsuspending cards from the AnKing deck
  • As suggested above, I also recommend not making your own cards for lecture material not covered in AnKing
• Test yourself using a commercial question bank
• Reinforce the material through watching some supplemental videos from a comprehensive resource to fill in gaps and deepen knowledge.
  • Utilize short-term memory before assessments by reviewing/cramming your notes for any material not covered in AnKing.

Anki Sketchy Micro Deck

Utilizing Anki for Lecture Content

If you're planning to use Anki in conjunction with lecture material, you will likely spend some time simply navigating the AnKing deck before you begin reviewing cards. Here are a few tips:

• When starting fresh, suspend all of the cards within the AnKing deck and then judiciously unsuspend cards as related material is covered in lecture or a supplementary resource
  • The AnKing deck tags utilize the Hierachical Tags add-on. This is a necessity for ease of use.
• Use the operator 'w:TEXT' in your search to refine the results. For instance, if you're learning about the antibiotic TMP (trimethoprim), searching for 'TMP' will bring up thousands of cards unrelated to the medication. Searching for 'w:TMP' returns fewer than 100 cards, all of which concern the antibiotic.
• Tag the cards that you're unsuspending instead of moving them into their own deck. You can then use the powerful filtered decks functionality within Anki to specifically study those cards.
  • The Hierachical Tags add-on allows you to be more precise in tagging cards, using the notation '::' in between tags to nest them within parent tags. For instead, I tagged my cards, 'M1::BLOCK::Week_#::LECTURE' for each lecture, which would then be contained as M1 → BLOCK → Week_# → LECTURE.
  • I would then use a filtered deck to study each week of lecture material.

• There is a dedicated field for 'Lecture Notes' in the AnKing master card type. Here, you may consider including a screenshot of lecture slide(s) or text that detailed a particular topic in lecture to better reinforce material.

Utilizing Anki for Early Step Studying

The extensive tagging within the AnKing deck makes reviewing cards in conjunction with supplemental review videos (in particular, those from Boards and Beyond, Pathoma, Physeo, Pixorize, and Sketchy) a piece of cake.

• When starting fresh, suspend all of the cards within the AnKing deck.
• The AnKing deck tags utilize the Hierachical Tags add-on. This is a necessity for ease of use.
• As you watch specific supplemental videos, unsuspend all of the cards that have that specific tag. You can then begin to review them in the AnKing deck itself or utilize the filtered decks functionality.
  • There is a special field in the AnKing master card type for 'Missed Questions' for images of questions you have missed in question banks. You might also consider tagging cards that align missed questions so that they can be reviewed in a filtered deck. The AnKing team put out an excellent video detailing this approach.

Principles for Anki

Although Anki can be a powerful means of memorizing vast amounts of material, some specific hurdles still remain:

1. Loss of context. Anki can give you piercing clarity of 'trees' in lieu of the 'forest.' You may memorize very particular details about conditions/pathways/etc, but lose the context in which that information is found and is useful.
2. Passivity and pattern recognition. If you're not careful, Anki becomes nothing more than pattern recognition (I see this string of words together and I know which words fill in the blank), preventing any actual learning or retention of material from occurring.

Anki Sketchy Reddit

Solutions

1. Loss of context
   1. Utilize built-in features. Almost all of the AnKing cards link to relevant excerpts and screenshots from First Aid, Sketchy, Pathoma, and Costanza. Although it adds a bit of time to reviews, clicking through and skimming these extra resources helps to reinforce the material and understand its relevance. (In addition, I also add screenshots of lecture slides to my cards to further develop these connections.) These features also help to correct for the passivity and pattern recognition problem specified above.
   2. Utilize the pop-up dictionary add-on or the AMBOSS add-on. The pop-up dictionary add-on allows you to instantly see other instances of a given term or concept in your deck, further forming connections. The AMBOSS add-on provides a streamlined definition for specific concepts or terms and provides a link to the relevant article on the AMBOSS website.
   3. Edit cards. Although there can be a slight learning curve involved in editing cards, adding your own notes and mnemonics to Anki cards can better your grasp on the material in question.
      1. For example, this card didn't immediately make sense to me and I added this short explanation to the 'Extra' section:

1. Passivity and pattern recognition
   1. Maintain a high degree of concentration when doing Anki reviews. Anki is valuable insofar as it allows you to actively recall previously learned material. Anki shouldn't be treated as your primary source of information (lecture or Boards and Beyond/Pathoma/Osmosis videos should be, ideally). More, if reviews are approached passively–you're just clicking through cards without trying to actually remember information–the exercise is almost futile. Thus, you should aim to be as focused as possible when using Anki.
      1. Using a pomodoro timer or a similar time-block system can give you that 'under the gun' feeling and potentially help with focus.
   2. Be (a bit) hard on yourself. Although it can be so easy to press 'Good' when you 'kinda' remember what a card is asking, get into the practice of repeating cards when you don't yet have a firm grasp on the material. Properly evaluating your performance makes the act of reviewing cards more active and has the potential to increase your long-term retention.
   3. Advice from Reddit:
      1. 'Read the card out loud to yourself & slowly. Reading it in your head is fine for test questions but make sure you are consciously answering the card & not just blurting it out. Even if I know the card immediately I still read the sentence then actively try to recall facts about the answer & associated information. A weird phenomenon I noticed was that sometimes I could rapidly answer a card only on instinct but once I started to slow down & answer trying to consciously think about it I wouldn't be able to answer it.'

Recommended Add-Ons

*Highly* recommended add-ons are listedwith a blue background.

AMBOSS pop-up definitions

Automatically detects terms within an Anki card and provides a streamlined pop-up definition. Requires a subscription to AMBOSS.

Anki Killstreaks

Adds some gamification to make Anki reviews more palatable. Works well in conjunction with Hitmarkers.

AwesomeTTS

There are a number of medications, bacteria, fungi, among other topics that have particularly hard-to-pronounce names. Using this add-on allows for text-to-speech output within Anki cards, automatically pronouncing whatever term you desire.

See the instructions on the add-on page. There is a bit of a learning curve.

Batch Editing

Seamlessly paste text or images to fields in multiple cards, which is especially helpful when utilizing screenshots from lecture slides.

See the instructions on the add-on page. There is a bit of a learning curve.

Browser Resizer

Makes the margins in the Browser smaller (or larger) for ease of use.

Allows for quicker searches in the Browser. See the instructions on the add-on page.

Browser Side-by-Side Editor

Amazon private internet access points. Allows the editor in the Browser to be viewed on the right side of the screen, instead of at the bottom.

Create Filtered Decks in Browser

Create filtered decks using tags within the Browser.

See the instructions on the add-on page. There is a bit of a learning curve.

Custom Background Image

Anki Sketchy Path Deck

Change the background of the Decks screen in Anki. See the instructors on the add-on page.

Customize Sidebar

Condenses the sidebar in the Browser and makes it easier to navigate.

Deck Stats

Adds additional information to the Decks screen.

Edit Field During Review

Allows fields within a card to be edited during review, which can helpful if you spot a typo or want to add additional details or images.

Fastbar

When I first came to medical school, I heard about Anki. It uses spaced repetition so you can memorize enormous amounts of information. You'd do well in your classes and ultimately the USMLE Step 1. However, the devil is in the details.

Anki sounded like a great idea, so I started to use it here and there to memorize a bunch of facts before each of my tests. It helped in the short term. However, I never ended up continuing to review these cards after the tests. Not studying the cards meant I forget them. This defeated the purpose of long-term spaced repetition altogether!

A few months later I started using the Brosencephalon deck. Many medical students claim to have found success with it in the past to prepare for Step 1. This deck covers most of the facts in First Aid but not everything. I actually liked this deck and was able to get through the cards fast.

The one qualm I had is I found myself memorizing the card more than learning the facts themselves. For example, I often knew the answer after reading only 3 words of the question! I could tell this blind memorization wouldn't translate to boards-style problems.

Towards the end of the year, I heard of this 'amazing' new deck called 'Zanki' which was 26,000+ cards. It promised to cover everything you need to know. Its sources included First Aid, Pathoma, Sketchy, and Kaplan. I then made what I now feel was a bad decision, and switched to the Zanki deck.

I thought to myself 'If I can just learn every single fact in that deck, I must be able to crush Step 1!'

This idea was wrong for 3 main reasons.

(Disclaimer: this post is my opinion. Many claim to use Zanki – and Brosencephalon – with good effect. However, their use conflicted with my study principles. A high Step 1 score is about mastery of the material. For me, mastery of material involves more than memorizing 26,000+ individual facts.)

1. It Was Unsustainable and Driving Me Nuts!

In theory, it sounds great that Zanki has 26,000 cards, and covers everything. However, I quickly realized doing all those cards sucked up all my time.

Over the summer of my first year, I was catching up on topics I had recently done. This included autonomic pharmacology drugs and renal. It wasn't too bad at first as I knew most of the material already. However, to get through these sections, I was adding 150-200 new cards a day to my Anki deck. Translation: I was adding 150-200 cards I needed to review the next day, the day after that, and so forth.

When I came back for second year, I started my neuro course which was an absolute beast. Before I knew it, I had accumulated almost 4,000 cards that went unreviewed.

Goodbye, spaced repetition!

You see, the entire point of Anki is that you do each card on the day that it is supposed to be reviewed. Otherwise, it defeats the whole point. So if I were supposed to review a renal card in 15 days, then for spaced repetition to work, I would need to see it in 15 days! The problem was, with such a backlog of cards to review, I was never seeing the reviews I needed to. I was only seeing the last day or two worth of cards and forgetting the rest.

Ultimately, this quantity of cards was too much for only having a year to go before Step 1. A year sounds like a long time, but not when you are trying to go through such an enormous number of cards and actually review them all. (Even for students who start early, it's not uncommon to hear they study 800+ cards per day.) I was burning out from doing Anki cards, and it was causing me stress that was counterproductive.

2. My Memory Was Too Fragmented

A conventional method for making Anki cards is to break down concepts into short flashcards. Zanki does the same. However, I found that Zanki's way of breaking down content had severe limitations.

By memorizing many little pieces, at best I could recall a specific card. I couldn't piece it all together. For example, I knew whether minimal change disease was nephrotic or nephritic syndrome. (It's nephrotic). I could do this for all the other renal glomerular disorders. However, if you were to ask me what the 5 main nephrotic syndromes were, I'd struggle to create a differential. I also couldn't tell you what the classic presentation for minimal change disease was.

My memory was becoming fragmented. I wasn't able to group content together which is a proven way of helping memorization. And unless a Boards question asked the exact fact on one of the cards, I was afraid I wouldn't be able to answer it.

3. It Didn't Translate Into Mastery of the Material

Memorizing tons of facts does not allow you to think at the level needed to do well on the boards and as a practicing clinician. Yes, I memorized a ton of information. But I couldn't connect it to disease presentation, pathogenesis, and algorithmic treatment approaches.

Don't get me wrong, memorizing is still very important to do well in medical school. It's impossible to make connections when you do not have the basic facts down. However, true mastery of material goes well beyond that. Spending my entire day memorizing facts prevented me from attaining mastery.

Three Changes I Made Since Stopping Zanki

Since stopping using the Zanki deck, I have changed my approach to using Anki. Here are the three significant changes.

1. Reviews First, New Cards Second

First, I am committed to not going too fast with new cards. If it is a decision between finishing my reviews for the day or doing the number of new cards I had planned on doing, then reviews come first. To enforce this, I set my Anki so that all reviews are shown first before I can do new cards. I have come to terms with the fact that I am not going to memorize every single little fact using Anki.

Anki is a great way to supplement your studies, but it should not be the end all be all. Not doing 150-200 new cards a day has given me tremendous amounts of time. I have used this time to do questions from USMLE RX. As I write this, it is November of my second year. My school has covered the basic sciences, immuno, renal, neuro, endocrine, and repro. I do 20 questions a day on these subjects with a thorough review. However, I am by no means consistent with this. Starting January, I will be sure to increase the number of questions I do a day.

2. Cards That Make Connections

My second change is to create cards that force me to make connections. I have been trying to stay away from simple memorization cards. As discussed above, I often memorized the Zanki card itself rather than the information.

Now, I try to connect pieces of information together. For example, a single card may say 'what is the presentation of abruptio placentae? What are possible causes?' My answer might be 'abrupt, painful bleeding in the third trimester. Possible DIC, maternal shock, and fetal distress.' These longer answers take time to get through, and I have seen my speed decrease by about 33%. However, my understanding and ability to make connections has definitely increased.

I learned the importance of cards that force you to make connections and understand disease presentations. Dr. Palmerton from yousmle.com, calls this understanding the pathogenesis to presentation. Dr. Palmerton has examples of these types of cards on his site and even offers a Step 1 deck which I have been using.

3. Decks That Reinforce Other Resources

Lastly, I have been using the pepper Sketchy micro and pharm decks which I love. Sketchy Medical uses cartoons as mind palaces. This allows you to memorize pharmacology and microbiology better. However, as good as these sketches are, without spaced repetition I eventually forget them. Thus, I have been using these pepper decks which incorporate all the videos from sketchy, so that I won't forget them.

I have also been using a random deck based on high yield facts from Boards and Beyond. I love the boards and beyond videos as they are a great way to provide context to First Aid. But again, I need to make Anki cards to help me memorize the information. Some of these pre-made cards are good, but I also like to supplement it with making my own cards.

Concluding Thoughts

Are you like me and do NOT have a photographic memory? If so, then spaced repetition is a must when it comes to reviewing for big exams such as the USMLE Step 1. A great way to incorporate spaced repetition into your studying is by using Anki. However, you must use it the right way!

My grades suffered by not using Anki correctly. Like others, I was memorizing tons of facts at a time. And I still do not think I have mastered the use of Anki. However, I am always trying to improve my study habits. As a medical student, you will find that this is half the battle.

Everyone is different. Many students have done well using a variety of study techniques. Don't be alarmed if your approach is drastically different than mine. I hope through sharing my experience you can take away some valuable information. Maybe you can learn from my own mistakes. Perhaps you've never heard of Anki before and are now willing to give it a try! Either way, I wish anyone who is reading this the best of luck with their studies. Please feel free to reach out with any questions.

Adam Nessim is an MD Candidate at the Albert Einstein College of Medicine in the Bronx, New York. He graduated from Cornell University with a Bachelors of Science with High Distinction where he majored in Human Biology, Health, and Society, and minored in health policy. He blogs at All Things Healthcare. He also shares his journey as a medical student on his instagram @allthingshealthcare.

Latest Update: 20 July 2020.

This short guide pertains directly to the use of Anki with pre-clinical coursework, although some principles may apply to medical training more broadly. This guide also assumes some working familiarity with Anki. If you are looking for a primer on Anki, please access this guide before proceeding further.

Table of Contents

• Principles
• Utilizing Anki for Lecture Content
• Utilizing Anki for Early Step Studying
• Principles for Anki
• Recommended Add-Ons
• Additional Resources

Principles

The use of Anki during pre-clinical training depends entirely on one's study objective, which can be conceived of as lying along a spectrum:

At one end, the priority is placed entirely on studying for Step 1 and shelf exams, while on the other end, learning lecture material is the sole focus. (Increasingly, fewer medical school curricula 'teach to the test' and thus may omit several topics that are relevant for board examinations from lectures.)

The majority of pre-clinical students likely find themselves in the middle of this spectrum, aiming to establish a good grasp on lecture content while also steadily preparing for Step (see Approach 3 below).

Approach 1: Early Step Studying

You are already planning on pursuing a competitive speciality; you are particularly Type A and like being 'ahead of the curve;' you enjoy standardized examinations and are comfortable with less-than-perfect performance on pre-clinical assessments

• Learn content from a comprehensive commercial resource (listed in 'Resources' below) in conjunction with First Aid.
• Study using the pre-made AnKing deck (increasingly the gold standard), unsuspending cards from tags as supplemental videos are viewed (see 'Utilizing Anki for Early Step Studying' below).
  • Fill in gaps, as needed, using your preferred comprehensive resource.
• Test yourself with a commercial question bank (listed in 'Resources' below)
• Reinforce the material by consistently reviewing your Anki cards and watching lectures provided by your medical school, taking notes on any material not covered in the above comprehensive resources.
  • To save on time, I recommended not making your own Anki cards for any lecture material not found in the AnKing deck. You might instead utilize short-term memory before assessments by reviewing/cramming your notes.

Approach 2: Learning Lecture Material

You are not currently planning to pursue a competitive speciality; you are not currently too focused on standardized exams; you want to focus on learning material rather than just being 'taught to the test,' which might bring on some undue stressand not bode well for performance on pre-clinical quizzes and exams

• Learn content from lectures provided by your medical school, taking diligent notes
• Study by creating all of your own Anki cards (absolutely not recommended) or searching the AnKing deck for cards that align with lecture content in addition to making your own cards for material not covered in AnKing (see 'Utilizing Anki for Lecture Content' below)
• Test yourself with the study objectives provided by lecturers, if available, as well as a commercial question bank, if desired.
• Reinforce the material by consistently reviewing your Anki cards and reviewing your notes, if helpful

Approach 3: Middle Ground Between Step and Lecture

You are considering a somewhat competitive speciality; you don't want the stress of studying for Step years in advance or the stress of having to catch up during the Dedicated period by not chipping away at some of the material now

• Learn content from lectures provided by your medical school, taking diligent notes
• Studyby unsuspending cards from the AnKing deck
  • As suggested above, I also recommend not making your own cards for lecture material not covered in AnKing
• Test yourself using a commercial question bank
• Reinforce the material through watching some supplemental videos from a comprehensive resource to fill in gaps and deepen knowledge.
  • Utilize short-term memory before assessments by reviewing/cramming your notes for any material not covered in AnKing.

Anki Sketchy Micro Deck

Utilizing Anki for Lecture Content

If you're planning to use Anki in conjunction with lecture material, you will likely spend some time simply navigating the AnKing deck before you begin reviewing cards. Here are a few tips:

• When starting fresh, suspend all of the cards within the AnKing deck and then judiciously unsuspend cards as related material is covered in lecture or a supplementary resource
  • The AnKing deck tags utilize the Hierachical Tags add-on. This is a necessity for ease of use.
• Use the operator 'w:TEXT' in your search to refine the results. For instance, if you're learning about the antibiotic TMP (trimethoprim), searching for 'TMP' will bring up thousands of cards unrelated to the medication. Searching for 'w:TMP' returns fewer than 100 cards, all of which concern the antibiotic.
• Tag the cards that you're unsuspending instead of moving them into their own deck. You can then use the powerful filtered decks functionality within Anki to specifically study those cards.
  • The Hierachical Tags add-on allows you to be more precise in tagging cards, using the notation '::' in between tags to nest them within parent tags. For instead, I tagged my cards, 'M1::BLOCK::Week_#::LECTURE' for each lecture, which would then be contained as M1 → BLOCK → Week_# → LECTURE.
  • I would then use a filtered deck to study each week of lecture material.

• There is a dedicated field for 'Lecture Notes' in the AnKing master card type. Here, you may consider including a screenshot of lecture slide(s) or text that detailed a particular topic in lecture to better reinforce material.

Utilizing Anki for Early Step Studying

The extensive tagging within the AnKing deck makes reviewing cards in conjunction with supplemental review videos (in particular, those from Boards and Beyond, Pathoma, Physeo, Pixorize, and Sketchy) a piece of cake.

• When starting fresh, suspend all of the cards within the AnKing deck.
• The AnKing deck tags utilize the Hierachical Tags add-on. This is a necessity for ease of use.
• As you watch specific supplemental videos, unsuspend all of the cards that have that specific tag. You can then begin to review them in the AnKing deck itself or utilize the filtered decks functionality.
  • There is a special field in the AnKing master card type for 'Missed Questions' for images of questions you have missed in question banks. You might also consider tagging cards that align missed questions so that they can be reviewed in a filtered deck. The AnKing team put out an excellent video detailing this approach.

Principles for Anki

Although Anki can be a powerful means of memorizing vast amounts of material, some specific hurdles still remain:

1. Loss of context. Anki can give you piercing clarity of 'trees' in lieu of the 'forest.' You may memorize very particular details about conditions/pathways/etc, but lose the context in which that information is found and is useful.
2. Passivity and pattern recognition. If you're not careful, Anki becomes nothing more than pattern recognition (I see this string of words together and I know which words fill in the blank), preventing any actual learning or retention of material from occurring.

Anki Sketchy Reddit

Solutions

1. Loss of context
   1. Utilize built-in features. Almost all of the AnKing cards link to relevant excerpts and screenshots from First Aid, Sketchy, Pathoma, and Costanza. Although it adds a bit of time to reviews, clicking through and skimming these extra resources helps to reinforce the material and understand its relevance. (In addition, I also add screenshots of lecture slides to my cards to further develop these connections.) These features also help to correct for the passivity and pattern recognition problem specified above.
   2. Utilize the pop-up dictionary add-on or the AMBOSS add-on. The pop-up dictionary add-on allows you to instantly see other instances of a given term or concept in your deck, further forming connections. The AMBOSS add-on provides a streamlined definition for specific concepts or terms and provides a link to the relevant article on the AMBOSS website.
   3. Edit cards. Although there can be a slight learning curve involved in editing cards, adding your own notes and mnemonics to Anki cards can better your grasp on the material in question.
      1. For example, this card didn't immediately make sense to me and I added this short explanation to the 'Extra' section:

1. Passivity and pattern recognition
   1. Maintain a high degree of concentration when doing Anki reviews. Anki is valuable insofar as it allows you to actively recall previously learned material. Anki shouldn't be treated as your primary source of information (lecture or Boards and Beyond/Pathoma/Osmosis videos should be, ideally). More, if reviews are approached passively–you're just clicking through cards without trying to actually remember information–the exercise is almost futile. Thus, you should aim to be as focused as possible when using Anki.
      1. Using a pomodoro timer or a similar time-block system can give you that 'under the gun' feeling and potentially help with focus.
   2. Be (a bit) hard on yourself. Although it can be so easy to press 'Good' when you 'kinda' remember what a card is asking, get into the practice of repeating cards when you don't yet have a firm grasp on the material. Properly evaluating your performance makes the act of reviewing cards more active and has the potential to increase your long-term retention.
   3. Advice from Reddit:
      1. 'Read the card out loud to yourself & slowly. Reading it in your head is fine for test questions but make sure you are consciously answering the card & not just blurting it out. Even if I know the card immediately I still read the sentence then actively try to recall facts about the answer & associated information. A weird phenomenon I noticed was that sometimes I could rapidly answer a card only on instinct but once I started to slow down & answer trying to consciously think about it I wouldn't be able to answer it.'

Recommended Add-Ons

*Highly* recommended add-ons are listedwith a blue background.

AMBOSS pop-up definitions

Automatically detects terms within an Anki card and provides a streamlined pop-up definition. Requires a subscription to AMBOSS.

Anki Killstreaks

Adds some gamification to make Anki reviews more palatable. Works well in conjunction with Hitmarkers.

AwesomeTTS

There are a number of medications, bacteria, fungi, among other topics that have particularly hard-to-pronounce names. Using this add-on allows for text-to-speech output within Anki cards, automatically pronouncing whatever term you desire.

See the instructions on the add-on page. There is a bit of a learning curve.

Batch Editing

Seamlessly paste text or images to fields in multiple cards, which is especially helpful when utilizing screenshots from lecture slides.

See the instructions on the add-on page. There is a bit of a learning curve.

Browser Resizer

Makes the margins in the Browser smaller (or larger) for ease of use.

Allows for quicker searches in the Browser. See the instructions on the add-on page.

Browser Side-by-Side Editor

Amazon private internet access points. Allows the editor in the Browser to be viewed on the right side of the screen, instead of at the bottom.

Create Filtered Decks in Browser

Create filtered decks using tags within the Browser.

See the instructions on the add-on page. There is a bit of a learning curve.

Custom Background Image

Anki Sketchy Path Deck

Change the background of the Decks screen in Anki. See the instructors on the add-on page.

Customize Sidebar

Condenses the sidebar in the Browser and makes it easier to navigate.

Deck Stats

Adds additional information to the Decks screen.

Edit Field During Review

Allows fields within a card to be edited during review, which can helpful if you spot a typo or want to add additional details or images.

Fastbar

Adds buttons to the top row of the Browser.

Frozen Fields

Maintains text within a field or fields when creating successive cards.

Hierarchical Tags

As noted above, allows for better organization of tags and ease of use of the AnKing deck.

BetterTags uses the same notion and includes other functionalities, but required Patreon support of Glutanimate, a renowned Anki creator.

Hint Hotkeys

Allows for hints to be revealed by hitting 'H' (or another specific key) during reviews. Especially helpful in conjunction with right-handed reviews.

Hitmarkers

Adds some gamification to make Anki reviews more palatable. Works well in conjunction with Anki Killstreaks.

Image Occlusion

Useful if you will be making cards involving diagrams, such as metabolic pathways or anatomical representations.

King of All Button Add-ons

Customizes the answer buttons when reviewing cards.

More Deck Stats and Time Left

Adds additional information to the Decks screen.

Opening the Same Window Multiple Times

Allows multiple instances of a window (e.g. Browser or Editor) to be opened within Anki.

Progress Graphs

Adds additional information to the Stats screen.

Resize Images in Editor

Special Fields

Allows tags to be shared between students without overwriting other elements of cards in a pre-made deck. See video tutorial.

Spelling Police

Spell-checker for Anki.

Rebuild All Button

Adds a button to rebuild all filtered decks to the home screen.

Resources

Anki

Anki Sketchy Path

Comprehensive Step 1 Resources

• Boards and Beyond
• AMBOSS
• Osmosis
• Pathoma
• Physeo
• Pixorize
• Sketchy

Anki Sketchy Step 2

Question Banks for Step 1

• AMBOSS
• USMLE-Rx
• Kaplan

UWorld and NMBE practice exams are considered sine quo non in Step 1 prep for more than 90% of American medical students; as such, they should be reserved only for your dedicated Step 1 studyperiod.