I always see my fellow medical students struggle with Anki because it “just doesn’t work for them.” Are you also in that group? I’m willing to bet that you haven’t tried these 5 strategies, which will help your retention go up and actually help you apply these tactics to a question-based program. I’m going to be showing you how you can retain more using Anki, rather than spending more time frustrated on why Anki isn’t working for you and then reverting to an inferior method of studying.
Comprehension First, Memorization Second
Active recall only works if you’re using your memory to pull out the information outside your brain. To accomplish that, you need to have a mental framework of the concept before you jump into Anki. It takes less time to learn something if you have a big “framework” of what you’re trying to learn because then you’re just testing yourself about specifics. For example, one example of this is when I’m trying to learn about the calcium regulation in the body. If I’m trying to learn about what PTH and calcitonin do, I need to know grossly which one is the calcium lowering versus the calcium increasing one. Then, I can figure out the specific effects of PTH in the bone, kidney, and intestines. Then, I need to figure out where they are released from, the PTH glands, and I can add more onto the framework which I started.
If you don’t have this framework, Anki is useless because you’re not really building from basics but rather memorizing random facts. Therefore, instead of jumping straight into Anki flashcards and trying to memorize facts which may have no bearing to each other, it would be better to build them into a scaffolding which you have created first. To complete this, I would recommend using study resources to quickly read through a chapter and make a mental model from it—by putting it into your words, you’re more likely to remember it. Then, when you’re doing your cards, use your mental model to change the cards to reflect what your model says. When you review your cards, it’s easier to relearn something when you remind yourself of your mental models.
This is congruent with the “minimum information principle”—simple material is easier to remember. Build from your basic mental model and fill in large gaps between information that you memorize in Anki.
Don’t Just Memorize Cards Based on Context Clues
There are two parts to this mistake: You shouldn’t copy paste missed questions, and Close Deletions are helpful but be careful in memorizing them.
When you’re reviewing missed questions, don’t just screenshot them and put them into the card with the correct answer highlighted out. When you’ll get this card, you’ll have memorized the question instead of the principle which made you get this question wrong. Most questions are telling you what the right answer is, so you need to learn the content error which you missed instead. This is a hard process, and this is what I struggled with all the time. Instead of reviewing the concept in question, I just brute forced more cards, thinking that the other concepts would cover me. Now I intentionally keep my cards low, and delete the ones which I’m simply memorizing. This allows me to be active when learning, and make sure that I’m focusing on the concepts to apply to different questions. (COMMENT DOWN BELOW IF YOU WANT TO SEE THIS VIDEO)
In the same vein, if you have random facts with fill in the blank cards (called Cloze deletions in Anki), then you might use context clues to answer the card. For example, look at this card:
On the surface, this is a fine card to have—it tests you that Sjogren syndrome is an autoimmune destruction of lacrimal and salivary glands. However, this fact doesn’t help you on tests because tests aren’t just fill in the blanks like this card. To answer the question on the test, you need to recognize the dry mouth and dry glands are Sjogren syndrome. Therefore, memorizing this card by itself is wrong. That’s why, when I turn over the card, there’s a lot of extra information in the card to help me review the different symptoms of Sjogren Syndrome. I can then recognize it on a question stem (If I click First Aid and Sketchy those resources would pop up to review as well, I just didn’t click them because they’re copyrighted material). SSA and SSB antibodies, as shown in the additional information, are related to this, and I can link that indirectly related fact into my mental model.
Don’t brute force these cards because you’re going to just get them right based on context clues rather than getting them right based on your knowledge of the underlying concept.
Don’t Make Vague Flashcards
When you’re making cards, make sure that you don’t just put cards which don’t have 1 correct answer. If you have a back of a card which tests multiple concepts, then you’re going to get it wrong.
When you’re making the card, make sure that you can convey your point in as little words as possible. This will restrict you to one word and disincentivize you from putting more on the card than you are ready for. For example, here are some of the things which I have to learn about Mars.
Mars is the fourth planet from the Sun and the second-smallest planet in the Solar System, being larger than only Mercury. In English, Mars carries the name of the Roman god of war and is often referred to as the “Red Planet”.
One note (with two cards) could be:
Which planet is the fourth from the Sun?
with the two words bolded “clozed” out. If you want to learn how to do that, check out my video explaining the shortcuts and hacks on how to use Anki. Another note could be:
What is Mars often referred to as?
Extra: Mars is named after the Roman God of War
You can even put an image in the back of the second card to drive the point home that it is a red planet. When you’re making cards, making sure that you have at least one image on the back rather than the front. This will avoid guessing the right answer based on context clues and will also show you the context around when you made the card in the first place. It will also help you understand the mental model which allowed you to learn the material on the card. When you’re reviewing those same cards, remember that they are not set in stone. That is, if you realize that one of the cards is wrong or vague based on the question that you put at the beginning, you can change it when you are reviewing it.
Focus on Higher Yield Information First
Doing Anki isn’t just about finishing all of the cards because sometimes in pre-made decks you might have a lot of superfluous cards which may not be very helpful. When you’re going through all of the cards, you should be able to figure out which ones you actually need and which ones feel very cursory and try to suspend or change those so you can more easily go over questions that you miss when you’re doing questions.
This way, you’re only remembering the information which truly matters and comes up on questions rather than wasting your time memorizing facts which aren’t testable. If you don’t see it in a question or it doesn’t come up when you’re practicing for the test, there is a high chance it won’t show up when you’re taking the actual test. Doing less cards but having a higher retention percentage of those cards is more important than doing many cards but not remembering the big picture.
If you’re trying to remember very high yield information, I suggest using memory techniques such as a memory palace, where you associate different facts with a picture or place, and make cards out of them, or you use mnemonics which stick in your mind with emotions. For example, for the mnemonic for PTSD, I remember it because I have PTSD from my surgery rotation.
D: Disinterest in usual activities
R: Reexperience of the event
E: Event or trigger preceding symptoms
A: Avoidance of triggers
M: Month or more of symptoms
S: Sympathetic arousal, Trouble sleeping
Not Doing Anki Every Day
The final reason Anki might not be working out for you is because you are not doing it every day. Although this is the most simple advice, it’s the hardest to carry out because it requires you to take a look in the mirror and realize whether you want to learn the material or not. It’s hard to do something every day, and the daily ritual of reviewing cards which have a lot of familiarity is hard, but the knowledge does slip through the cracks given enough time.
For example, when I had to study for STEP 1, in my second year I was tired of doing Anki and I stopped it for a month. Well, that month meant that cards piled up, and I needed to go through my entire collection, day by day, and cull it down until there were no more cards left. It was so annoying, and it was then that I realized that if I was making a commitment to go through the agony of spaced repetition, and keeping the facts of medical school in my brain while studying less, I would need to commit to at least going through my cards every day.
Even if I wasn’t doing Anki, I would need to make sure that I was studying every day. The reason I like Anki, and the reason I still think you should use it even if you haven’t liked it so far, is because it offers a structured way to tell you when you are done and you don’t have to decide what exactly you have to review at any given day.
Thanks for reading this blog post! If you’re interested in other blog posts, check out my website where I post more of these essays. I have a newsletter as well, where I share each video and blog post that I make as well.