How to Make Effective Anki Cards to Prepare for the USMLE

For many of us, our first impression of Anki is that it is seems way too complicated, and that reviewing cards could be just as time consuming as making them! But for many who have mastered Anki, or have at least gotten into the habit of using it regularly, it is an indispensable study tool. Personally, I gave into the hype of Anki after starting my USMLE Step 1 studying, and I now believe it is one of the most useful study resources available for medical students.

The benefits of Anki are many, including the benefit of space-repetition (which we’ve reviewed previously here), something that is not easy to do with paper flash cards, or possible in other flash card apps. But even for students who have been avid Anki card users, one of their biggest questions is still “How do we make effective Anki cards?” Indeed, the optimal benefit from Anki comes with making and using cards in a way that will allow not only maximum information retention and recall, but also retention and recall of the right information, i.e., the facts you need to know to answer questions correctly.

Anki Cards Should be Targeted and Personalized

In studying for your USMLE exams, primarily the Step 1 exam, you will get the most out of Anki by using it as a very targeted tool—one that targets your personal weaknesses. Accordingly, it is very important to make cards very selectively and cards that address specific gaps in your knowledge. As the sheer amount of content you need to master for the USMLE can be overwhelming, you may find yourself with over 10,000 cards unless you get in the habit of thinking critically about what deserves to be made into a flash cards. With that said, using large Anki decks like Brosencephalon and Zanki, not only contain and unmanageable amount of cards, thus not allowing the maximal benefit of space-repetition, but also not personalized to address your weaknesses. I, for example, during my short stint with trying to use Brosencephalon, often ran into cards that I thought were obvious or redundant. More importantly, these pre-made decks to not target your personal knowledge gaps, and reviewing these decks will force you to waste countless hours reviewing material you already have a sufficient grasp of from the perspective of answering USMLE questions correctly. But how do we identify those gaps in our knowledge in order to craft a personalized set of Anki cards?

Why it’s Important to Make Your Own Cards

Many students acknowledge the downside of pre-made decks such as Brosencephalon and Zanki, but question the value of the process of making one’s own cards. Although it’s important to review your cards and take advantage of spaced repetition, the process of making cards is just as useful for information retention. Making cards—which requires you to critically think about what information is important, and to understand the information well enough in order to essentially teach it to yourself—is one of the most active ways you can learn. Manipulating information in the way that is required when you make cards sets you up to retain as much as 95% of this information after 2 weeks, compared to only 5% information retention at 2 weeks when you learn passively by listening to a lecture or reading a textbook (like First Aid!). Active learning is critical for the USMLE, when the demands on your memory are extremely high, and you will be required to retain and recall a very large body of fairly esoteric facts, particularly for Step 1. Furthermore, the time required to make Anki cards is not as much as one might expect—with practice, many students end up spending 5 minutes or fewer per card. One remaining question, once one acknowledges the importance of making cards, is when in one’s studies is it the best time to start making cards?

Treat Anki as a Supplement to UWorld

The best time to make Anki cards is as you go through your UWorld Qbank, and a single pass of UWorld is often all that’s required if you use the Anki flashcard method, since you will retain far more information, removing the need to refresh your knowledge by repeating a Qbank. Making Anki cards as you move through UWorld allows you to target your Anki card creation based on the questions you answer incorrectly. Almost all of your Anki cards should come from questions that you get wrong. Occasionally, it can be appropriate to make cards for questions where you feel you completely guessed and got the question correct by chance, but you should be sure to avoid making greater than 1,500 cards total for any given USMLE exam, as a deck larger than this usuall