Anki Q&A: Part 1

Since I've started using Anki and writing about it on this blog, I’ve received a few questions about how I use it on a daily basis. Because I think Anki is awesome (though certainly not the only way to study for medical school – or study anything else, for that matter), and because if one person has a question, then usually there are several others with the same question, I’ve decided to write up a brief “Anki Q&A” based off of questions that I’ve received or I've seen commonly asked online. It’s important to note, however, that Anki is an extremely versatile tool, and though I use it in certain ways, the way I use it is far from the only way to do so. There is no “right” and “wrong” here – there are certainly more or less optimal ways to use the program, but ultimately it comes down to what works best for you – and what is best for you may not even be using Anki in the first place, depending on your study style. So take everything below as more of a starting point than as Anki gospel. If you have any other questions, please feel free to post them below in the comments section and I may add them to the post later on.

Image politely stolen from here

Q: Why Anki?

A: I’ve written before about why I use Anki, and you can click here to read a more in-depth explanation of the program and how to navigate its nuts and bolts. Briefly, though, I use Anki as a systematic way to retain the information that I’ve worked so hard to learn for the long haul. Before starting medical school, I commonly heard or read the writings of medical students bemoaning the fact that they feel as though they had forgotten large amounts of information as time passed. Obviously, to some extent, that’s inevitable. Also, much of the information we learn, particularly early on in medical school, isn’t crucial to remember to “be a good doctor.” Nevertheless, I did the binge-and-purge method of studying throughout undergrad, and frankly only remember half of it all, if that. I didn’t want that to be true for medical school.

On a practical level, the process of making cards for Anki helps me to consolidate the information I am learning into discrete units of information that I can then tie together for a broader understanding of major concepts. Of course, simply staring at your notes after class or writing a summary page for each lecture or *insert method here* can do the same thing, so that’s not really unique. What is unique is that Anki then forces me to review that information precisely when I need to – I see it before I forget it but not until I need to, thereby helping me to avoid wasting my time by relearning information before a test that I had learned a few weeks ago in lecture and forgotten or by reviewing information that I already know.

Q: So you like flashcards. Why not something like Firecracker?

A: I’ve personally not used the Firecracker program, but I’ve heard great things about it. However, I personally find the process of creating flashcards to be helpful in terms of making sure that I truly understand a concept before I just start mindlessly memorizing it. Also, Anki is pretty much free (the iPhone/iPad version costs about $25, but the desktop and Android versions are completely free). So that’s cool. That said, if you’re someone who doesn’t want to make flashcards (which is certainly a time commitment) but you want the advantages of spaced-repetition, I could see Firecracker being a great option.

Q: How many cards do you make per lecture?

A: Depends on the lecture. I usually try to shoot for somewhere around 20-50 cards per lecture, but honestly that depends largely on the type of cards I’m making (cloze vs. image occlusion vs. basic, etc.) and the content of the lecture. On average, as of late anyway, I’ve probably been making closer to 70-100 cards/lecture for physiology and immunology – mostly image occlusion cards. While that might seem like a lot, they really go pretty fast when I’m reviewing them later, mostly because I really try to have a card for each discrete fact that I want to remember, rather than, say, 10 facts on one card.

Q: How long does it take you to make your cards each day, and how much time do you spend reviewing old cards?

A: On average, I’d say it takes about 1-1.5 hours to make cards for an hour-long lecture. Since I usually have about two lectures a day, I spend around 2-3 hours reviewing the lectures/clarifying concepts/making cards, and then maybe a half an hour reviewing them, depending on how many I made. Additionally, it takes anywhere from 30 minutes to an hour and a half or so to review old cards that are due that day, again depending on how many cards I made the previous day (and how focused I stay while reviewing them…). That said, the time spent reviewing old cards can be distributed throughout the day thanks to the Anki app that I have on my phone – that way, I can just knock out a few cards here and there throughout the day, so that by the time I’m ready to sit down and make new cards for the day, I’m done reviewing old cards or only have a few left.

Q: What type of cards do you make? What kind of stuff do you include?

A: Depends on the class/topic/how I'm feeling that day/etc. I started out making a lot of basic flashcards (e.g. "List the 4 steps of xzy," "What is abc?"). When anatomy hit, I found online textbooks to be very helpful because I could screen capture an image and use image occlusion to make cards out of it. For physiology, it's more conceptual so I've found myself using more cloze deletion cards. In fact (and this probably isn't the best way of doing things, but whatever), for long processes or complicated concepts where it's helpful to have a lot of information in one spot for future reviews, I'll make a really long card with all the relevant information I need and then the cloze the heck out of it, so that for some cards I have almost 20 individual clozes per card. You could also just put the relevant sentence or two on a card, and then put all of the excess stuff in the "extra" box so that it pops up for review when you answer the card, but putting it in the card makes it more likely for me to actually take the time to review stuff when I'm rushing to get through my cards.

You can also write up a paragraph or two of information (e.g. how sodium is handled in the nephron), throw in a few pictures, arrange things so it all fits within your screen, screen capture it all, and then use image occlusion to block out words or phrases within a sentence (basically cloze deletions). Heck, if you’ve got good slides, you can just use image occlusion on those to make a decent, quick card.

Q: Do you keep reviewing all of the cards you’ve made throughout the year? Or do you stop reviewing certain decks/cards after you’ve had an exam on that material?

A: So far I've kept reviewing all of my decks - I'm still reviewing some cards from our very first classes, and still reviewing things from anatomy last year. That, to me, is one of the major purposes of using Anki - a systematic way to review old material so that it's at least a little bit fresher when it comes time to take, for example, Step 1, or even if you just need to call upon the knowledge for whatever. That said, I do suspend certain cards that I wrote that contain details that really are irrelevant for anything but the test. However, I also only try to make cards for things that are worth remembering, so I really don't end up suspending a ton of cards.

That method isn't the only way to do it, obviously, but it is, for me at least, the method that is most consistent with what I want to get out of Anki - I view it not just as a way to do well on the next test (although it serves that purpose well), but as a way to review information that would otherwise slowly degrade over time, and using its spaced-repetition algorithm to eventually shift that information into my long-term memory. It's a commitment (I have around 12000 cards total now, and review anywhere from 200-400 old cards per day while making an additional 50-200 cards per day on most days - most of which is probably a bit excessive), but it's also my primary method of study, and no one ever said medical school would be easy. I personally would hate to have to tackle all of the information we learn without something like Anki to help me organize and process it. 

Anki might seem like a lot of work, and it can be, but it has been the best thing ever in medical school. It provides an organized way for me to integrate the information I'm learning, systematically review it, and retain that information for the long term. It can be a lot to keep up with on some days, but even though my weekdays are probably consistently busier than some of my classmates, my weekends are usually free, and I'm generally done by a reasonable time during the week anyway (usually, by the time I get home, review lectures for that day, make cards for those lectures, and review those cards, it’s around 5-7 pm). And it's paid off in terms of grades. Everybody learns differently, but this definitely has worked well for me.

Note: Anki Q&A: Part 2 can be found here.