Education & Training Flashcard Folly: Will Use of Spaced Retrieval Memory Devices in Medical Student Study Regiments Lead to Unforeseen Deficits?

Flashcard Folly: Will Use of Spaced Retrieval Memory Devices in Medical Student Study Regiments Lead to Unforeseen Deficits?

By Stephanie Balint, on behalf of the SAEM Education Committee

For those of you who completed medical school within the past few years, you are probably all too familiar with Anki. For anyone who isn’t familiar, Anki is a flashcard program embedded with an algorithm to facilitate spaced repetition of learning. An ingenious team of four medical students from the University of Utah School of Medidine crowd-sourced high yield topics for Step 1 and compiled a deck of almost 30,000 cards known as “AnKing.” This has become a staple study resource for most medical students. The Liaison Committee on Medical Education (LCME) is the accreditation body for MD programs in the United States and Canada. Accreditation standards are requisite for Title VII funding, MD licensure of graduates, and residency eligibility of graduates. In 2002, the accreditation standards were reformatted and subsequently there was an increase in stringency. These standards are available for review here. As curricula became more integrated, the additional volume of information presented a challenge for students. While study programs are widely available, they can cost from $249 per year (USMLErx) to $539 per year (UWorld). The innovative medical students from the University of Utah School of Medicine created a deck to help promote equity in medical student access to study materials.

While the medical student community spreads the message of the importance of Anki use on platforms like Reddit, Student Doctor Network, and via word of mouth, scholarly data on efficacy is sparse. One of the first investigations

“As ‘time’ in medical school is limited, students should be aware of the opportunity cost of the hours spent solely on flashcards.”

on the efficacy of Anki use suggested a correlation between Anki use and Step 1 score. While this study was a survey is likely not generalizable due to sampling of medical students at UNC School of Medicine only, it was an important first step in investigating how this trend may benefit students. While the report did not specify frequency of AnKing use, 80% of students reported using premade flash cards.

I am a daily Anki user and I find the resource invaluable; however, there is one caveat of which students should be aware. While this tool can be fantastic for learning facts for recall, flashcards were never intended to teach integrated decision-making which is such a key element of medicine. As “time” in medical school is limited, students should be aware of the opportunity cost of the hours spent solely on flashcards. One must still dedicate time to learning decision making and critical thinking skills. Neuroscientists have elucidated the role of neuroplasticity in learning. We know that synaptic strength and even grey matter volume correlate with repetition of use. Students may benefit from guidance on complementing flash card use with critical thinking practices. There is currently no evidence to support this hypothesis, but it may be valuable to examine the ability of students to perform the critical thinking arena versus time spent on Anki to see if this issue is emerging. ABOUT THE AUTHOR

Stephanie Balint is a secondyear medical student at the Frank H. Netter MD School of Medicine, Quinnipiac University. She applied to medical school with the goal of becoming an emergency department physician. Prior to medical school she worked as an emergency medical technician, National Guard Healthcare Specialist, and emergency department RN for five years. She has worked as an advanced practice registered nurse in the emergency department at a 122-bed community hospital in Connecticut since 2020.