How to revise for medical school exams

Top 10 Reasons Medical Students Should use Spaced Repetition

Dr Jack O’Sullivan (Medical Education & Digital Content Editor, Sethi Health)

The challenging nature of medical school means students are always trying to improve the way they learn. Many are turning to a technique called spaced repetition, where instead of ‘cramming’ a topic over the short-term, students place gradually increasing intervals in their revision. This lets you cover and retain much more material, but can be tricky to employ. Anki is a free flashcard program that employs spaced repetition automatically to let you absorb large amounts of knowledge, fast. It has worked wonders in helping me become a doctor, so I’ve written ten reasons on why you should give spaced repetition with Anki a try today!

1: Easy to Use

Anki’s powerful software puts spaced repetition into action through fully customisable digital flashcards. The only requirement is that the cards have a front and a back, and Anki does all the rest. The front of each card acts as a prompt, which might be a written question, a picture, or even a sound. The back of each card has an answer. Cards can then be placed into collections called ‘decks’, e.g. for neurology or cardiology. Reviewing a deck brings up each of its cards in turn. Once you’ve tried to recall the answer on the other side of the card, you can click to flip it around and check your answer. Then you just click to say how hard or easy the question was, and you’re straight on to the next card.

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Figure 1 An example of an Anki flashcard, with answer shown (1)

2: Adapts to Your Needs

Wouldn’t it be great if you didn’t have to organise your revision? Where spaced repetition really shines is in how it adapts to your personal learning needs. With the answer system we discussed, Anki slowly builds a picture of the things you struggle to remember more than others. It then organises your flashcards in such a way that you see the topics you are stronger with less frequently as time goes on. This exploits the spacing effect: a phenomenon where learning is greater when spread out over a longer period of time.

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Figure 2 The German psychologist Hermann Ebbinhaus pioneered the concept of the spacing effect, building a hypothesis he dubbed the forgetting curve (2)

Basically, Anki rearranges your cards to make a personal revision schedule which focuses on the topics you find hardest, whilst allowing areas you’re stronger on to move to the back of the ‘queue’ as they settle into your long-term memory.

3: Avoid Cramming, Learn Long-Term

Are you a crammer? Every medical student knows it’s best to revise little and often, but usually we end up rushing through material – only to forget half of it the week after the exam. With spaced repetition however, you won’t have to go rifling through your notes from months ago when exams roll round because they’ll have been gradually drip-fed into you over the year. Plus, once the exams are over and you’ve taken some time to relax, Anki will remember your progress and be there to ease you back in, so that you won’t have to relearn it all again later on. This is especially useful for medical students because it prepares you for life-long learning, which is essential for a career as a doctor.

4: Pocket Portable

If you’d told me when I started medical school that I’d be brushing up on anatomy on the bus, or catching up on chest x-rays in the gym, I’d have thought you were mad. However, one of the best things about spaced repetition with Anki is that whether you’re on your laptop, tablet, or phone, you can always pull up a quick revision session. This flexibility is especially valuable for medical students, who are well known for their nomadic and sporadic study schedule across lots of hospitals and clinics. The phone app also comes with a slew of useful features like a whiteboard, automatic synchronisation with your computer, and best of all, it’s free (at least for Android!).

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Figure 3 The useful whiteboard feature on the Anki Android app. (1)

5: Heart Murmurs On the Go

Medicine is an incredibly broad-ranging degree, often requiring knowledge that question-answer flashcards can’t help much with. I mean, how could you put the sound of a heart murmur on a card? Thankfully, Anki lets you make just about anything into a question, including just that. One side of the card can show a picture of an auscultation site, whilst also playing a recording of anything from aortic stenosis to bronchial breathing. All you need is a pair of headphones to get some crucial practice in on what is normally a very tricky skill to master – and with spaced repetition follow-up, you can rest easy knowing your hard-earned knowledge will be retained.

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Figure 4 An example auscultation flashcard from the Anki community (3)

Try your ear in a busy place to make it even more like the real deal! Find a free deck on heart auscultation here.

6: Find and Share Flashcards

Have you ever revised a topic, only to find out later about some really good resource that could have saved you hours of work? Whether for spaced repetition or not, making your own flashcards can be a time-consuming process that can leave you feeling like you’re reinventing the wheel. Another great thing about Anki however is its ready-made decks, made by a global community of students. These are easily searchable and are rated by users, making it simple to find great flashcards from the get-go. One great example comes from Dr Stefan Ebmeier, creator of ‘Flashfinals, a collection of over 3,000 Anki cards aimed at a UK medical school syllabus.

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Figure 5 A selection of topics available from the Flashfinals website (4)

Try collaborating with other medical students to put together the best deck possible for your course!

7: Awesome Add-ons

Spaced repetition via Anki is supported by a buzzing community of programmers who are constantly putting out useful and innovative ‘add-ons’, expanding its already robust features. These can include simple things, like improvements to the layout or colour scheme, all the way to my favourite add-on: a ‘heatmap’ showing you how many days you’ve revised for.

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Figure 6 The ‘Review Heatmap’ add-on for Anki, available from AnkiWeb (1)

This is great for anyone trying to build up their work ethic at medical school, as it is easy to lose momentum as the term stretches on. To go with this, Anki automatically collects useful information about your study habits, including what time of the day you tend to be better at answering questions, and what your overall accuracy is for different topic areas.

8: Manage your Mnemonics

All too often in medical school, you’re required to memorise some kind of list, or sequence, or otherwise complicated set of information. Although simply going over the topic repeatedly can help keep it in your short-term memory, you need to be a bit more clever to trick your brain into holding onto it long-term. One popular method is to use mnemonics – memory aids that play on words to make otherwise unmemorable facts easier to recall. For example, the facial nerve branches can be remembered with ‘To Zanzibar By Motor Car’. One problem with this is that it can be cumbersome keeping track of them all. With Anki however, it’s easy to keep quick notes like these on the backs of your flashcards, not only storing them safely but also allowing them to be timely reviewed in keeping with your spaced repetition of the topic they link with.

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Figure 7 Do you love your mnemonics? Keep track of them so they’re there when you need them with Anki (1)

9: Paperless, Searchable and Sortable

Even after finishing your first week of medical school, you’ll know what it’s like to have to share your attention between lots of different topics. It can be difficult to keep all the plates spinning with paper notes, as it becomes harder and harder to sort through things and to juggle incoming modules. As a spaced repetition tool, Anki is great for offsetting this because of the powerful way it allows you to sort your flashcards through the use of ‘tags’ and ‘decks’. Decks can be used to reflect the modules of your degree, allowing you to quickly focus on, for example, cardiology, if you have a long case coming up. Tags can similarly be used to highlight content: you could make a tag called ‘December Exam’, and apply it to all the cards relevant for that exam, if you wanted to quickly focus on it.

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Figure 8 Anki lets you easily sort your flashcards into decks based on speciality (1)

10: Saves Time for You

The last and possibly most important reason that I use spaced repetition is because it frees up so much time. With the workload being so intense at medical school, working smartly is essential to make sure you are able to keep to a routine that not only looks after your grades, but also your health. I reinvested the time I saved into hitting the gym, eating right, and seeing family and friends. It’s all too easy to let these fall by the wayside as you train to be a doctor, but they are crucial from start to finish. The better you feel on a day-to-day basis, the more you’ll get out of your placements, and the more you’ll enjoy them too!

To sum up, I feel spaced repetition made the single biggest difference in my journey to becoming a doctor, allowing me to work efficiently and effectively not just for my exam, but for my career, too. If you are interested in giving it a try, I would heavily recommend the Anki platform – head to their website for the desktop client. When you’re set up, check out Google Play or iTunes for the Android or iPhone apps respectively. Make sure to also search up Anki on YouTube for some great video tutorials, too!

Read more from Dr Jack O’Sullivan – follow him on Twitter or check out his personal website. E-mail him at jack@sethihealth.co.uk

References

  1. AnkiDroid Open Source Team. AnkiDroid Flashcards [Internet]. AnkiDroid Open Source Team; 2017. Available from: https://play.google.com/store/apps/details?id=com.ichi2.anki
  2. Wranx. » Ebbinghaus and the forgetting curve [Internet]. 2016 [cited 2017 Jul 5]. Available from: http://www.wranx.com/ebbinghaus-and-the-forgetting-curve/
  3. AnkiWeb. Physical Exam: Heart Sounds – AnkiWeb [Internet]. 2013 [cited 2017 Jul 5]. Available from: https://ankiweb.net/shared/info/441595417
  4. Ebmeier S. Flashfinals: Flashcard revision resource for UK medical students [Internet]. 2016 [cited 2017 Jul 5]. Available from: http://flashfinals.co.uk/#about