What is ANKI?
ANKI is a free, open-source flashcard program that uses spaced repetition and active recall to help you remember information more effectively than passive review. At its simplest, ANKI is a digital version of physical flashcards — but it’s “smart.” Instead of you deciding when to re-see a card, ANKI schedules each card’s next appearance based on how well you recalled it. That means that easy cards are shown less frequently and difficult cards are shown more often, optimizing your study time so you spend the most time on what you don’t yet know. The desktop program and the online sync service (AnkiWeb) are maintained from the official Anki site; you can download the desktop version at the official Anki page.
Why it matters for MBBS students: medicine is an enormous, cumulative subject. On any given day you might need to remember: dozens of cranial nerve functions, hundreds of drug-mechanism / adverse effect pairs, scores and criteria for diagnoses, and stepwise management algorithms. Without a scheduling system, most of that information fades quickly; with ANKI, your review workload becomes predictable and efficient. ANKI also supports multimedia (images, audio, LaTeX) and advanced card types (cloze deletions, image occlusion), which is perfect for anatomy diagrams, ECG tracings, microbiology images and drug mechanism flowcharts.
What are its principles?
ANKI stands on two psychological pillars: spaced repetition and active recall. These are not marketing buzzwords — both are backed by decades of cognitive science. Below I expand on each, with practical MBBS examples and analogies.
Spaced repetition — the “booster shot” model for memory
Spaced repetition is the idea that information is best retained if reviews are spaced out over increasing intervals — not massed together (cramming). The practical reason: when you first learn something, your memory trace is fragile; if you revisit it just before you’d naturally forget it, you strengthen that trace dramatically. Each successful recall increases the “stability” of that memory and lengthens the interval before you should next review it.
Concrete MBBS example: When you learn the branches of the aortic arch (brachiocephalic, left common carotid, left subclavian), ANKI will show that card shortly after initial study (same day), then a few days later, then a few weeks later, then months later. By spacing reviews strategically, you might review that single card 4–6 times in a year and retain it indefinitely — far fewer hours than re-reading a textbook repeatedly.
Evidence: The spacing/distributed practice effect is well documented (see meta-analyses and large reviews). One widely cited quantitative review (Cepeda et al., 2006) analyzed hundreds of studies and demonstrated strong spacing benefits for verbal learning tasks. For practical medicine studying, that means spaced reviews beat re-reading or single cram sessions for durable recall.
Analogy: Think of the immune system. Primary vaccination primes the system; booster shots at spaced intervals strengthen and prolong immunity. Spaced repetition gives your memory timed “boosters.”
Active recall — the “viva training” approach
Active recall requires you to retrieve an answer from memory instead of passively looking at it. The act of retrieval strengthens neural pathways more than re-exposure alone. In practical study, this is why you do better if you hide the answer and force yourself to recall it, rather than simply re-reading the same paragraph 10 times.
MBBS example: Suppose you read about acetaminophen toxicity and its mechanism. You might feel confident by re-reading the mechanism and antidote. But if you create an ANKI card with the front “Mechanism of acetaminophen hepatotoxicity and antidote” and force yourself to recall (n-acetylcysteine as antidote; mechanism: NAPQI accumulation due to glutathione depletion), every successful retrieval strengthens the ability to recall that under exam pressure or in clinic.
Analogy: Viva practice. When you verbally answer exam questions or teach classmates, you’re doing active recall. ANKI mimics that by presenting the prompt first and forcing recall before revealing the back of the card.
How the two work together
Spaced repetition controls when to review, and active recall controls how to study during each review. Combined, they let you: (a) minimize total review time, (b) protect long-term retention, and (c) focus on weak points.
Practical tip: Convert lectures or notes into small, atomic cards (one concept per card) to maximize the power of active recall and make spaced schedules efficient. Don’t try to cram an entire paragraph into one card — break it down.
How these principles help in the long-term retention of stuff
Long-term retention means you can reliably retrieve knowledge not just for the next exam, but across years — so that what you learn in 1st year (e.g., physiology) is still accessible in later clinical years and during internship. Here are concrete mechanisms and examples for how ANKI’s principles achieve this.
Strengthening memory traces with optimal re-exposure
Each successful retrieval increases a memory’s stability (the time it remains accessible). Spaced repetition schedules reviews at the point where memory is about to fail; this “desirable difficulty” makes recall harder (and thus more effective) than repeated easy rehearsals. Over repeated spaced retrievals, the memory trace consolidates and requires less effort to recall later.
Clinical example: Consider the steps of cardiopulmonary resuscitation (CPR). You may learn them in a skills lab and quickly repeat them. If you add an ANKI card with the step sequence and revisit it at spaced intervals, you are less likely to forget in high-stress real-life scenarios (such as an in-hospital arrest during internship).
Transfer to long-term systems and clinical reasoning:
ANKI’s repeated retrieval builds raw factual knowledge which becomes the substrate for higher-level clinical reasoning. For instance, if you deeply know the pharmacokinetics and contraindications of beta-blockers, you will be quicker and safer while choosing medications for a patient with heart failure, asthma, or diabetes.
When factual recall is automatic, cognitive load reduces, enabling better problem-solving. In exam terms, this is the difference between struggling to remember a mechanism during a long case vs smoothly retrieving it when needed.
Efficiency and diminishing maintenance cost:
A big advantage: after initial intensive review, the number of future reviews required for a card falls dramatically. Well-matured cards may only need occasional reviews (months/years apart), freeing you to learn new material. This is a huge win for MBBS students who always have new, heavy content each semester.
In short: ANKI changes your study curve from endless re-reads to a predictable, low-maintenance long-term memory system.
How ANKI works for USMLE students, how prevalent it is there, and why it is not prevalent in India
ANKI’s rise in the USMLE community is instructive because it shows how community ecosystems (shared decks, tutorials, seniors’ endorsements) accelerate adoption.
Why ANKI exploded among USMLE takers:
1. Exam format is recall-heavy: USMLE Step 1 and Step 2 emphasize application of many factual items. Flashcard-style recall maps well to exam preparation.
2. Community decks: Large, well-curated shared decks (Zanki, AnKing) mapped to high-yield resources (First Aid, UWorld, Pathoma) make it easy to start. The AnKing project even provides an integrated “Step Deck” and tutorials to onboard users. Having these ready-to-use decks reduces the time needed to create cards.
3. Peer culture: In many US/USMLE circles, seniors recommend ANKI early; seeing peers use it builds social proof and accelerates adoption. The “review streak” or heatmap is social motivator as well.
Prevalence in India — why it’s lower (but changing)
Teaching culture: Many Indian medical colleges prioritize lecture-based learning + note memorization. Seniors and teachers often recommend mnemonics or lecture notes rather than SRS.
Exam focus: Historically, Indian MBBS/PG entrance style questions emphasized rote knowledge and short-term performance for specific tests. That made cramming effective for passing certain exams.
Lack of large shared medical decks (previously): While USMLE stacks had many community decks, India-oriented decks mapped to Indian MBBS exam syllabi were less prevalent earlier. This has been changing with communities creating India-centric decks and bridges to popular resources.
Awareness gap: Students who haven’t seen a senior use ANKI may assume creating thousands of cards is an impossible upfront cost, not realizing that many decks are available and that the long-term gain outweighs the setup time.
However, this is changing: with more Indian students preparing for NEXT/NEET-PG and appreciating knowledge retention for clinical years and residency, ANKI uptake is steadily growing. Community resources, YouTube tutorials, and localized deck creation are helping.
Practical takeaway: If you’re in India and feel like ANKI is uncommon around you — you can start alone, get small wins (daily reviews), and then teach juniors; that’s how the culture spreads.
Why long-term memory is always better than short-term memory
You already liked the initial section on this; let’s deepen it with concrete scenarios and cognitive science ideas.
Cognitive load and clinical performance:
Long-term memory frees working memory. Working memory (the “mental desk” where you juggle pieces of information) is limited. If you have to consciously recall every small fact while trying to diagnose a patient, your working memory will clog. If many facts are stored in long-term memory and can be retrieved automatically, your working memory is free to construct diagnostic hypotheses and manage patient communication.
Example: During a busy ward round, remembering the first-line drugs for acute bacterial meningitis (empiric therapy choices) should be automatic. If you must momentarily look up ceftriaxone dosing, your diagnostic and communication fluency suffers. Long-term memory makes bedside care faster and safer.
Durability and life-long practice
Short-term memory is ephemeral: cramming will give transient performance but poor retention. Medicine is not a sequence of discrete short tests — it’s a lifetime of clinical practice. What you learn in the first two years forms the scaffolding for your later specializations. Long-term memory becomes a professional toolbox.
Economy of learning
Time invested in building long-term retention yields improving returns. Once a topic is consolidated, you invest less time to maintain it. Short-term memory requires repeated future cramming before each exam, which is inefficient and stressful.
Stress resilience
Under stress (exams or clinical emergencies), your brain’s retrieval becomes less efficient. Material stored in long-term memory requires less effort and is more resilient to stress-induced retrieval failure. In practical terms, well-reviewed ANKI cards are more likely to be recalled in viva or emergency situations.
<u>How to install ANKI on various platforms (desktop, Android, iOS)</u>
Below are step-by-step instructions and practical tips for each platform; these steps reference the official Anki manual and app pages.
Desktop (Windows / macOS / Linux)
1. Download: Go to the official Anki site (apps.ankiweb.net) and download the installer for your OS. (Always use the official site to avoid modified builds.)
2. Install: Run the installer and follow prompts. On Windows, you’ll get a start menu shortcut. On macOS, drag Anki to Applications. If you use Linux, use the package appropriate for your distro or the AppImage. The official manual has platform-specific troubleshooting steps.
3. Create profile: On first run, create a user profile and set basic deck options.
4. Sign up for AnkiWeb: Create a free AnkiWeb account (from ankiweb.net) to enable syncing across devices.
Why start on desktop? Desktop supports add-ons and full customization. Creating cards, importing decks, bulk editing, and installing advanced add-ons (Image Occlusion Enhanced, FSRS helpers) all happen on desktop.
Android (AnkiDroid)
1. Install: Search for “AnkiDroid Flashcards” on Google Play and install. It’s free and maintained separately but fully compatible with Anki decks and AnkiWeb syncing.
2. Login & sync: In AnkiDroid settings, sign in with your AnkiWeb account to sync cards.
3. Use: AnkiDroid supports most core features (review, create notes/cards, basic media support), but add-ons do not run here — they’re desktop only.
Practical tip: AnkiDroid is excellent for on-the-go reviews (bus rides, line at the mess). Use desktop for heavy editing and add-on work.
iOS (AnkiMobile)
1. Install: Search “AnkiMobile Flashcards” on the App Store. This is a paid app; purchases support Anki development.
2. Login & sync: Sign in with AnkiWeb.
3. Limitations: iOS is feature-rich, but add-ons cannot be installed (desktop only), and advanced scheduling customizations sometimes require desktop editing.
Note on versions & FSRS: Newer versions of ANKI and AnkiMobile are adding FSRS support or custom scheduling options; check your app update notes and Anki forums for specifics. Some forum threads discuss using FSRS on mobile and how custom scheduling interacts across platforms.
What are the advantages of using ANKI on a desktop?
Use the desktop as your “production studio” for decks. Key advantages:
1. Full add-on support: The desktop allows installation of add-ons to extend functionality — Image Occlusion Enhanced, Review Heatmap, Stats extras, FSRS4Anki helpers. Add-ons dramatically speed up workflow for medical students (image occlusion for anatomy, auto-cloze generators, batch editing). The Image Occlusion Enhanced add-on is widely used for making anatomy cards and is available via AnkiWeb.
2. Bulk import & editing: Drag large media, import CSVs or shared decks, perform multi-card edits, and use keyboard shortcuts for efficiency.
3. Custom scheduling & algorithm control: Desktop gives you access to deck options, advanced scheduling, and the ability to paste custom scheduling code (e.g., FSRS parameters) if you want fine control. FSRS adoption historically required desktop setup; there are guides and GitHub repos (fsrs4anki) documenting it.
4. Better UI for card creation: You’ll make image occlusions, do complex cloze templates, and add LaTeX or sound files easier on desktop.
5. Backup & export control: Desktop makes manual backups and exports simpler, and many community instructions assume desktop use.
Short version: create and manage on desktop; review everywhere.
What are the disadvantages of ANKI on Android?
AnkiDroid is excellent for mobile review, but there are limitations:
1. No add-ons: Desktop add-ons (Image Occlusion Enhanced, FSRS helper scripts) don’t run on Android. You must create IO cards on desktop and then sync for mobile review.
2. Editing ergonomics: Typing long card content or creating many occlusions is slower on mobile than on desktop.
3. UI fragmentation: Different Android devices have varying screen sizes and input methods; some complex card layouts may not display perfectly.
4. Battery and notifications: Mobile review risks interruptions (calls, battery) and can tempt you to do rapid but shallow reviews if you multi-task.
Still: AnkiDroid is indispensable for “dead time” reviews. Use it for repetition, not heavy deck authoring.
What are the disadvantages of ANKI on iOS?
iOS (AnkiMobile) is polished, but:
1. Paid: AnkiMobile is a paid app, unlike AnkiDroid which is free. Payment is a small barrier for some students but supports development.
2. No add-ons: Same as Android — add-ons are desktop only.
3. Feature parity & timing: Some advanced scheduling customizations and beta features historically appear on desktop first. However, the Anki ecosystem is actively evolving and iOS is catching up in many areas. Forum posts show users discussing FSRS and iOS behavior; always check the latest app version and release notes.
Video tutorials
Best video tutorial, teaches you everything about anki
https://youtu.be/8zaKVFC9Eu4(sit with a laptop/ipad/android with anki installed as described previously then watch this video at1.5x, its a 3 hour long video but it covers A-Z of Anki)
Other Resources:
- Anki manual - Click here
- Video series(Click on the lines to watch them):
Read Supermemo's article for making cards effectively.
FSRS algorithm: what exactly it is, parameters, retention rate, and interval lengths
What is FSRS?
FSRS stands for Free Spaced Repetition Scheduler. It’s a new way Anki decides when to show you cards so that you remember them for the longest time while doing the fewest reviews.
Think of it like having a personal memory coach built into Anki.
How FSRS Works — Step by Step
1. It studies you while you study.
Every time you review a flashcard, FSRS notices how well you remembered it. Over time, it learns your personal memory patterns — maybe you’re great at remembering anatomy terms but struggle with drug names, or maybe you forget things faster after a busy week.
2. It guesses your “memory clock” for each card.
FSRS tries to predict: “If I don’t show this card again, how long until you’ll probably forget it?”
This “memory clock” is different for each card and for each person. It’s not a fixed rule — it changes as you learn.
3. It schedules reviews just in time.
FSRS wants to catch you right before you forget a card. This is the sweet spot:
Too early = you waste time on something you already remember.
Too late = you’ve already forgotten and have to relearn it.
4. Your button presses guide it.
When you hit “Again”, “Hard”, “Good”, or “Easy”, FSRS treats this as feedback:
“Again” means: Oops, I forgot — I need to see this much sooner.
“Hard” means: I remembered, but it was tough — show it a bit sooner than normal.
“Good” means: Perfect timing — do this again next time.
“Easy” means: I knew it instantly — you can wait much longer to show me again.
5. It adapts and improves over time.
FSRS starts with rough guesses, but the more you use it, the more accurate it becomes.
After a while, it stretches your review intervals more and more — saving you hours of extra work without harming your memory.
Why FSRS Feels Different from Old Anki Scheduling:
Old Anki used a more rigid, “one-size-fits-all” formula. It didn’t really understand you — it just followed set numbers.
FSRS is dynamic — it learns your forgetting speed for each card and adjusts. That’s why you might notice some cards come up more often than others, and some take months to reappear.
In short:
FSRS is like a personal trainer for your memory. It observes how quickly you forget or remember each card, predicts when your brain will start to lose it, and brings it back just in time. This way, you spend less time reviewing but remember things for much longer.
Key components and terms in FSRS
Stability (S): How long the memory is expected to last without review. Higher stability → longer next interval. Stability updates after each review depending on whether you recalled the item.
Retrievability / Retention (R): The target probability of recall at a future time point. Users often set a desired retention (e.g., 0.9 or 90%); FSRS then computes intervals that aim to give that probability.
Difficulty / Quality: How hard an item is for you personally. Tougher items have smaller increases in stability after correct reviews and require more frequent review.
Δt (time since last review): The actual interval between reviews — FSRS uses Δt as input to compute expected recall probability and to update stability
How intervals function
FSRS uses a mathematical model to predict recall probability P(recall | S, Δt) and updates S after each review depending on whether you recalled it. If you answer correctly, S increases multiplicatively; if you forget, S decreases and the card often enters a re-learning stage. The scheduler chooses the next Δt so that expected recall reaches the target retention R.
Practical consequences for students
Personalization: FSRS adapts to each card and user, offering intervals that better match memory dynamics than a one-size-fits-all schedule.
Retention target choice: Setting a higher retention target (e.g., 95%) increases the review load but gives stronger long-term retention; a lower target (e.g., 80%) reduces daily load but accepts more forgetting. Many med students aim for ~85–90% as a balance. FSRS allows explicit target settings.
Implementation notes
FSRS has implementations and helper add-ons (fsrs4anki) and community guides for configuring it on Anki decks. Many forum threads and GitHub docs explain parameter meanings and migration steps. If you want to adopt FSRS, install the helper on desktop and read the guides carefully — FSRS changes review cadence and initial learning steps should be configured thoughtfully.
-compiled by ChatGPT et al
excellent work
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