Anki Sketchy

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A trend in med school is using pre-made Anki decks with 20,000+ cards that promise to cover “everything” on Step 1. These include Zanki, Brosencephalon, and a host of others.

The allure is obvious. “Memorize a gazillion facts, and you’ll do great on Step 1!” However, there are many hidden costs (and questionable assumptions) underlying this approach. Here Adam Nessim describes why he started using Zanki – and why he stopped.

I’m telling you, Anki = long term memory. The cards in this deck contain small, Sketchy Flashcards cropped portions of the overall sketch – these force you to focus on all of the small details of each sketchy are cards for which I added my own memory hook. Sketchy Microbiology and Sketchy Pharmacology. Utilizing Anki for Early Step Studying. The extensive tagging within the AnKing deck makes reviewing cards in conjunction with supplemental review videos (in particular, those from Boards and Beyond, Pathoma, Physeo, Pixorize, and Sketchy) a piece of cake. I’m telling you, Anki = long term memory. The cards in this deck contain small, Sketchy Flashcards cropped portions of the overall sketch – these force you to focus on all of the small details of each sketchy are cards for which I added my own memory hook. Sketchy Microbiology and Sketchy.

Here is Adam Nessim:

How I Came to Use Zanki

When I first came to medical school, I heard about Anki. It uses spaced repetition so you can memorize enormous amounts of information. You’d do well in your classes and ultimately the USMLE Step 1. However, the devil is in the details.

Anki sounded like a great idea, so I started to use it here and there to memorize a bunch of facts before each of my tests. It helped in the short term. However, I never ended up continuing to review these cards after the tests. Not studying the cards meant I forget them. This defeated the purpose of long-term spaced repetition altogether!

A few months later I started using the Brosencephalon deck. Many medical students claim to have found success with it in the past to prepare for Step 1. This deck covers most of the facts in First Aid but not everything. I actually liked this deck and was able to get through the cards fast.

The one qualm I had is I found myself memorizing the card more than learning the facts themselves. For example, I often knew the answer after reading only 3 words of the question! I could tell this blind memorization wouldn’t translate to boards-style problems.

Towards the end of the year, I heard of this “amazing” new deck called “Zanki” which was 26,000+ cards. It promised to cover everything you need to know. Its sources included First Aid, Pathoma, Sketchy, and Kaplan. I then made what I now feel was a bad decision, and switched to the Zanki deck.

About Anki Anki is a program which makes remembering things easy. Because it's a lot more efficient than traditional study methods, you can either greatly decrease your time spent studying, or greatly increase the amount you learn. Anyone who needs to remember things in.

I thought to myself “If I can just learn every single fact in that deck, I must be able to crush Step 1!”

Anki

This idea was wrong for 3 main reasons.

(Disclaimer: this post is my opinion. Many claim to use Zanki – and Brosencephalon – with good effect. However, their use conflicted with my study principles. A high Step 1 score is about mastery of the material. For me, mastery of material involves more than memorizing 26,000+ individual facts.)

1. It Was Unsustainable and Driving Me Nuts!

In theory, it sounds great that Zanki has 26,000 cards, and covers everything. However, I quickly realized doing all those cards sucked up all my time.

Over the summer of my first year, I was catching up on topics I had recently done. This included autonomic pharmacology drugs and renal. It wasn’t too bad at first as I knew most of the material already. However, to get through these sections, I was adding 150-200 new cards a day to my Anki deck. Translation: I was adding 150-200 cards I needed to review the next day, the day after that, and so forth.

Anki Sketchy Biochem

When I came back for second year, I started my neuro course which was an absolute beast. Before I knew it, I had accumulated almost 4,000 cards that went unreviewed.

Goodbye, spaced repetition!

You see, the entire point of Anki is that you do each card on the day that it is supposed to be reviewed. Otherwise, it defeats the whole point. So if I were supposed to review a renal card in 15 days, then for spaced repetition to work, I would need to see it in 15 days! The problem was, with such a backlog of cards to review, I was never seeing the reviews I needed to. I was only seeing the last day or two worth of cards and forgetting the rest.

Ultimately, this quantity of cards was too much for only having a year to go before Step 1. A year sounds like a long time, but not when you are trying to go through such an enormous number of cards and actually review them all. (Even for students who start early, it’s not uncommon to hear they study 800+ cards per day.) I was burning out from doing Anki cards, and it was causing me stress that was counterproductive.

2. My Memory Was Too Fragmented

A conventional method for making Anki cards is to break down concepts into short flashcards. Zanki does the same. However, I found that Zanki’s way of breaking down content had severe limitations.

By memorizing many little pieces, at best I could recall a specific card. I couldn’t piece it all together. For example, I knew whether minimal change disease was nephrotic or nephritic syndrome. (It’s nephrotic). I could do this for all the other renal glomerular disorders. However, if you were to ask me what the 5 main nephrotic syndromes were, I’d struggle to create a differential. I also couldn’t tell you what the classic presentation for minimal change disease was.

My memory was becoming fragmented. I wasn’t able to group content together which is a proven way of helping memorization. And unless a Boards question asked the exact fact on one of the cards, I was afraid I wouldn’t be able to answer it.

3. It Didn’t Translate Into Mastery of the Material

Memorizing tons of facts does not allow you to think at the level needed to do well on the boards and as a practicing clinician. Yes, I memorized a ton of information. But I couldn’t connect it to disease presentation, pathogenesis, and algorithmic treatment approaches.

Don’t get me wrong, memorizing is still very important to do well in medical school. It’s impossible to make connections when you do not have the basic facts down. However, true mastery of material goes well beyond that. Spending my entire day memorizing facts prevented me from attaining mastery.

Three Changes I Made Since Stopping Zanki

Since stopping using the Zanki deck, I have changed my approach to using Anki. Here are the three significant changes.

1. Reviews First, New Cards Second

First, I am committed to not going too fast with new cards. If it is a decision between finishing my reviews for the day or doing the number of new cards I had planned on doing, then reviews come first. To enforce this, I set my Anki so that all reviews are shown first before I can do new cards. I have come to terms with the fact that I am not going to memorize every single little fact using Anki.

Anki is a great way to supplement your studies, but it should not be the end all be all. Not doing 150-200 new cards a day has given me tremendous amounts of time. I have used this time to do questions from USMLE RX. As I write this, it is November of my second year. My school has covered the basic sciences, immuno, renal, neuro, endocrine, and repro. I do 20 questions a day on these subjects with a thorough review. However, I am by no means consistent with this. Starting January, I will be sure to increase the number of questions I do a day.

2. Cards That Make Connections

My second change is to create cards that force me to make connections. I have been trying to stay away from simple memorization cards. As discussed above, I often memorized the Zanki card itself rather than the information.

Now, I try to connect pieces of information together. For example, a single card may say “what is the presentation of abruptio placentae? What are possible causes?” My answer might be “abrupt, painful bleeding in the third trimester. Possible DIC, maternal shock, and fetal distress.” These longer answers take time to get through, and I have seen my speed decrease by about 33%. However, my understanding and ability to make connections has definitely increased.

I learned the importance of cards that force you to make connections and understand disease presentations. Dr. Palmerton from yousmle.com, calls this understanding the pathogenesis to presentation. Dr. Palmerton has examples of these types of cards on his site and even offers a Step 1 deck which I have been using.

3. Decks That Reinforce Other Resources

Lastly, I have been using the pepper Sketchy micro and pharm decks which I love. Sketchy Medical uses cartoons as mind palaces. This allows you to memorize pharmacology and microbiology better. However, as good as these sketches are, without spaced repetition I eventually forget them. Thus, I have been using these pepper decks which incorporate all the videos from sketchy, so that I won’t forget them.

I have also been using a random deck based on high yield facts from Boards and Beyond. I love the boards and beyond videos as they are a great way to provide context to First Aid. But again, I need to make Anki cards to help me memorize the information. Some of these pre-made cards are good, but I also like to supplement it with making my own cards.

Sketchy

Concluding Thoughts

Are you like me and do NOT have a photographic memory? If so, then spaced repetition is a must when it comes to reviewing for big exams such as the USMLE Step 1. A great way to incorporate spaced repetition into your studying is by using Anki. However, you must use it the right way!

My grades suffered by not using Anki correctly. Like others, I was memorizing tons of facts at a time. And I still do not think I have mastered the use of Anki. However, I am always trying to improve my study habits. As a medical student, you will find that this is half the battle.

Everyone is different. Many students have done well using a variety of study techniques. Don’t be alarmed if your approach is drastically different than mine. I hope through sharing my experience you can take away some valuable information. Maybe you can learn from my own mistakes. Perhaps you’ve never heard of Anki before and are now willing to give it a try! Either way, I wish anyone who is reading this the best of luck with their studies. Please feel free to reach out with any questions.

Step

Adam Nessim is an MD Candidate at the Albert Einstein College of Medicine in the Bronx, New York. He graduated from Cornell University with a Bachelors of Science with High Distinction where he majored in Human Biology, Health, and Society, and minored in health policy. He blogs at All Things Healthcare. He also shares his journey as a medical student on his instagram @allthingshealthcare.

Target: 255+

Score: 273

First of all, we have to talk about the foundation of basic subjects in medical school. I did basic sciences for the first 2.5 years in my med school and I passed an exam similar to step 1 in the end. So I had to review my basic sciences a couple of times. In addition, I knew I would eventually have to pass USMLEs when I entered medical school so, in addition to the big books (like Robbins and Guyton) that we studied there, I would also supplement some Pathoma, Kaplan or Goljan to build more USMLE-specific knowledge. Therefore, my foundation was good because I had done some of the USMLE review books here and there besides my big textbooks and overall I was a pretty good student.

Because of that, I never did relatively large review books for my actual Step 1 prep (like Kaplan and Goljan, which include a lot of low-yield information), except for some small subjects.

One thing that was a little bit of a challenge for me was lack of extra time besides my med school so I didn’t really have much chance of working solely on step 1 until 5th year which for me started in September 2018. Even then, I had to do step 1 with clinical rotations. At the end of 5th year, I had to pass an exam similar to Step 2 CK in my med school so I had to drop all my Step 1 prep and study for that. I also had to participate in a lot of extracurricular activities. So I had a huge gap from May 2019 to October 2019.

At the end of October, I had to do some med school stuff too but it was a lot lighter than before. So that’s when I did some real studying. I started my dedicated period in December and wrote the exam on March 12th, 2020.

Anki Sketchy

Now I will break down the study process. Before I get into it, I want to say that for me, learning medicine always had two parts – understanding and memorization. There is no point in memorization until you have understood the concept.

Complete Uworld Qbank For USMLE Step 1

Sources used for USMLE step 1:

  1. BnB (everything except for what I did in Kaplan)
  2. Kaplan (Biochemistry, Molecular, Genetics, Immunology)
  3. Pathoma
  4. Sketchy (Micro)
  5. Anatomy Shelf Notes
  6. UWorld
  7. FirstAid USMLE Step 1

First Aid for the USMLE Step 1 2021 PDF Direct Download

Anki Decks used for Step 1:

  1. Zanki (Biochem, Immunology, Basic Pathology, Reproductive)
  2. Lolnotacop (Follows sketchy micro and uworld micro)
  3. Lightyear (everything else – follows Boards and Beyond and FA)
  4. Dorian’s Anatomy Deck

I am separating Anki altogether because if I had to separate one source that helped me get this score, it would be Anki. Those of you who don’t know about it, it’s a flashcard platform that automatically organizes patterns of spaced repetition (frequency by which you see each learned card after you have studied it). It can be used on PC, Mac, Android, iOS. You can search it on YouTube, there are tons of tutorials on how to use it. The best thing is, you don’t even have to make your own cards, there are pre-made Step 1 decks available on MedSchoolAnki and Reddit. I have listed the decks that I used above.

Studying process for USMLE Step 1:

I didn’t really have any fixed schedule because of other things I had to do along with step 1. I would watch as many videos as possible in the time I had each day and I would review them via PDFs the next morning. In the case of Kaplan, I just read through the PDFs, those videos are too slow for me. I love BnB videos though. They are quick, thorough and always get right to the point. When I was done with the subject/system in BnB/Kaplan/Pathoma, I would review it with FA. All this time, I also did Anki (New cards in the evening, after studying and reviews in the morning). Always do Anki. Seeing those concepts multiple times throughout your prep time is what locks them in your brain.

In my dedicated 3 months, I did Uworld and Anki along with Self-Assessments. I would get up at 8 am, take an hour for the morning routine and then a whole day of studying until 10 pm. After 10 pm I would watch some Netflix and go to sleep at 12.

Now I know a lot of people start using Uworld right away along with other study materials to primarily study from it and they don’t really care about the scores they get on it. I have nothing against that, it’s a proven method and it works. I personally didn’t touch Uworld until I covered everything before my dedicated period. For me, it was kind of an assessment tool besides a learning tool. That made me look forward to each block I wrote. I would write one block (random, timed – makes it feel like the real thing) in the evening and review the questions the next day (both correct and incorrect, there is so much that I learnt from the questions I answered correctly). I made my own Anki cards from the information that I wasn’t familiar with in those explanations. I also did my Anki reviews (like I said, always do Anki. Make sure you don’t forget anything).

So, my dedicated was 3 months of UW, Anki, Self-assessments. Many people use FA with UW but I ended up reading FA just once in my whole prep. Anki replaced it for me.

Pathoma Videos, PDF Books, Study Note

Self-assessments for Step 1:

  1. NBME 18 – 257 (2.5 months out, UW 30% done)
  2. UWSA1 – 277 (1.5 months out, UW 60% done)
  3. NBME 23 – 252 (1 month out, UW 80% done. Tough one.)
  4. AMBOSS Self-Assessment – 266 (2 weeks out, UW almost done)
  5. UWSA2 – 277 (1 week out, UW done)
  6. Free 120 – 90% (3 days out)
  7. NBME 24 – 269 (2 days out)
  8. Uworld First (and only) Pass: 92,3%

I was pretty nervous before the exam but it all went away once I started writing the test. It wasn’t tiring at all during the process but I felt how exhausted I was after the exam ended. I marked 10-15 questions per block but I tend to mark many questions. If I’m not 100% sure about the answer, I mark it.

The test itself was harder than UW and NBMEs. The stems were long and the answers – vague. They didn’t really give you buzzwords like they do in Uworld tests. Definitely do at least one of the new NBMEs. The real thing was abundant in ethics and weird anatomy questions, just like new NBMEs.

The 3 week waiting period was the worst, especially because of the COVID-19 lockdown. I didn’t think I did well compared to my self-assessments because there were a lot of questions that I wasn’t 100% sure about. I thought I was in the high 250s or low 260s but I didn’t really imagine 270s. I thought it was almost impossible on the real thing. Therefore, you can imagine my reaction when I found out.

Thank you if I didn’t bore you and you made it this far 🙂

Anki Sketchy Surgery Deck

Good luck on your exam!