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Best Anki Settings for Medical School (With Full Explanation)

In this article, I am going to tell you what the best settings are if you are using Anki in medical school. By the end, you will know what the settings mean and how you should be manipulating them to your advantage.

Quick Summary

Here’s a quick summary of the article so save you some time.

  • The Steps is one of the most crucial setting options to understand – if you don’t know what numbers to use, then use “60 1440 4320 10080 25920”
  • A lapse is when you forget a card, For the lapse settings option, you can use “4320 10080 25920”
  • Understanding the settings can come later. First, get used to Anki and just be consistent.

If you don’t know what Anki is and want an introduction, check out this article. If you already know what it is but want to get used to the basics of how to use it then check out this article.

Explanation of Anki Settings

Here is a brief explanation of the key settings in Anki.

The Anki settings are complicated. There is no getting around that.

Default Anki Settings

It took me many months to get used to the different numbers. Therefore, for beginners, it is can be intimidating and overwhelming.

I am here to put you are each and tell you don’t worry. You have found yourself in capable hands.

Firstly, I will describe each of these settings, starting with the most important.


The steps that I use constantly change depending on the situation. Yours probably should be too after understanding what they mean.

My current steps

The numbers that are inserted into the steps field tell Anki the “intervals” that your card should be when in the “learning” phase.

Now if you have never heard of those words before then let me put it another way.

The steps tell Anki when you want to next see the card. However, there is a limit. After your final number (so in the above example, after the 14000), Anki then defaults to its usual way of calculating when you want to see the card; by multiplying by 2.5.

To understand this whole concept further, have a look at this diagram.

Explaining the “steps” in Anki settings

It may seem a bit abstract but if you can understand this then you will be able to understand anything in this article.

Each circle represents when you review a card. You see the card at increasing intervals. For example, you might see a card on 1st Jan, then 3rd, 10th and 30th. You can see that the interval between these reviews increases each time.

So what does this have to do with the steps setting option?

Well, in this box you write down the intervals (represented as arrows on the image) that you want to see the card while in the learning phase (I will explain the learning phase below). Here is an example:

Example of Steps: 60 1440 2880 5760
This means: 1 hour, 1 day, 2 days, 4 days

If you select “good” the first time you see a card, you will see it in 1 day. Then the next time you press “good” you see it in 2 days. Then 4 days. If you press “again” at any point, you see the card again in 1 hour.

The reason that the numbers are weird is that you have to write it in minutes. If you want to see the card after one day, that is 1440 minutes.

Learning vs. Graduated

There are two phases that your card is in. Initially, you are in the learning phase, and the card is “graduated”.

The main difference between learning and graduated is that you can specifically say what the intervals are in the learning phase. In the graduating phase, you cannot.

If you are still confused then I suggest you check out this excellent video by Suppy M.D.

Graduating Interval

This one is a bit easier to understand, so if you understood the “steps” section, you will get this in no time.

Graduating interval

After the final step that you have written (for example, in the image I gave earlier, I had 60 1440 5760 14400, then the final step would be 14400 – aka 10 days), a card is known as graduated.

After graduation, you need to tell Anki what the first interval should be. It’s like how your university helps find your first job after graduating.

If you put the graduating interval as 21600 (aka 15 days), then after the final step (which had a 10-day interval in our example), you would see the card again in 15 days. See the image below for further clarification.

Explaining the graduating interval

Easy Interval

The easy interval is the interval if you press “Easy” on any card while it is in the learning phase.

Easy interval

For example, let’s say you see a card and think it is easy. Using the settings that I have given above, I would see the card again in 4 days after pressing the “Easy” button.

It will skip all of the intervals you write in the “Steps” box and immediately graduate the card.

Starting Ease

The ease is something that you don’t need to worry about but here is an explanation for those that are curious.

Starting Ease

The “ease” of a card is essentially a multiplication number. It tells Anki what to multiply your card’s interval by once it has been graduated.

By default, this is set to 250%. Therefore, if you last saw a card 10 days ago, once you press good, you will see the card again in 25 days. This is because you do 10*2.5 (the 2.5 is from 250%).

The interval increased from 10 to 25.

If you change the starting ease, you will change this multiplication factor. If you change it to 300%, multiply each interval by 3.

You shouldn’t change it from the default 250% unless you know what you are doing and have been using Anki for a while.

Maximum Reviews/Day and Maximum Interval

Moving onto the “Reviews” tab we have the maximum reviews per day and the maximum interval.

Maximum Reviews/Day and Maximum Interval

The maximum number of reviews/day tells Anki the highest number of reviews you want to do in a day. Remember that “review” is just a fancy way of saying “doing a flashcard” (or, in other words reviewing a flashcard).

Most people set this to 9999 to ensure you see all the cards Anki’s algorithm wants you to see.

You never actually end up seeing that many reviews, but it is just a way to ensure you see all the cards that you are supposed to see.

The maximum interval is the most significant gap between the cards you allow the Anki algorithm to have.

By default, it is set to 100 years (36500 days). In my opinion, this is pointless. I set my interval lower (1 year – 365 days). It ensures that, at the most, I see my cards at least once a year.

The “Lapses” Steps

Under the lapses tab, you can find another “Steps” box.

The “Lapses” Steps

This section is for when you forget your card after it has been graduated.

You see, while a card is in the learning phase, any time you press the “Again” button, the card goes back to the first number that you inputted in the steps option box (which was 60 minutes in the example given before).

However, if you forget the card once you press again after a card has been graduated, you have “lapsed”. You have forgotten the card.

There are two important things to know when you forget a card.

  • The card starts with the new “Steps” intervals as defined in the “Lapses” section – You no longer multiply each card by 2.5 to get the new interval. You essentially reset the card and see the card in intervals of 60 1440 5760 etc.
  • The “ease” decreases by 20% – Each card starts with an ease of 250% (meaning the card’s interval is multiplied by 2.5 every time). However, once you “lapse”, this decreases to 230%. If it happens again, it will decrease another 20%. It keeps decreasing until you reach 130% (where you multiply the intervals by 1.3).

The whole point of this option is to tell Anki how well you want to relearn a card once you have forgotten it.

This is a bit complicated, so don’t worry too much about it if you are just starting with Anki. Go down to the section where I discuss the best Anki settings and just copy the numbers that I suggest.

You don’t need to understand everything all at once.

New Interval

The second thing you will find in the lapses tab is the New Interval.

New interval

When you lapse (i.e. forget a card), you start re-learning that card.

Once you have relearnt it, the new interval of the card needs to be decided. This is what this option is for.

By default, this is set as 0%. This means that whether the interval of the card was 365 days (meaning you haven’t seen the card in a year), or 30 days, you will start with a new interval of 1 day.

However, in reality, you probably know the card with the 365-day interval a lot better than the one with the 30-day interval. So starting them both again from scratch would be pointless.

In the example I have given, I have set the New Interval percentage to 20%. This means that the new interval of the 365-day interval card would be 365 * 0.2 (aka 20% of 365), which equals 73 days.

Therefore you would see that card again in 73 days.

Other Definitions

Below are some of the more accessible settings to understand and so thought I would clump them all here.


Found in the “New Cards” tab.

The order tells Anki if you would prefer to see the cards in order added or randomly.

New Cards Per Day

Found in the “New Cards” tab.

This one should hopefully be self-explanatory. It means the number of new cards that you will see every day.

A “new card” is in the learning phase. In other words, it is a card in your list of cards to learn that you have never seen before.

You can access your entire list of cards by going to the “Browse” section and selecting “Whole Collection” in the top left.

Bury Related New Cards Until the Next Day

Found in the “New Cards” tab.

When ticked, this box tells Anki to “bury” (essentially moving a card into the future) any cards which are from the same note.

You may have a card which is {{c1::Paris}} is the capital of {{c2::France}}. In this case, you have two separate cards.

Card 1: […] is the capital of France
Card 2: Paris is the capital of […]

It is best if you don’t see both of those cards together. If you did see both cards in succession, the second card you saw would not be challenging, and you would be able to answer it straight away.

Bury Related Reviews Until the Next Day

Found in the “Reviews” tab.

Similar to the explanation given above. This setting tells Anki to bury a card from the same note that you are reviewing.

The difference between this option and the above one is that this one is about reviews. That means cards which are already graduated.

On the other hand, the previous option concerned new cards. Those are cards which are still in the learning phase.

I would set both of them to tick.

Leech Threshold and Leech Action

Found in the “Lapses” tab.

If you forget a card 8 times, Anki marks the card as “leeched”. This is just a way of saying you should do something as you cannot remember the card well.

The “Leech Threshold” allows you to change when Anki will mark it as leeched from 8 to any number you like. For example, if you change it to 6, Anki will mark any card you have forgotten 6 times as leeched.

Remember that forgetting a card is when you press “again” on any card after it is graduated.

The “Leech Action” asks what you want to do with a card once it has been leeched. Either you can suspend the card (i.e. put the card on hold and no longer see it), or simply tag it (which is where you will be able to see all your leeched cards with your tags).

So here are the settings are would choose for my medical school exams.

I have three options for you to choose between:

  • Conservative – For the one who wants to learn the cards thoroughly before you graduate them
  • Mr Middle (recommended) – For someone who knows a good amount of the material but still wants to go through the cards well
  • Know-it-All – For those that just want to quickly get through all their cards

I have a section after this that talks about the settings you should use if you want to cram.

If you are unsure which category you fit into, then don’t worry. Just choose the Mr-Middle option, and you will be completely fine.

Ultimately, it is more about being consistent and doing the cards properly than choosing your settings.

Please note that I have only shown the “New Cards” and “Lapses” tabs for each option. The Max Reviews/Day should be set to 9999 and the Maximum Interval to 365. Other than that, the defaults will do for the Reviews, General and Description tabs.

  • Conservative

A conservative is someone who wants to properly learn every card.

They want to be extra careful that they don’t get stuck in “ease-hell” (where you are doing too many cards later on as you didn’t learn them properly initially).

Here are the settings I would use if I were being conservative:

Be aware: these settings will likely result in you doing more cards in the short term (1-3 months) but less in the long term (9-12 months).

Conservative Approach – New Cards Tab
Conservative Approach – Lapses Tab

The steps go as follows: 1 hour, 1 day, 3 days, 8 days, 20 days, 35 days.

The “Lapses” steps exclude the 1 hour and 1 day steps.

  • Mr Middle (recommended)

Mr Middle are the recommended setting for most people. It is for people who already know a bit of the content and want to know the cards reasonably well.

Mr Middle Approach – New Cards Tab
Mr Middle Approach – Lapses Cards Tab

The steps go as follows: 1 hour, 1 day, 3 days, 7 days, 18 days

The “Lapses” steps exclude the 1 hour and 1 day step.

  • Know-it-All

A know-it-all is someone who already knows the cards relatively well.

You should know that these settings may result in you not learning the cards as well as you should; therefore, you may forget many of them after a few months.

Know-it-All Approach – New Cards Tab
Know-it-All Approach – Lapses Cards Tab

The steps go as follows: 1 day, 5 days, 16 days

The “Lapses” steps exclude the 1 day step.

Even though cramming isn’t the best way to study in medical school, it is still a way many people revise. Therefore, here are the settings you should use if you are using Anki to cram in medical school.

For cramming, I would not suggest using the cramming feature in Anki unless you have the V2 scheduler checked. I will not check this if I have a lot of cards in review/learning.

However, if you have the V2 scheduler already ticked (which can be found in the preferences), you can create a “custom study” session and then do any number of cards.

See the gif below to see how to create a custom study session.

Creating a custom study session

Deleting any of these cards returns them to the original deck.

If you cannot do this, then I suggest the following settings for cramming with Anki.

Note that Anki isn’t meant for cramming, and you should try to avoid it at all costs.

Cramming Approach – New Cards Tab
Cramming Approach – Lapses Cards Tab

The steps go as follows: 10 mins, 30 mins, 3 hours, 12 hours, 1 day, 2 days, 4 days

The “Lapses” steps exclude the 10 mins, 30 mins, 3 hours and 12 hours steps.


Let’s conclude everything we have been talking about.

Try to mix and match to suit your needs.

The options that I have given are just guidelines. Use them with your common sense and adjust them as you see fit.

Other Great Resources

I know that the Anki settings can be challenging to understand, so here are some great resources that will help with exactly that.

If you want to see some of my videos about Anki, start with this Introduction to Anki.

You can see all of my Anki articles on this page.

If you enjoyed this article, share it with your friends and colleagues who might find it useful.

Have a good day!

Level Up Your Skills With This Incredible Course by the AnKing!

Also, check out the AnkiHub and AnKing Membership to become an Anki Ninja!

This is not a paid banner, but I get a commission for every person who uses the link.

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