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Does Anki Really Work? – A Detailed Analysis

A lot of medical students use Anki to help them memorise vast amounts of information, is there any real evidence to show that it works? Is it a tool that genuinely can help you learn stuff, or if it’s more effort than it’s worth. That’s what we are going to be answering right now.

Contents

Quick Answer

The short answer is YES, Anki does work. However, you have to make it work for you. If you are consistent and ensure you put your all into it, you can excel in memorising anything.

What is Anki?

For people that don’t know, Anki is a tool that uses flashcards to help you memorise cards. I have a full post explaining what it is and how to use it (check it out here) so I won’t go into much depth.

Does Anki Help With Studying?

Yes. Anki works.

But you have to know how to use it.

Saying Anki doesn’t work is like saying a screwdriver is at fault for not being able to weld metal together.

It is a tool. And that means to get the most benefit out of it you need to understand every part of it.

A carpenter has different tools for different jobs.

They wouldn’t use a screwdriver to cut wood.

In the same way, when studying, you need to use Anki for what it is good for.

You cannot expect Anki on its own to be able to get you a top 0.1% score. You need to use it for what it’s good at, and then when there is a better tool available for a particular job (e.g. practice questions to improve exam technique), use that tool instead.

“Anki is only effective if you know how to make it effective.”

Remember that Anki is only effective if you know how to make it effective.

Therefore, to summarise, Anki depends on the user’s mastery of studying and knowing how and when to use Anki.

Is Anki an Efficient Way to Learn?

Of course, it is efficient!

The question is not is it efficient, but how much more efficient?

This is what Michael Nielsen says in his excellent (but very long) article on Anki.

It takes 8 seconds to review a card.

If using a conventional flashcard approach, each flashcard would be looked at for 7 minutes a year (8 seconds per card for reviewing and 52 weeks in a year = 6.9 minutes per flashcard per year).

Over 20 years, this results in each card being reviewed for a total of over 2 hours!

By contrast, Anki’s ever-expanding review intervals quickly rise past a month and then out past a year – as long as you don’t have a max interval limit that is.

Currently, my average interval is 5.2 months per card (after over 400 days of doing Anki). This means that by the same calculation, I will only have to review a card for 6 minutes over the entire 20 years!

That’s saying you will save 20 times more time by doing Anki!

And this even allows for occasional failed reviews, which resets a cards time interval to 0 (unless tampered within the settings).

However, this is only an estimation and will vary depending on how often you press “again” and how long you tend to do Anki for.

If you only are intending to do Anki for 6 months, the amount of time saved might be less, but there will still be some time saved for sure.

Even with these limitations, the point of the calculation still stands.

If you think 6 minutes of your time to memorise a fact in Anki is worth it, then add the card and learn it!

Remember, many of the important things we know in life are facts that we never knew the importance of.

This is especially important if you are gunning for that top 0.1% exam score.

To summarise, we found that over 20 years, you can be over 1500% more efficient for each card when learning using spaced repetition compared to conventional flashcard learning.

Infographic: Does Anki Really Work?

What Does the Science Say?

Correlation of Anki Use and Exam Scores – Does Anki Improve Exam Performance?

One 2015 study queried all medical students at their institution following the USMLE Step 1 exam for self-reported use of various study methods with or without spaced repetition. They found that higher scores correlated with those students who reviewed more cards in Anki.

In this study, 72 medical students from the Washington University School of Medicine completed a survey about their use of Anki. They had completed the two-year preclinical curriculum in 2014 and had taken the Step 1 exam.

On average, the students used Anki for 24.5 weeks (6 months) and tried learning 5086 different flashcards.

Completing an additional 1700 Anki flashcard was associated with an additional point on Step 1.

Interestingly, those who used another flashcard software specifically tailored for USMLE step 1 (Firecracker), did not see any increase in Step 1 score (in other words, the correlation between Firecracker use and Step 1 performance was not statistically significant).

This could suggest that self-made flashcards help students more than pre-made decks, however, this cannot be proven.

The factors which resulted in increased exam performance include:

  • Number of exam-style questions completed
  • Number of unique Anki flashcards seen
  • Previous exam scores (those that did better on pre-medical school exams did better on the USMLE exam)
  • Test anxiety (those that were less anxious performed better)

However, no study is perfect.

Some of the reasons the study falls short (study limitations)

  • The data from the study was self-reported and anonymous, so the data given could have been falsified
  • Students who complete more practice questions or flashcards may simply study more in general and so it was simply hard work that resulted in better exam results (known scientifically as confounding factors)
  • Similarly, students who have certain traits like better concentration and self-direction may be more likely to use more practice questions or Anki flashcards

In conclusion, students who use studied more Anki flashcards performed better on the USMLE.

Does Active Recall and Spaced Repetition Work?

Here is a summary of the benefits of active recall and spaced repetition:

Active recall:

  • Helps solidify memory in the brain
  • Testing yourself once is more effective than rereading the same passage four times

Spaced repetition

  • Remember facts in the long term
  • Can work even within a single say (gaps of 1 min, 10 mins, 60 minutes etc.)
  • When compared, spacing out your study with active recall build in (using active recall and spaced repetition at the same time) has significantly better results than just one on its own

I have an entire post dedicated to just this topic which you can check out here.

More Studying = Better Exam Results?

This 2015 study discusses how increased time to study the material results in better exam performance.

This is how the research was conducted:

  1. These researchers created a flashcard and quiz application called “Alert Student” (similar to Anki, however, the app had an additional quiz component).
  2. They enrolled 96 medical students who were split into two groups.
  3. One group had studied the material before having a quiz (group A).
  4. The other group had no study period at all (group B).
  5. There were 3 sessions in total, separated by a one-week interval.

The results were as follows:

In the study-quiz group (group A), accuracy in answering questions increased from 27% → 73% → 82%.

In the quiz group (group B), accuracy increased from 24% → 33% → 42%.

The study-quiz group (group A) achieved a much sharper increase in recall accuracy than the quiz group.

What does all of this mean?

The most likely explanation for higher the increase in recall for the study-quiz group is the additional time-on-task.

As stated earlier in “Is Anki an Efficient Way to Learn?“, you may spend only a few minutes in your whole life studying a card. This is not very long, and the above study shows that increased time-on-task (i.e. more time studying) increases exam performance.

So what should you do?

This could suggest that more time to learn the material before making Anki flashcards is required.

However, this might not always be feasible.

Anki is a great application, but it can get overwhelming if you are trying to do 1.5 hours of Anki card and on top of that 2 hours learning new material.

Therefore it could be suggested that time is prioritised on material that is known to be more important (e.g. in Medicine, heart attacks are seen by all Doctors, so knowledge about them is needed throughout life).

In the end, a balance must be made between studying new material and reviewing Anki cards.

Using Anki in the Short Term

So we know that Anki works.

But how well does it work in the short term?

Well, this 2011 study has found that “although students use testing as a learning strategy, they seem to be unaware of its superiority in supporting short‐term knowledge retention”.

This is how they conducted the study:

  1. 80 medical students enrolled
  2. Exposed to 30 flashcards for four learning cycles, each consisting of a study period and a test period.
  3. Half studied the flashcards while the other half were tested on the flashcards
  4. Retention was assessed after 1 week and 6 months

These are the results they found:

Testing was better than repetitive studying after 1 week.

However, after 6 months general recall was poor and no difference between the restudy and retest groups was observed.

Interestingly, they also found that what the students predicted they would get did not correlate with what their exam performance. i.e. just because they thought they were going to do well didn’t mean they were going to do well and visa versa.

So, to conclude, repetitive testing is a better learning strategy than repetitive studying for short‐term but not long‐term knowledge retention.

So does this mean that Anki can’t be used in the long term?

Using Anki in the Long Term

As mentioned in the section “Correlation of Anki Use and Exam Scores – Does Anki Improve Exam Performance?“, medical students saw an increase in performance of 1 exam point per 1700 Anki flashcards they did (2015 study).

They also did an average of 6 months of Anki.

This means that over the long-term, Anki does work.

So why did the author of this 2011 study state that it is “unclear if the benefits of spaced repetition can be maintained in the long term”? (see “Using Anki in the Short Term“)

Well, there are many differences between the studies.

The 2011 study looked at exam how well students remember information after 6 months. They could not find a difference in memory after retesting the material after such a long time.

The 2015 study, on the other hand, looked at people who did Anki every day. In this case, there was a difference in long term memory for those who did more Anki cards.

So in conclusion, you should ensure you stay consistent with Anki in the long term as it will show an improvement to your exam scores.

Doctors Using Anki

Radiology trainees used Anki in this 2019 study which resulted in an average score increase of 10% after two sessions of using Anki with lectures in between.

The study was conducted as follows:

  1. A deck of 84 cards with images, clinical diagnosis and normal radiographs was developed.
  2. 18 doctors reviewed the flashcard deck once.
  3. They then attended a 2-week block of daily 1-hour radiology lectures.
  4. On the last day, doctors again reviewed the flashcard deck.
  5. A survey was also administered at both time points.

This resulted in an average score increase of 10% between the flashcard review sessions.

All of the responding doctors believed the flashcard method would improve their ability to recognize and diagnoses.

Obviously, this is not what Anki is intended for.

However, it shows that even if you don’t want to do Anki every day, you can still utilize it effectively by using a method derived from one mentioned in the study.

Another thing which should be mentioned is that some of the knowledge learned in medical school cannot be simply learned for exams, but rather needs to be stored for future recall during clinical practice service.

This study shows is that Anki may be useful for medical students well beyond just medical school.

Using Anki for Learning Languages

There is evidence to suggest that Anki is a great tool for learning Languages.

In a 2016 study, a 72-year-old lady with Aphasia (a type of language problem) used Anki for 20 months to help her remember 139 words.

This is significantly better than most patients with this disease (Primary Progressive Aphasia) typically do when using non-Anki based methods to improve language – it is normally about 40 words.

Here are some of the main points to take from this study:

  • The patient didn’t brute memorise words. After seeing every flashcard, she attempted to make connections from a pre-made sentence e.g. “a [Trombone] is a type of [musical instrument]”. She repeated the target word in each cloze sentence, which was intended to strengthen associations between the target and activated semantic/episodic information. This may be needed to learn a language well with Anki.
  • The patient knew cards that were studied earlier on (between 0-10 months) better than the ones studied later on (between 11-20 months). The authors could not conclude whether this was down to having more time to learn the cards, or because the patient’s disease deteriorated over time so was not able to learn cards as well in the second 10 months.
  • They also discuss if lapsing a card has any impact on retention. The more lapses a card has the less well someone is likely to know that card. However, it seems in the long term that is not the case. It seems that lapsed cards were remembered just as well as non-lapsed cards after the 20 months, most likely because lapsed cards are seen more often and so can have more time to be learned.

No study is perfect. Here are some of the limitations of the research that was conducted:

  • Although it is promising, it is only one patient who attempted this.
  • Secondly, the patient had a brain disease, meaning if a normal person did this same experiment, the results would be significantly different. However, it can be viewed positively.
  • She did not do Anki every day. Rather, she reviewed cards about 3–4 times a week. This could be viewed positively as if she learned so many cards by only doing Anki 3-4 times a week, someone who does Anki every day should do even better.

Even with these limitations, you can still conclude that Anki is an excellent resource if you want to learn languages. Especially when compared to the other expensive options that can be found online like Rosetta Stone.

A Limit to Brainpower

Some people use Anki for many years and claim to learn a lot.

This begs the question: Is there any limit to your brainpower?

What if some people are just naturally poor exam performers or have a bad memory?

Well, one piece of research done in the 1980s presented a student who engaged in a task that involved recalling a random sequence of digits.

After more than 20 months, the student went from a digit span of 7 to 80. This memory is comparable to those of memory champions.

These results show that memory is a skill that can be improved by practice even by an average student.

Using Anki in the Classroom

So we all now know that Anki is great for learning loads of facts like in medical school and even learning languages. But could it somehow be used in a classroom setting to help high school kids?

Well luckily, someone has tried that out!

An English teaching started using Anki for 9th and 10th-grade students at an American public high school (article). The class is filled with mostly unmotivated teenagers who don’t care too much about grades (although as he states there are always exceptions).

They all did Anki every day, in class, as a group.

Every night he wrote up cards which averaged about 7 new cards per lesson period.

Every day, they studied for about 8 minutes at a rate of 3.5 cards per minute. He would read each card out loud, offering time to think, and then calling on someone to answer.

Based mainly on his judgment, he would choose and press a response button in Anki.

Exam scores did not go up much on the reading comprehension section (48 to 52%) as reading levels are very difficult to boost in the short term.

Exams score in the terminology and concept section were better (53 to 75%) while the material that was covered before the pre-test also showed encouraging signs. Being the earliest material, there might have been some expected lowering of scored, but the scores stayed relatively on par with the already strong score (82 to 85%).

So we all now know that Anki is great for learning loads of facts like in medical school and even learning languages. But could it somehow be used in a classroom setting to help high school kids?

Well luckily, someone has tried that out!

An English teaching started using Anki for 9th and 10th-grade students at an American public high school (article). The class is filled with mostly unmotivated teenagers who don’t care too much about grades (although as he states there are always exceptions).

They all did Anki every day, in class, as a group.

Every night he wrote up cards which averaged about 7 new cards per lesson period.

Every day, they studied for about 8 minutes at a rate of 3.5 cards per minute. He would read each card out loud, offering time to think, and then calling on someone to answer.

Based mainly on his judgment, he would choose and press a response button in Anki.

Exam scores did not go up much on the reading comprehension section (48 to 52%) as reading levels are very difficult to boost in the short term.

Exams score in the terminology and concept section were better (53 to 75%) while the material that was covered before the pre-test also showed encouraging signs. Being the earliest material, there might have been some expected lowering of scored, but the scores stayed relatively on par with the already strong score (82 to 85%).

It is difficult to ascertain how much of the benefit of the boost in exams scores is due to Anki, however, it is an interesting self-conducted experiment that may give an insight into the use of Anki in a more widespread basis.

My Experience With Anki

Anki has been a great tool for me.

During the Coronavirus lockdown, our clinical placements were cancelled and exams delayed. If it was not for Anki I would have slacked and not done any work.

As it was, I did 30+ minutes of Anki each day, still doing at least 5 new cards a day.

This has prevented me from becoming lazy and let me remember what I had done earlier in the year.

My Statistics

I have been using Anki everyday for over a year (400 days) at this point.

Here are my stats:

The total number of reviews over the last year
This graph shows how most of my cards were reviewed at midday
This shows how I get 91% of young cards correct while only 82% of mature cards correct (correct means selecting “good” on a card)

Can you get Good Exam Results with Just Anki? / Is Anki on Its Own Enough?

Anki on its own is not enough. You can get 80% of the knowledge with Anki, but that final 20% will remain elusive.

You should be using other resources that will help solidify your knowledge and connect the dots from different facts together.

I suggest using a question bank or doing practice questions.

When you start your course/module, Anki should be the main thing you do.

However, when you get closer to your exams, you should start answering more and more questions.

How does Anki Fare Over a Long Period of Time?

Pretty well.

The more mature a card is, the more likely I am to forget it.

That may seem obvious, but it is discouraging at first. Especially when you start forgetting 20% of mature cards.

I might not have a great memory compared to some other people who use Anki, however, I still know things from 6 months ago as well as if it was learned last month.

If I haven’t seen a card for 1 whole year, there is some information which is lost.

I can lose context of what a particular card means if the interval is too long. When this happens I try to remember as best as I can, however, don’t lose sleep over it. As long as I am getting the general gist of a card correct, I will press good.

As time has gone on, I have become less strict with “failing” my cards (i.e. pressing the “again” button).

Do you Retain Everything You Attempted to Retain?

Kind of.

Anki is great for helping retain random bits of facts that you wouldn’t otherwise remember.

Even after having not seen a card in 3+ months, I can still remember what the answer to the card is which is just incredible.

However, when a card is particularly difficult, it can get to the point where my “ease” very quickly drops to below 200% (the ease is the multiplication factor of each card – it is lowered every time you press “again”).

This can get annoying I start seeing cards too often. So I often cheat and press “good” even if I forget. That is because retention is not the same every day and can even vary depending on what time of day you review your cards.

If I do my cards in the morning, my retention of information is higher. In the afternoon, it tends to be lower.

On average, I used to remember 85% of cards, with bad days as low as 80% and good days as high as 90%.

However, now I realised that there is no need to be strict with pressing “again”.

That might be a controversial thing to say, but I believe it to be true.

Sometimes, I know that the only reason I got a card wrong was that I wasn’t paying full attention to Anki. In the past, I used to press “again” as I had gotten the card wrong. Now, if I think that it was a genuine mistake, and I would have remembered the card if I was paying attention or if it was earlier in the day, I press “good”.

To the Anki purest, this may seem like blasphemy.

But the main reason I do this is that pressing “again” too often can make you see a card way too often.

This can be very demoralising and prevent me from doing Anki every day, which is where the real benefit of Anki lies. Therefore, it is better to sacrifice being “pure” with my button pressing and keep the motivation of not having too many reviews to do in the future.

How Much has Anki Impacted your Studies?

Significantly

I have had several exams over the last year. Some I used Anki more and some I used it less.

Mostly my exam scores were similar on all of those occasions.

So what’s the point of using Anki if it doesn’t improve my exam score?

Anki has allowed me to work significantly less than average for the entire year. It is an efficient way to learn, and when it comes to my end of year exams, I do not need to revise for hours and hours a day.

It has allowed me to start this business while also maintaining a good social life.

These are the real benefits of Anki.

I couldn’t have done much better on my exams considering how little I revised each day (I did 1/1.5 hours of Anki every single day while my friends did nothing – then, they started to pull 8 hour days when exams go nearer).

Staying Consistent in the Long Term

I have decided to use Anki even when not revising for exams – I am in it for the long haul.

My final year Medical School exams will take place in Spring 2022, and so staying consistent with Anki over 2/3 years has its benefits.

However, it can be annoying as there is a daily cost of using Anki. Many days during the holidays I have wanted to just forget about Anki. Never touch it again.

It can be frustrating when you are having a nice day out to then realise when you get home you have to do another 30 minutes of Anki.

Even still, I am going to stick with it.

That’s because I recognise the benefits of Anki.

When it comes to revising, I do not have to put in hours and days worth of revision just before an exam. A few practice questions are enough to get the grades I want.

How do you Stay Motivated?

To stay motivated there are a few different techniques that I use:

  • Do at least 1 new card a day – I have several decks that I only do one new card a day for (e.g. Spanish and Geography) because they are things that I want to learn rather than need to learn. Even though doing 1 new card a day is not useful (the Geography deck has 10,000+ cards which it would take 30+ years to do)a, it helps me psychologically feel that I am still making progress in the deck, and so keeps me motivated to do the reviews every day.
  • Review Heat Map Add-on (see image below) – This is a great tool that helps me visually think about how consistent I have been. It makes me want to keep my streak.

This add-on helps me stay motivated to do Anki every day

Do You End up Memorising Cards (Versus Understanding Cards)?

Yes, this does happen. But I would argue if 80% of the cards you understand and 20% of the cards you begin to memorise, on the whole, it is still beneficial to do Anki

You can get around this by doing the thing which I talk about in my How to Use Anki blog which is to attack the topic from multiple angles at the same time.

This is where you have multiple flashcards which relate to one topic but are worded in different ways and come at it in different angles.

This helps have a better factual base to pull from and can create connections between cards in your head.

Do You Only Remember the Information in Cards When Doing Anki?

Am I able to remember cards when not given any context? What about if the question is worded differently in an exam?

Well, if I have learned the card well then when it comes up in an exam/in real life I end up visualising the card in my head.

This is can be extremely useful as when you get multiple cards on a topic all coming together in your head, you get a good understanding of the subject matter.

If I haven’t learned the card well then it can be very difficult to remember the card outside of Anki. This can be especially challenging when being quizzed by doctors on the wards. The lack of context makes it hard to bring up the information that I know I know from doing Anki cards.

However, because a lot of medical schools exams are multiple-choice, this is not as much of an issue.

When I see the context around the question, it is much easier to think of the Anki cards.

Does Missing a Day Matter?

Although I have never missed a full day of Anki, I do not think there is a lot of harm if you only miss one day (I actually have now missed a day and still don’t think it’s a big deal).

However, you need to be incredibly careful that missing one day doesn’t turn into missing two days, then three days, then a week and then a month.

Staying consistent is important.

Even though you could theoretically miss one day and nothing bad happen, I wouldn’t suggest it.

If you want to know how to miss a day then check out this video by the AnKing on how to do it.

How Long Does it Take to Learn Anki? (Timeline)

Timeline of how long it takes to learn Anki

0 – 2 weeks: You’ll make a lot of mistakes. Keep on going!

3 – 5 weeks: Getting the hang of it.

6 – 12 weeks: Do lots of research to get your head around the complicated bits of Anki (e.g. Browse). This is where you can dive deeper into the nitty-gritty.

12 – 52 weeks: You know how to use Anki, however staying consistent starts to become a real challenge.

52+ weeks: Still learning but at a much slower pace. Have in most parts “mastered” Anki and have made it part of your routine so no longer difficult to be consistent.

How Hard do Most People Find Anki to Learn?

In an online survey, 500 Anki users were asked various questions about Anki. One of them was as follows:

If you were recommending Anki to a friend, how easy would you say Anki is to learn overall? 

53% gave a rating of 4 or 5 (1 being very easy – 7 being very difficult).

Therefore, the general position was that there is a learning curve for Anki (particularly for new users), but once overcome, users are fine with it.

Downsides of Anki

Let’s say you are in a room of students.

You are all doing group work involving answering questions.

Someone next to you decides that they know the answer, however when pressed for the reasoning, they respond with “I don’t know. I just saw ______ on my card.”

They don’t try to use any critical reasoning.

After memorising this fact in Anki, they simply vomit back that information with no other usefulness.

What I am trying to say is that Anki is great for helping you to remember study, however, you may just end up memorise random facts with no context behind any of them.

As mentioned in this 2015 study, recall accuracy (just regurgitating information) does not necessarily correspond to knowledge retention (actually knowing the information).

The Daily Cost

On any particular day, Anki is not very effective.

What I mean is that Anki is only useful when used consistently over a long time.

Let’s say that one beautiful sunny day, you decide you want to learn the trombone.

The annoying thing is that to ensure you stay consistent with Anki, you will have to still spend 1 hour of your day reviewing cards (and therefore not doing any trombone learning!).

Now this in and of itself is not a big issue. However, Anki has to be done at the beginning of the day your mind is still fresh.

This is because the brainpower required is high and leaving it till the end of the day can cause a significant impact on your memory.

Therefore what will end up happening is that even though you feel motivated to learn the trombone, you force yourself to do your reviews, and then by the end, you can end up being too tired to do what you wanted to do in the first place.

This is what I like to call the “daily cost” of doing Anki every day.

There are days where you want to do other things, but Anki forces you to spend less time on those things that you enjoy.

The upside i that eventually, you do get used to this.

After 1+ year of doing Anki every day, I do not have this issue as much as I have learned how to deal with it appropriately.

Should You Use Anki?

Yes.

That is the simple answer.

Just start today and see how you find it.

After a few months, you will start to see the benefits. So keep at it. You won’t regret it.

When Should You Start Studying for Medical School Exams?

There is no right or wrong answer to this.

I would recommend that you start using Anki from the first day of medical school. Start getting used to the software and find out if your cup of tea.

If you stay consistent, you will reap the rewards at the end of the year when you won’t have to slog hours and hours in the library.

There is no right or wrong answer to this.

However, if you don’t feel like doing Anki from the beginning of the academic year, you should at least start 6 months before your exams. This will give you enough time to make the cards that you want (or go through an online, pre-made deck) and help supplement your other revision methods.

Conclusion

It does work: however, it requires you to stay consistent over a long period.

Anki is a great resource that you should start using from today.

It can help you memorise the capital cities of the world or learn a new language. Anki can build your knowledge of hobby topics that you always wanted to know.

And best of all, it’s free!

References

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