Duke Med Anki Guide

Quick. How do patients with Cushing’s disease respond to a low-dose dexamethasone test? Not sure? How about this. What molecule is deficient in Kartagener’s disease? Wait. You don’t know? But we learned these nuggets just a few months ago in Normal Body!

If you didn’t have the answers to these questions on the top of your head, you’re not alone. Forgetting never stops. It’s pretty depressing actually. And it’s not a matter of how smart you are. There are constraints on what the human brain can do and we’re just not wired to record and recall the mass of information we’re exposed to in medical school (and in life). But that doesn’t mean we’re helpless. The truth is, we don’t forget everything, but we also don’t remember nearly as much as we’d like. The question is, how can we increase our retention of important information for the long term?

Anki Basics

What is Anki?

Anki is a free flashcard program that utilizes a utilizes a review system based on the idea of spaced repetition. There are other programs like Anki. These include Super-memo, Mnemosyne, and Mental Case. In my opinion, Anki is the best SR program out there. In terms of ease of use, functionality and aesthetic appeal, Anki blows all the other programs out of the water. And did I mention it’s free? :) In addition, there is a very active online community associated with Anki, so if you ever have questions or prob-lems, you can go to the Google group and ask your question. This is invaluable and I’ve made use of this group a lot. I’ll admit, Anki isn’t perfect. There are some features that are somewhat ungainly and there are some things that could be better - as you’ll see if you use the program - but those minor annoyances are far outweighed by Anki’s bene-fits.

Making Cards

Anki allows you to do two major things: (1) Make custom, searchable, media-compatible digital flashcards and (2) review those cards according to a spaced repetition algorithm.

The nice thing about Anki is that it is content agnostic. People use Anki for everything. In fact, as you might imagine, it’s really popular with people learning foreign languages.

Regardless of what you’re studying, the fact remains, you need good cards. People do share their Anki decks with the public, and you can download these and start studying immediately. But if you want to use Anki for class or to study a particular textbook or re-view book, you need to make your own cards.

When I tell people that you need to make cards, the first thing they say is, “Jeez, isn’t that a lot of work? I don’t have time for that.”

My response: Yes, it’s more work than just running your eyes over some text or power-point slides. And yes, that takes time. But you know what takes more time? Having to go back and re-read whole chapters of textbooks, or reviewing 1000 lecture slides be-cause you forgot 50% of what was said. So, the work with Anki is front end. A little bit more time spent at the beginning will save you tons of time in the long run. Plus, as you get better, card-making becomes quick and intuitive. And if you use electronic sources to study, such as online textbooks or websites, you can make cards effortlessly.

Making your own cards is also an important part of the learning process, I think. There is instructive value in doing it. For example, if you’re reading a Robbins chapter, if you know that you need to extract information to make a card, you will read much more at-tentively than if you didn’t have to make a card. Having to make a question out of a fac-toid forces you to think about that information and to actively engage it.

Bottom line: I recommend making your own cards.

So how do we do that?

Let’s begin.

Step 1: Make a new deck.

When you open up Anki for the first time, you’ll be brought to the deck browser screen. This is your home base where all your card decks can be found.Yours will be blank the first time. So you need to make your first deck. Do this by going to File -> New. Name your deck whatever you want.

Step 2: Making your first card.

Making cards with Anki is quite easy.

Open your new deck. Go to the top left cor-ner and click on the green “Plus” or “Add” icon.

Now you have to add information to the “Front” and “Back” of the card.

Here is an example. In the front you write your question, and in the back you write the answer.

Click add and you’re good to go. Another blank card template will show up and you can continue the process.

Keep doing this until you’re done making the cards you want to make.

Some notes on Deck and Card Organization

There are different schools of thought as to how you organize and manage your cards. Do you make a different deck for every topic or do you have one big deck for every-thing?

I see the merit in having one big deck, but I like to compartmentalize my studies for vari-ous reasons. One reason is that sometimes I want to do selective studying. I also want to be able to share certain cards with other people and having discrete decks for differ-ent topics makes that easy.

My suggestion: Make a different deck for each class or textbook you study.

There is also the issue of tags. Tags are useful organizers. Within a deck - which repre-sents a certain topic - you might have subtopics that you’d like the cards to be grouped under. For example, in your anatomy deck, you might want to have some cards tagged as “Head and Neck” or “Abdomen” and so on and so forth. Basically tags help you do very selective study when you want to cram. More on that later though.

Principles for Card Making

The quality of your cards will determine how beneficial your studying is. As they say, garbage in = garbage out. So it’s critical that you make cards that will give you the best chance of retaining the information on those cards.

I’m going to now list several tips for good card making, but there is really one major prin-ciple you should remember:

Keep it short and sweet.

1. Do not learn if you do not understand. Memorizing facts that have no meaning to you is a waste of time. I define learning as acquiring and retaining information. Un-derstanding is making meaningful connections between those learned facts. Whether it’s reading a textbook, or listening to a lecture, or a combination of the two, you need to do something

2. The simpler the better: This is undoubtedly the most important principle for making good flashcards. It is much easier to remember a short, concise answer than a long-winded sentence. The same can be said of questions. Limit questions to no more than two sentences if you must. Make the questions unambiguous, as this helps you recall information much more easily. If a concept or idea has multiple compo-nents, break that concept down and discrete questions from each part. For example. Let’s say you have a statement like this:

Catecholamine release results in increased cardiac output, bronchiodilation, vasocon-striction and lipolysis. On the other hand, insulin release is inhibited by these molecules.

The wrong way to make a card from this statement would be just to ask: “What are the effects of catecholamines?”

The right way is to break it down. So, you would make multiple cards:

- What is the effect of catecholamines on cardiac output?- How do catecholamines affect the diameter of the bronchi?- Effect of catecholamines on lipolysis?And so on and so forth.

Another reason you want to keep your answers short is because of grading. If you’re scoring yourself honestly and accurately, you need to get the answer completely cor-rect. If you have multi-part answers and you only get some parts right, how do you grade yourself? Some things on that card you don’t need to see for a while, whereas other parts (the parts you got wrong) you need to see sooner. If you have multiple com-ponents as your answer, you can give yourself an honest score that will appropriately time your next review. So that is another reason that you should make discrete, single part answers.

Exceptions: Sometimes it’s nearly impossible to not break these rules. For example, when learning a multiple-step mechanism, it’s difficult to make discrete questions. You could make questions like “What is step 1 of the clotting cascade?” but that becomes re-ally cumbersome. When I learn a mechanism, I learn it as a whole, single entity and I find it much easier just to give the whole thing in full rather than making a different card for each step. So for mechanisms I break my rule about not making multipart answers.

Lists - in medicine there are lots of lists. Lists of symptoms, lists of diseases caused by certain pathogens, etc. But lists are really pretty bad for long term memorization. So, whenever I can, I try to make discrete questions out of lists (like the example above

about catecholamines). However, there are many times where there is just no good way to ask a question except to ask for a list. If you must make a list question, I suggest the following: (1) Keep the lists under 5 points, (2) MAKE A MNEMONIC!. Mnemon-ics make your task of memorizing discrete com-ponents of a list much

easier because in actuality, you’re memorizing one thing rather than 5. It’s no surprise that med students are expert mnemonic-makers. So put that skill to use in making list cards.

3. Use media whenever you can: A picture is worth a thousand words, and that’s certainly true when making flashcards. The beauty of making dig-ital flashcards with Anki is that it’s ef-fortless to just copy and paste an im-age right into your card. You can imagine how useful that would be in anatomy or pathology, or anything you need to study where there are a lot of visuals. In fact, sometimes, the picture can even serve as the ques-tion, such as in the anatomy example below. Sometimes, I even use audio.

For example, if I want to learn to identify heart sounds, I can use the audio function in Anki to make the front of my card an mp3 file of the 1st heard sound (S1) or 2nd (S2) and then I need to say which one it is. Remember: media is your friend.