They say you never forget your first time. It’s true. And I will never forget the first exam for which I used flashcards to prepare. It was way back in 2007, just before the first iPhone debuted and long before I had discovered online flashcard systems. I was in my second semester at the University of Texas, getting ready to sit the first examination in Introductory Biology, Part Two. I had made it through the first semester in tact, and felt excited about my progress toward this far-off-in-the-distance goal of becoming a doctor. But the pace was starting to pick up, and I was drowning in reading assignments and learning objectives. How was I ever going to keep up with all of this information? I wondered.

I knew that I, like most students (even if they haven’t realized it yet) was a tactile, experiential learner. I couldn’t remember something just because it was mentioned once in lecture (I envy you endlessly, auditory learners!). I needed to hold it in my hand, draw it out, or teach it to someone else. Only then was it going to stick. I learned by solving problems, and I loved classes like calculus and physics because most of the teaching was reinforced by multiple sets of questions. The harder courses, for me, were the ones that told a story, requiring me to know hundreds of seemingly random facts.

What I need, I thought to myself, is a way to turn every fact I’m supposed to know into a small question, and then do those questions over and over again until I have memorized every ounce of content that may be covered on this exam.

That’s when I realized that this is exactly the opportunity that creating flashcards affords.

The Benefits of USMLE Flashcards

Flashcards allow you to actively engage in the material you’re trying to learn by generating hundreds of questions about the content. These can be small, fact-based questions, or they can be more conceptual. Every time you create a set of flashcards in earnest, you are becoming a miniature professor, writing your own version of the exam in your head.

And take heed, my friends. Since the best flashcards are the ones that you put a lot of thought into making, doing this well means doing it without distractions. This means no television, no music and, yes, no BuzzFeed.

Flashcards were my little secret to scoring high on the USMLE Step 1.

I’m going to repeat that.

Flashcards were my little secret to scoring high on the USMLE Step 1.

Whenever a student has signed up for our services, the first thing I do is make sure that they understand how to make good flashcards. Because unless you’re a savant (in which case, hey, more power to you!), you are going to struggle to cram all of this into your head.

Don’t fret!

This is where online flashcard software comes in.

Now, you may know that money can’t buy you love. What you might not realize is that it also can’t buy you a trusty set of flashcards.

The truth is—and careful here, this may be a big pill for you to swallow—the best flashcards are the ones that you make for yourself! No amount of cutting corners by purchasing the latest deck of guarantee-laden online flashcards is going to make up for the benefits you will reap from pouring your own blood, sweat, and tears into customizing your personal flashcard decks.

So quit trying to cut corners! You won’t regret taking the long way. I promise.

“But I don’t like flashcards,” you say. “I’ve tried them before and they didn’t work for me.”

Fair enough. But are you sure you tried them the right way?

“What’s the right way?” you ask, feigning indifference.

Well, I’m so glad you asked. Please allow me to show you.

There are a variety of online flashcard programs out there. Personally, I use AnkiWeb. Why? Because word of mouth is a powerful thing, my friends, and this was the first program I ever heard about. That said, I may have come to AnkiWeb because of word of mouth, but I stayed because of its comprehensive approach to triaging information.

What do I mean by that?

AnkiWeb has a built-in feature that allows you to decide for yourself how well you know a fact, a decision that then determines when you will be presented with that fact again.

• Perhaps you know something really well – fine, let’s not review that card again until ten days from now. Yay for progress! 
• Or perhaps you’re reviewing the clinical features of tuberous sclerosis (the bane of my existence!), in which case, you’re probably going to need to see that card again sometime in the next sixty seconds. 

September 2015 Update: Memorang also has the promise to be a new and possibly better Anki, so be sure to check them both out to see which one works best for you.

I think you get the point here. But just in case – the problem with more passive modalities of learning, like reading through First Aid, or reviewing terser summaries you’ve handwritten based upon your reading, is that you have no way of triaging information. Perhaps you know 80% of the material you’re reading – you don’t need to see it again right now! If we had all the time in the world, it would be fine to review the entire story again in the process of picking up those few facts that you know. But this is the USMLE Step 1. There are simply too many facts, and we certainly don’t have all the time in the world!

The key is to work through the latest edition of First Aid and make multiple flashcards:

• The more individual flashcards, the better. 
  
• The less amount of information each flashcard contains, the better.
• The more decks of flashcards, the better. I recommend having separate decks for the pharmacology at the back of each chapter as well.

If you’re doing this right, you will end up with at least 4,000 individual flashcards, split into about 30 decks based on the sections of First Aid.

Now, if you’re anything like my fantastic students, you’re going to excitedly start flashcard-making process, and in a couple of weeks, you’re going to hit what I call “the wall”.

What is “the wall“?

• “But Sarah, I don’t have enough time to review all the flashcards that I am making. This seems so fruitless.”
• “But Sarah, I keep running into a problem where I am reviewing the same cards over and over and cannot make progress in each one of these decks.”
• “But Sarah, there are just too many flashcards to be made. There is no way I am going to get through all of these. Maybe I should just buy some of the pre-made decks I have seen on the Internet.”
• “But Sarah, I miss my social life.”

Here’s what I say:

• As long as you’re making them in a non-distracted way, the process of making the flashcards is highly beneficial. Apart from this, you should be finding a way to squeeze flashcard review into your daily routine. Download the mobile app and review them during breakfast, or while riding your bike. (The stationary bike at the gym! Not the Citi Bikes, please!)
• You can adjust the settings in AnkiWeb so that you can review many more cards before cycling through the ones that you’ve already declared you don’t know. Also, consider selecting the “10 minutes” time period for repeat review, as opposed to the “60 seconds” time period, in order to avoid treading too much flashcard water. 
•  I will be frank here: Suck it up. You can do this. The more time you spend thinking you can’t do it, the less time you will spend making flashcards. 
•  I can’t help you with this one. But I can tell you that it gets better. Medical school is a legalized form of hazing and this too shall pass. This is the investment phase of life. 

The bottom line is this: If you feel like you’re drowning in flashcards, you’re probably doing it right.

Just keep swimming.

Update June 2016: Since the publishing of Sarah’s post in May of 2014,  we’ve also been introduced to Memorang, which not only performs all the same functions as Anki, but is far more mobile user-friendly. (Anyone who has tried to use Anki from a cell phone will understand this frustration.) All in all, both are definitely worth checking out for your study needs.