Is AnKing too much with p/f step 1?

[Matthew9Thirtyfive]

How likely is skipping wards going to happen

Not very likely unless they’re willing to fail clerkships in order to do well on step 2, which would be extremely counterproductive.

---

Members don't see this ad.

 

[Redpancreas]

so it begins

To be fair, integrating/tying in M2-M3 content is a good thing for those looking to learn medicine in general. I personally believe what we learn in M3 should really be learnt in M2 with M2 having clerkships and M1 basically being a cram of Step 1 basic science stuff currently covered in M1-2. Those basic-science/clinical connections should be made and if someone wants to do that, I'm not going to tell them not to. That said, I don't think it's the path to 260+ on Step 2 CK.

 

[Thesimplelifeofamyloid]

To be fair, integrating/tying in M2-M3 content is a good thing for those looking to learn medicine in general. I personally believe what we learn in M3 should really be learnt in M2 with M2 having clerkships and M1 basically being a cram of Step 1 basic science stuff currently covered in M1-2. Those basic-science/clinical connections should be made and if someone wants to do that, I'm not going to tell them not to. That said, I don't think it's the path to 260+ on Step 2 CK.

My professors attempts to integrate clinical content in preclinical just ultimately was an up-to-date paragraph slapped on a ppt slide

 

[Redpancreas]

My professors attempts to integrate clinical content in preclinical just ultimately was an up-to-date paragraph slapped on a ppt slide

Yeah, they definitely did that sort of thing too at my place. NYHA HF criteria, DKA algorithm, etc were all present in my M1-2 notes when I skimmed through them before throwing them out. When I saw it as an M2 in the way our current system is run, I was like IDGAF and was worrying more about forgetting the pharyngeal arches so I didn't miss the third order questions. If lecturers did emphasize it, I was like please stop, this isn't in First Aid and I know it's not gonna be on our in-house exam or Step 1 so I'm just going to tune you out.

Once I got to rotations, I realized how valuable those nuggets I ignored were which is why I think the didactic components of M2 need to be incorportated with actual rotations so you can see what's important and what's not. The stakes need to be applied to what we need to know to be physicians.

 

[Thesimplelifeofamyloid]

Yeah, they definitely did that sort of thing too at my place. NYHA HF criteria, DKA algorithm, etc were all present in my M1-2 notes when I skimmed through them before throwing them out. When I saw it as an M2 in the way our current system is run, I was like IDGAF and was worrying more about forgetting the pharyngeal arches so I didn't miss the third order questions. If lecturers did emphasize it, I was like please stop, this isn't in First Aid and I know it's not gonna be on our in-house exam or Step 1 so I'm just going to tune you out.

Once I got to rotations, I realized how valuable those nuggets I ignored were which is why I think the didactic components of M2 need to be incorportated with actual rotations so you can see what's important and what's not. The stakes need to be applied to what we need to know to be physicians.

I think it comes down to presentation and organization. Boards and Beyond in their step 1 materials does a great job at putting relevant clinical content into their videos, and their step 2 videos do an even better job of this. If something is jammed in a 100 slide long ppt, people aren't going to learn from it

 

[Redpancreas]

I think it comes down to presentation and organization. Boards and Beyond in their step 1 materials does a great job at putting relevant clinical content into their videos, and their step 2 videos do an even better job of this. If something is jammed in a 100 slide long ppt, people aren't going to learn from it

If you compare the dinosaur lectures from your PhD (some of which are recycled from PhD classes they teach) to commercial lectures designed for medical school, of course BnB, etc. is going to look better. Ultimately, the system is still not where it needs to be to train medical students for residency and better integration between the didactic and clinical curriculum is needed.

 

[Matthew9Thirtyfive]

Wow every time I read threads like this it makes me so thankful I ultimately chose the school I go to.

 

[Ho0v-man]

Yeah, they definitely did that sort of thing too at my place. NYHA HF criteria, DKA algorithm, etc were all present in my M1-2 notes when I skimmed through them before throwing them out. When I saw it as an M2 in the way our current system is run, I was like IDGAF and was worrying more about forgetting the pharyngeal arches so I didn't miss the third order questions. If lecturers did emphasize it, I was like please stop, this isn't in First Aid and I know it's not gonna be on our in-house exam or Step 1 so I'm just going to tune you out.

Once I got to rotations, I realized how valuable those nuggets I ignored were which is why I think the didactic components of M2 need to be incorportated with actual rotations so you can see what's important and what's not. The stakes need to be applied to what we need to know to be physicians.

I don’t know how it is at other schools, but we had a clinical course that was 100% step 2 info. You couldn’t punt this stuff at all because you would definitely fail if you did. It was our hardest class by a mile.

I hated it at the time, but doing well in that class really made third year a breeze.

 

[Redpancreas]

Wow every time I read threads like this it makes me so thankful I ultimately chose the school I go to.

To be fair man, I think maybe your outlook and positivity plays a part, especially if residents are telling you you are at the R3 level. Props to you.

 

[Redpancreas]

I don’t know how it is at other schools, but we had a clinical course that was 100% step 2 info. You couldn’t punt this stuff at all because you would definitely fail if you did. It was our hardest class by a mile.

I hated it at the time, but doing well in that class really made third year a breeze.

Mine didn't.

I honestly do think some DO schools do a better job with integration of clinical material like how to work up common diseases and give a lot more OSCE work which gives students confidence to start rotations. Since OMM was a thing, I think MSUCOM (the school whose curriculum I'm most familiar with) had regular OSCEs too which prepared them a lot and having a course dedicated to Step 2 material can help with M3 shelf exams.

 

[Lucca]

Unlike step 1, wards and shelf exams are already prepping you for step 2. 2 weeks to get through the UWorld you haven’t yet done and review should get everyone where they need to be. The step 1 average jumped from 200 to 235 over a decade and a half. The average step 2 performance doesn’t have much room to “inflate”, comparatively. My hope is this will be sufficient. Unless of course they re write the test to be “better” at differentiating students, I.e asking more and more obscure minutiae that will never matter to anyone but will create a multi million dollar test prep complex anyway.

My worst nightmare is preclins taking a research year to study for step 2 for a year before wards.

 

[Thesimplelifeofamyloid]

Unlike step 1, wards and shelf exams are already prepping you for step 2. 2 weeks to get through the UWorld you haven’t yet done and review should get everyone where they need to be. The step 1 average jumped from 200 to 235 over a decade and a half. The average step 2 performance doesn’t have much room to “inflate”, comparatively. My hope is this will be sufficient. Unless of course they re write the test to be “better” at differentiating students, I.e asking more and more obscure minutiae that will never matter to anyone but will create a multi million dollar test prep complex anyway.

My worst nightmare is preclins taking a research year to study for step 2 for a year before wards.

Everyone always forgets that the step 1 and step 2 scores are not interchangeable. A 230 on step 1 is the 43rd percentile while a 230 on step 2 is the 17th percentile. Percentile wise, a 230 step 1 scorer (43 percentile) would have to get a least a 245 (46 percentile) on step 2 to match their original score or more to do "better."

 

[mmchick]

Just do what works for you. With Step 1 being P/F, you shouldn't be doing anything that is highly stressing you out, but you should also be taking it seriously because people are frankly lying to you or themselves if they feel they can memorize all the information you need for Step by going through curriculum and not revisiting that material again. Path, pharm, micro.. there's no way one can genuinely memorize all that information without doing some sort of spaced retrieval. I think some people think they can wing the exam and it'll come to bite them in the ass once they sit down for practice tests.

You shouldn't worry about unsuspending a lot of the AnKing deck, for instance, for cloze series, I usually pick one card to unsuspend. This saves loads of cards to do and get's the ultimate point across. You also shouldn't worry about more foundational concepts if you can generally recall that info while you're looking at the card. If you have a strong background in say metabolism, maybe you don't have to unsuspend a bunch of those cards and can instead focus on other areas. Just curate it to what your needs are and do what works for you. Everyone will swear up and down what they think the best process is, but ultimately, it just comes down to what works for you specifically.

I plan on catching up on AnKing this summer with previous curriculum that I didn't review after the blocks were over during M1. I personally am going to go through First Aid as I don't feel like watching BnB videos unless I really forgot specific stuff. I've been able to skip out on like 50% of the cards in the First Aid tags, it's working so far for me personally. But if it starts to get stressful, I'll scale it back a bit.

 

[Welshman]

My original comment probably got lost in the sauce way back in the beginning but I just want to say it again because I’m a die hard anki guy who’s done the 400k reviews

For P/F step1 and preclincial, the best thing to do would be the original Zanki deck (which is the main part of Ankings remake). IMO, if you want to be a well rounded doctor I think you should know essentially everything in costanzo, all of pathoma and probably most of sketchy micro (forget the parasites). These topics are the core step1 and step2 (the core of medicine really). Most importantly for you guys, there are only about 17,000 of these cards and they are the best written cards you will ever see which makes them much faster to learn. It cannot be overstated how much faster and better these core cards are than the nightmare of biochem and neuro expansions.

If you watch sketchy you can learn the new 50-100 cards associated with that video in less than 30 minutes and it’s all high yield across the steps, the reviews go even faster. If it’s taking you more than 10-12 seconds to do these cards as reviews something is going very wrong (they should really be done in <10s). Ditching the 1000s of the biochem cards which take an hour just to get through just 100 reviews is life saving.

there’s also a lot of talk about keeping up with old cards, this really isn’t a big deal if you use anki properly and control neurotic med student tendencies like having a minimum interval of 1 month. Trust yourself, don’t lie and hit good if you got it wrong, and Make the minimum interval a year or unlimited and the reviews die down dramatically. Also be aware of ease hell, this cannot be overstated as well.

If you do this by the time tou get to step 2 and shelves you’ll be pleasantly surprised that most of the step2 anki deck is already complete and you’ve kept up with it over the years so you can comfortably jump straight into UW. You’ll also then find that essentially every step2 UW question has been turned into an anki card that seamlessly fits into your existing workflow.

Finally, if you’re going to commit to Anki, I strongly recommend learning a bit about the decks history, it helps understand their structure and definitely recommend learning how the program and algorithm works so you can adjust when you need to.

 

[RapidEyeMovementLearning]

N=1 but I have a friend with a 260+ Step 1 who only did Pharm and Micro cards from Anking during M1. Then started doing AMBOSS immediately in M2, and would un-suspend Anking cards for concepts from any questions he got wrong. Started Uworld in Winter and did the same thing. Was only doing ~200 flashcards per day which is like 30 min-1hr max. Made a handful of cards himself from incorrects. I think he eventually matured only 40% of the deck once he finished step1.

 

[DigNewton]

...the best thing to do would be the original Zanki deck (which is the main part of Ankings remake). ...there are only about 17,000 of these cards...

Maybe I just don't know how to use Anki well enough yet, but how do I find those 17k cards? When I combine the costanzo/pathoma/sketchy micro/sketchy pharm tags, I see ~20k cards. When I select the "Zanki Step Decks" subdeck in Anking, I get ~22k cards.

 

[Welshman]

Maybe I just don't know how to use Anki well enough yet, but how do I find those 17k cards? When I combine the costanzo/pathoma/sketchy micro/sketchy pharm tags, I see ~20k cards. When I select the "Zanki Step Decks" subdeck in Anking, I get ~22k cards.

Tags are the best way to do it, it could be more than 17k I don’t have it memorized, and they’ve been detagging and adding cards to sections so it may have grown by a few thousand. Perhaps when I last looked I didn’t include the sketchy cards which would make up the difference too ~4K. The most important sketchy pharm cards are the ones in the notacop deck, mostly micro and Anti-neoplastic.
If you’re looking at the sub deck that will include a lot of additional cards. You’ll want to use tags to search for the ones you want. You can also use the BGAdd and AKAdd tags remove the recently added ones

 

[DigNewton]

Tags are the best way to do it, it could be more than 17k I don’t have it memorized, and they’ve been detagging and adding cards to sections so it may have grown by a few thousand. Perhaps when I last looked I didn’t include the sketchy cards which would make up the difference too ~4K. The most important sketchy pharm cards are the ones in the notacop deck, mostly micro and Anti-neoplastic.
If you’re looking at the sub deck that will include a lot of additional cards. You’ll want to use tags to search for the ones you want. You can also use the BGAdd and AKAdd tags remove the recently added ones

Awesome, thank you. Looks like lolnotacop + costanzo + pathoma has ~16.5k cards, so maybe you do have it memorized.

 

[Matthew9Thirtyfive]

N=1 but I have a friend with a 260+ Step 1 who only did Pharm and Micro cards from Anking during M1. Then started doing AMBOSS immediately in M2, and would un-suspend Anking cards for concepts from any questions he got wrong. Started Uworld in Winter and did the same thing. Was only doing ~200 flashcards per day which is like 30 min-1hr max. Made a handful of cards himself from incorrects. I think he eventually matured only 40% of the deck once he finished step1.

Yes, that is an n=1. Unfortunately not really meaningful except to say that it is possible to do well with only moderate anki use.

 

[efle]

Alright maybe this makes me an ass or a dinosaur but I don't understand why anybody wants to work through a deck of 17,000 flashcards when you can easily learn the useful part of preclinical just from your professors and videos like B&B, pathoma, sketchy? Isnt the whole point of anki to let you ram the minutiae that separates a passing score from a derm score into your long term retention? Theres no need for that anymore and you cant flashcard reasoning

 

[MedScat]

Alright maybe this makes me an ass or a dinosaur but I don't understand why anybody wants to work through a deck of 17,000 flashcards when you can easily learn the useful part of preclinical just from your professors and videos like B&B, pathoma, sketchy? Isnt the whole point of anki to let you ram the minutiae that separates a passing score from a derm score into your long term retention? Theres no need for that anymore and you cant flashcard reasoning

I don't retain when I just watch those videos so I have to watch and then do anki cards and then it's harder to forget and then you blow people out of the water by remembering things on rotations....the cards just reinforce those videos in a very effective manner. The anki cards from anking are written in a fashion where its not just remembering details it helps you remember mechanisms too and pathophys

 

[Matthew9Thirtyfive]

Alright maybe this makes me an ass or a dinosaur but I don't understand why anybody wants to work through a deck of 17,000 flashcards when you can easily learn the useful part of preclinical just from your professors and videos like B&B, pathoma, sketchy? Isnt the whole point of anki to let you ram the minutiae that separates a passing score from a derm score into your long term retention? Theres no need for that anymore and you cant flashcard reasoning

Maybe because active learning using cards or questions is like 1000% more effective and efficient than passively watching videos. That is well supported.

 

[Welshman]

Alright maybe this makes me an ass or a dinosaur but I don't understand why anybody wants to work through a deck of 17,000 flashcards when you can easily learn the useful part of preclinical just from your professors and videos like B&B, pathoma, sketchy? Isnt the whole point of anki to let you ram the minutiae that separates a passing score from a derm score into your long term retention? Theres no need for that anymore and you cant flashcard reasoning

17k sounds like a lot but it’s pretty manageable. Personally, by using anki I saved tons of time and did well compared to people who just used lectures. If you’re able to watch a video and do well that’s amazing but active recall and distributed practice are some of the best ways to learn and anki takes care of that for you.

Why pour over the same lecture slides 20 times when you have excellent premade decks that allow you to quickly stratify the content you know and don’t know? Move the easy stuff to a week from now to make sure you got it and focus on the hard concepts again tomorrow. Anki also identifies these for you because it’s an active learning process where you’re testing yourself. You can plan to look at slides again but it’s terribly inefficient.

I felt bad for people trying to divine the high yield stuff out of lecture slides or watching the same BnB/sketchy video for the 3rd time. That’s the real time suck, Trying to figure out where your gaps are and then fix them with content review without anki. You can try to do this with a q bank but there’s no way you can cover as many topics as quickly compared to a new flash card every 8-10 seconds.

If you get in the anki train, whether P/f or not, part of the beauty is that your workflow is totally streamlined and consistent. Do your reviews, watch BnB, do your new cards from that video. Repeat until done. Then polish off the application with your favorite q bank. This was more than enough for my graded classes using both NMBE and in house exams.

I found the whole process rather therapeutic.

 

[efle]

Maybe because active learning using cards or questions is like 1000% more effective and efficient than passively watching videos. That is well supported.

Flashcarding is excellent for retaining discrete recall. It will never help you learn clinical reasoning. That's the difference I'm trying to highlight. Anki is an incredibly powerful tool for performing what is now an incredibly useless task. Walking around with First Aid for Step 1 memorized cold should not be anyone's goal anymore

It sounds like you guys used it pretty differently than some of my friends though. As an example I used to have tons of classmates doing flashcards on their phones or laptops during our small group sessions. Literally a world-class radiologist or pathologist could be trying to engage the room by asking people to take a stab at very interesting cases, and instead MS1-MS2s are too busy flashcarding obscure First Aid content. Doing 200k+ cards and multiple Qbanks was like a failsafe recipe for a great board score so people just pounded it as priority #1. If you're just using bits and pieces to reinforce areas with a lot of discrete stuff like anatomy, then keeping anki around makes a ton of sense. The anki use I saw some people doing though...that needs to die.

 

[Matthew9Thirtyfive]

Flashcarding is excellent for retaining discrete recall. It will never help you learn clinical reasoning. That's the difference I'm trying to highlight. Anki is an incredibly powerful tool for performing what is now an incredibly useless task. Walking around with First Aid for Step 1 memorized cold should not be anyone's goal anymore

Lol wat? It’s hard to have clinical reasoning when you don’t know the foundational knowledge. Anki teaches you the discrete facts that you can then learn to apply to clinical reasoning through cases and questions.

It sounds like you guys used it pretty differently than some of my friends though. As an example I used to have tons of classmates doing flashcards on their phones or laptops during our small group sessions. Literally a world-class radiologist or pathologist could be trying to engage the room by asking people to take a stab at very interesting cases, and instead MS1-MS2s are too busy flashcarding obscure First Aid content. Doing 200k+ cards and multiple Qbanks was like a failsafe recipe for a great board score so people just pounded it as priority #1. If you're just using bits and pieces to reinforce areas with a lot of discrete stuff like anatomy, then keeping anki around makes a ton of sense. The anki use I saw some people doing though...that needs to die.

Yeah I haven’t seen anyone do that.

 

[efle]

Lol wat? It’s hard to have clinical reasoning when you don’t know the foundational knowledge. Anki teaches you the discrete facts that you can then learn to apply to clinical reasoning through cases and questions.

Maybe I should download anking and look at a few random cards

If I grab 20 how many would you guesstimate fall under "not something most attendings would know"?

When I looked over friends shoulders it appeared to be first aid in flashcard format. Maybe I missed all the good cards

 

[Matthew9Thirtyfive]

Maybe I should download anking and look at a few random cards

If I grab 20 how many would you guesstimate fall under "not something most attendings would know"?

When I looked over friends shoulders it appeared to be first aid in flashcard format. Maybe I missed all the good cards

I’ll say that in my n=1 experience, I have known stuff that my residents and attendings have forgotten because I’m closer to it from doing anking, and the information was actually clinically useful or relevant most of the time. Now they could have just looked it up, but I saved them some time by just having that recall.

 

[Welshman]

I think it would be a gross mischaracterization of the Anking deck to consider it First Aid in flash card form or that it’s only helpful for memorizing discrete facts cold… it’s definitely good for that too but you can put anything in it and learn anything from it. It’s far more detailed than FA. It’s a source you can learn from if you have the broad strokes down. This is especially true if you read through the extra material on the cards and the amboss add on, which automatically links keywords to its library, triples down on this.

I agree with Matt, Few things in medicine are intuitive unless you know the “facts” behind them. Nitro lowers BP but unless you know the fact that about reflex tachycardia the guy with a dissection is going to have a bad time. But if you know it, it’s obvious. I would argue that it’s the minutae that really allows someone to clinically reason and sets physicians apart from mid levels. On one had you can memorize that the great professor C does Y when Z happens, or you can understand what Y does and why Z happens and apply it to other situations appropriately.

Being taught by world class faculty is cool, they usually have interesting stories and experiences, but for medical students their unique insight is totally lost. You have a world class pathologist working through a case that really gave him a run for his money, while half the class doesn’t even know what tissue they’re looking at yet. If the radiologist wants to work through a stroke case but the student can’t tell you where the MCA is or what it supplies they’d probably be better off doing the anki on it. Cards they should have done before the session so they could actually have gotten something out of it but alas.

If you took 20 random cards and had a random attending do them they’d probably get most of them wrong because it’s not how they’re used to seeing information and it’s pure recall of a specific item. There’s a certain familiarity you need with the cards or the material they’re made from to really get in the groove. 20 purely random cards would feel jarring. But to answer your question more, if it was their specialty they would probably know almost all of them. A psychiatrist is going to know every one of the psych cards I can think of but they’d blow for sure on repro/gyn cards while an gyn attending would nail it and vice versa. Doesn’t mean that the psych or gyn cards were useless esoteric facts.

 

[deleted952648]

Flashcarding is excellent for retaining discrete recall. It will never help you learn clinical reasoning. That's the difference I'm trying to highlight. Anki is an incredibly powerful tool for performing what is now an incredibly useless task. Walking around with First Aid for Step 1 memorized cold should not be anyone's goal anymore

It sounds like you guys used it pretty differently than some of my friends though. As an example I used to have tons of classmates doing flashcards on their phones or laptops during our small group sessions. Literally a world-class radiologist or pathologist could be trying to engage the room by asking people to take a stab at very interesting cases, and instead MS1-MS2s are too busy flashcarding obscure First Aid content. Doing 200k+ cards and multiple Qbanks was like a failsafe recipe for a great board score so people just pounded it as priority #1. If you're just using bits and pieces to reinforce areas with a lot of discrete stuff like anatomy, then keeping anki around makes a ton of sense. The anki use I saw some people doing though...that needs to die.

Genuine question - what makes someone a "world-class" radiologist or pathologist? Research output at a powerhouse? Seeing tons of zebra cases?

 

[efle]

Genuine question - what makes someone a "world-class" radiologist or pathologist? Research output at a powerhouse? Seeing tons of zebra cases?

Yeah to me personally, its having many years experience with all the crazy zebras and high volumes of a quaternary center, that and being a great teacher. I think that's also where the reputation for training programs usually comes from - the reason something like JHH Osler medicine residency is considered top notch training is because it means you live and breath a big census of complex and rare patients.

 

[Miles Gloriosus]

Yeah to me personally, its having many years experience with all the crazy zebras and high volumes of a quaternary center, that and being a great teacher. I think that's also where the reputation for training programs usually comes from - the reason something like JHH Osler medicine residency is considered top notch training is because it means you live and breath a big census of complex and rare patients

I wonder if surgical residents would agree. Would be nice to hear their thoughts….but might not since their voices might be drowned out by all the noise coming from the army of fellows in their way.

 

[efle]

I wonder if surgical residents would agree. Would be nice to hear their thoughts….but might not since their voices might be drowned out by all the noise coming from the army of fellows in their way.

I've heard other specialties can go the opposite direction for sure. Ortho and neurosurg in academic programs that dont operate enough bread and butter, academic EDs that dont have their frontline do as much themselves because of all the available services, etc. Whereas for something like rads or path you want to be at the place that all the weird rare stuff is congregating

 

[fdgjfg]

Alright maybe this makes me an ass or a dinosaur but I don't understand why anybody wants to work through a deck of 17,000 flashcards when you can easily learn the useful part of preclinical just from your professors and videos like B&B, pathoma, sketchy? Isnt the whole point of anki to let you ram the minutiae that separates a passing score from a derm score into your long term retention? Theres no need for that anymore and you cant flashcard reasoning

It's by no means a necessity anymore, but I think premade anki decks have utility for some learners.

One advantage of anki is that the workflow is extremely straightforward and requires less attention or executive function. It's like a pre-drawn vial of drug ready to be injected, while class lectures are more like chemical reagents that have to first be processed into drug, then drawn up, then injected. The practical usage of anki also inherently lends itself to operant conditioning and reward learning in a way that reading lecture notes doesn't - you're in this artificial environment encountering discrete structured tasks, in which you receive immediate feedback/reward, and can have momentary lapses in concentration between encounters. It feels good to get cards right and see the number of remaining reviews tick down for the day, in comparison with the relatively ambiguous and unstructured alternative of passively reading/listening to lectures.

Many of my friends were able to passively read/listen their way to good grades and step scores - for them, the only additional utility of anki would be those first aid tiny minutiae. For others, the gulf is much larger - either barely scraping by using passive techniques (still with significant time investment), or exceeding expectations using anki (with only marginally more time investment). Anki still does a very good job of teaching the basics, even with more conceptual things - cards can sort of be used as "mini practice questions" in which you try to synthesize what you know and make sure your answer to the card meshes into that conceptual framework. This usually comes with liberal use of the "extra" section and supplemental figures, notes, and tables.

It'd be interesting to do a hypothetical study examining preferences and learning outcomes with different learning styles (passive vs anki) and correlating it with a few key factors, both psychological (probably executive function, and maybe something like Big 5 neuroticism) and neurobiological (rate of dendritic spine formation and stabilization, long-term potentiation, long-term depression/extinction learning). Perhaps if you have relatively high executive function, low neuroticism, and learn things quickly (rapid spine formation/LTP, slow LTD) passive works well, and for the opposite (lower executive function and slower LTP) anki is better. For the first learner, anki would feel restrictive and unnecessary - being forced to learn in an overly structured manner for marginal gains. For the second learner, anki is freedom - freedom from the disruptions of anxiety or lapses in attention, and additional executive function required to drive home a slower more stubborn rate of learning reinforcement.

 

[efle]

It's by no means a necessity anymore, but I think premade anki decks have utility for some learners.

One advantage of anki is that the workflow is extremely straightforward and requires less attention or executive function. It's like a pre-drawn vial of drug ready to be injected, while class lectures are more like chemical reagents that have to first be processed into drug, then drawn up, then injected. The practical usage of anki also inherently lends itself to operant conditioning and reward learning in a way that reading lecture notes doesn't - you're in this artificial environment encountering discrete structured tasks, in which you receive immediate feedback/reward, and can have momentary lapses in concentration between encounters. It feels good to get cards right and see the number of remaining reviews tick down for the day, in comparison with the relatively ambiguous and unstructured alternative of passively reading/listening to lectures.

Many of my friends were able to passively read/listen their way to good grades and step scores - for them, the only additional utility of anki would be those first aid tiny minutiae. For others, the gulf is much larger - either barely scraping by using passive techniques (still with significant time investment), or exceeding expectations using anki (with only marginally more time investment). Anki still does a very good job of teaching the basics, even with more conceptual things - cards can sort of be used as "mini practice questions" in which you try to synthesize what you know and make sure your answer to the card meshes into that conceptual framework. This usually comes with liberal use of the "extra" section and supplemental figures, notes, and tables.

It'd be interesting to do a hypothetical study examining preferences and learning outcomes with different learning styles (passive vs anki) and correlating it with a few key factors, both psychological (probably executive function, and maybe something like Big 5 neuroticism) and neurobiological (rate of dendritic spine formation and stabilization, long-term potentiation, long-term depression/extinction learning). Perhaps if you have relatively high executive function, low neuroticism, and learn things quickly (rapid spine formation/LTP, slow LTD) passive works well, and for the opposite (lower executive function and slower LTP) anki is better. For the first learner, anki would feel restrictive and unnecessary - being forced to learn in an overly structured manner for marginal gains. For the second learner, anki is freedom - freedom from the disruptions of anxiety or lapses in attention, and additional executive function required to drive home a slower more stubborn rate of learning reinforcement.

Extremely good point. I think the personality types common among med students definitely pair well with a tool that lets them directly convert hours of their time into progress through a quantifiable body of knowledge to master. I'd probably be horrified at how many people would still be studying this way even if Step 1 ceased to exist altogether

 

[Lem0nz]

I wonder if surgical residents would agree. Would be nice to hear their thoughts….but might not since their voices might be drowned out by all the noise coming from the army of fellows in their way.

Depends on the goal. There is a clear, clear difference between someone trying to 'solve' a disease process and someone trying to treat patients. We have these weird surgeon scientist folk who are 'world class' surgeons. Some of them truly are pretty amazing at operating, but most aren't. There are certainly community surgeons out there who operate way more, way faster, and almost certainly have better outcomes. The problem is they don't publish any of it and really have no incentive to. It won't pay them more money and whatever reputation boost they may get is not relevant because these surgeons already have full panels and full days. They also tend to be more versatile.

I've been to po-dunk no where and operated with people who are scary as hell. I've been to MSKCC and operated with 'the world's best'. And I've been to high volume quaternary referral centers that lack the name and prestige but absolutely have the volume. The best surgeons were at the last. But getting back to my original point - those surgeons will never cure cancer nor will they really advance the field in any meaningful way. They WILL treat tens of thousands more humans over the course of their career which is equally as important.

The 'world class' surgeons also tend to get referrals that no one else wants or can manage which makes for a weird comparison. Re-operative/recurrent cases or cases that require a very extreme and radical surgical approach if surgery is going to be undertaken at all. Cancer is the easiest to conceptualize for this because its been studied the most. It naturally makes them have worse outcomes and an outsized reputation. When you're on the receiving end of some of these patients and dealing with their complications because the patient flew 1,000 miles for some obscure, rare, or super radical surgery... well. You really wonder if the world class surgeon was applying good judgement in operating in the first place sometimes.

I guess very hard to quantify but the best surgeons I've seen were at quaternary community referral centers where the system served patient populations of at least 750k+. We don't really compare well to our comrades though. A surgeon scientist =/= an academic surgeon specializing in a single disease at its most complex and publishing the forefront of clinical trials in that realm =/= a general specialist treating massive volumes of patients =/= general surgeons solving whatever walks in the door =/= rural surgeons. They're all very, very different. We need world class versions of all of them. The scientists feed the ultra specialists with new tech and drugs, the ultra specialists set up the clinical trials, the high volume surgeons implement it, and the general surgeons and rural surgeons make sure people don't fall through the cracks as best they can.