Spaced Repetition Apps Are Reshaping Med School Study Habits
A generation of medical students treats Anki as essential infrastructure. The evidence behind spaced repetition is solid; the way students use it is more complicated.
Spend any time in a medical school library in 2026 and you will see laptops open to one of three or four flashcard applications. Anki, Brainscape, and a handful of newer competitors have become as central to medical training as anatomy atlases were a generation ago. The dominance is striking enough that several US medical schools now mention spaced-repetition software in their orientation materials.
The underlying science is sound. Spaced repetition, the practice of reviewing information at increasing intervals timed to forgetting curves, has roughly four decades of supporting research. A 2024 meta-analysis in the journal Medical Education reviewed 38 studies and found that spaced-repetition users scored 9 to 14 percent higher on board-style exams than peers using traditional review methods. The effect was largest for fact-dense subjects like microbiology and pharmacology.
How Students Actually Use the Tools
The textbook prescription for spaced repetition involves brief daily review sessions of personalized cards. The reality in medical school is closer to several hours per day of pre-built decks downloaded from public repositories. The most popular Anki deck for US medical students, known by a single nickname, contains over 35,000 cards covering the entirety of basic medical sciences.
Dr. Olu Akinwande, who teaches second-year medical students at the University of Pittsburgh, has watched the practice change over a decade. “Students do not flashcard the way the research describes anymore. They consume premade decks as a primary learning method. Whether that produces the same benefits is genuinely unclear.”
The Evidence Is Less Clear for Premade Decks
Most spaced-repetition research used cards that students created themselves. The act of formulating a question often consolidates learning before the first review. Premade decks skip that step. A 2025 study at three US medical schools compared 220 students who used premade decks heavily with peers who used self-made cards. Board scores were similar, but qualitative interviews suggested that premade-deck users had more fragmented mental models of disease processes.
“They can answer a question about a pathway, but they have trouble explaining why the pathway matters,” said Dr. Liesel Faber, who led the Pittsburgh portion of the study. “It is a different kind of knowledge.”
The Hidden Costs
Several faculty have raised concerns about the time cost. A 2025 survey at five medical schools found that students spent an average of 22 hours per week on flashcard review during preclinical training. That time has to come from somewhere, and faculty report that classroom attendance, anatomy lab engagement, and peer discussion have all declined.
Dr. Akinwande has begun to question whether the trade-off is worth it. “Their exam scores are stable. Their ability to think through a case at the bedside is, in my opinion, worse than a decade ago. I cannot prove that, but it is what many of us see.”
What the Best Users Do Differently
Among students who use spaced repetition well, several patterns recur. They use premade decks as supplements rather than primary materials. They add their own cards based on questions they got wrong, which research suggests produces stronger encoding. They cap daily review time and protect other study modalities.
“The students I worry about least are the ones who use Anki for an hour a day and spend the rest of their time reading, drawing diagrams, and talking through cases with peers,” said Dr. Faber. “The students I worry about most are the ones who do Anki for six hours and nothing else.”
Implications for Other Disciplines
Spaced repetition is spreading to law school, where students use it for case names and rules, and to language learning, where it has long been popular. The same questions about active versus passive use apply. Tools that automate review are powerful, but they do not substitute for the work of organizing knowledge in the first place.
For students considering integrating spaced repetition into their study habits, the practical guidance is to make some of your own cards, particularly for the most conceptually difficult material, and to treat premade decks as one tool among several rather than the foundation of a study plan.
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