The pre-clinical medical sciences course at Cambridge (MVST) is predominantly theoretical and assessment consists of formal written exams at the end of the year. Two key learning skill are 1) understanding concepts and 2) memorising facts. In my experience, different people prefer one way over the other – I never had to rely on rote learning to get through exams until I came to Cambridge. This was disadvantageous during exam term, as the first components of examination (MCQ or SAQ based papers) rely heavily on fact-based knowledge. These components are critical to passing 2^nd MB and differentiate between students to a greater extent than the essay questions in terms of tripos classification (i.e. there is less spread between students in essay paper marks than in MCQ paper marks).

Thus, despite only counting for 50% of the final tripos class, doing well and scoring more than 90% on 2^nd MB exams is a strong predictor of achieving a high overall class. This post contains some tips and tools I picked up along the way that I found to help with rote learning, that centres around the software Anki.

Anki

Anki is a powerful flashcard software and it’s a free download for Mac, Windows and Android (the iOS app costs money and I don’t recommend downloading it – just use the mobile version of ankiweb.net). Create an account and it syncs your flashcards across your devices too. There are plenty of YouTube tutorials covering the technical aspects of using the software.

Anki uses a technique called ‘spaced repetition’ to help you retain information. Once you’ve finished a set of cards, it flags them for review at a later date. The interval depends on how easy you could recall those cards. For example, if you indicate that a card was easy it is flagged for follow up in 4 days; if you indicate a card was hard it is scheduled for follow up the next day. These intervals can be changed in the settings if you prefer. Spaced repetition has been shown to work in human¹, rat² and pigeon³ models of learning. Although this is anecdotal evidence, Anki definitely helped me in 2^nd year when it came to learning drugs for MODA and the minute details of BOD lectures. I’m convinced Anki pulled my paper 1 grades up from around ~80% in MVST1A to high 90s in MVST1B.

It should be noted that Anki requires you to be consistent – a large backlog of cards is not easy to go through, so make sure you complete whatever cards are marked for review on the day they are meant to be reviewed. There are daily limits that Anki sets which you can change – I changed mine to 20 new cards per deck per day and unlimited review cards per day. Closer to exams, I reset the review counter and go through the cards as if they are new cards.

Optimising flashcard design

Having a powerful flashcard software is not the end of it. Making good flashcards just as important. My advice for flashcard design:

Write the answers in the form of numbered lists
Try avoid having more than 6-7 bits of information on each card
Write the front of the card as a question
Use the image occlusion plugin (it covers parts of images with labels that can be revealed in the answer card) to learn diagrams – very useful in NHB

First, an example of a bad flashcard:

Recalling this flashcard is quite difficult and it is not retained well in memory. There’s no list, the front of the card is not a question, and facts are not grouped into similar categories. It would better to split this card up into multiple cards or have more than one question on the front of the card.

Here is an example of these changes implemented to make a better flashcard:

From the front of the card you know there is one fact about penicillin classification, and there are four facts about its mechanism that you need to recall.

Image occlusion cards are useful for studying diagrams, like this diagram of the inner ear you will come across in NHB.

The red label is revealed on the answer card to show the name of the tagged structure.

Conclusion

Spaced repetition is a useful technique for memorising facts that are vital for a strong performance in end of year exams. Anki is a free flashcard software using this technique with many plugins that can help revise material. The key to making the most out of Anki is to be consistent and do the cards on the day they are flagged for review. Flashcards should also be optimized to make reviewing them less tedious, increasing efficiency.

References

Ausubel DP, Youssef M. The Effect of Spaced Repetition on Meaningful Retention. J Gen Psychol. 1965; 73: 147-150.
Roberts WA. Spaced Repetition Facilitates Short-Term Retention in Rat. J Comp Physiol Psych. 1974; 86 (1): 164-171.
Roberts WA. Short-Term Memory in Pigeon – Effects of Repetition and Spacing. J Exp Psychol. 1972; 94 (1): 74-&.