Active Recall and Spaced Repetition for Step 1: Why They Work (and How to Start)

If you’re in medical school, you’ve probably heard people talk about active recall and spaced repetition like they’re some kind of magical learning tools. And honestly? They kind of are – if you use them right.

As a tutor and on my personal journey through medical school, I’ve seen firsthand how these strategies can transform the way you study and boost long-term retention. In this post, we’ll break down what they are, why they work (based on science!), how to get started, and why Anki is your best friend in the Step 1 (and beyond) prep journey.

What Is Active Recall?

Let’s start with active recall. It’s the process of actively retrieving information from memory rather than passively re-reading or highlighting.

Example: Instead of re-reading your notes on the cardiac cycle, you might close your eyes and ask yourself:

“What are the phases of the cardiac cycle? What valves are open or closed in each?”

 

Then, you mentally walk through the answer before checking yourself. The more you have to struggle to pull the answers out of your memory, the stronger the connections you make, and the easier it becomes over time. 

Why It Works:

Research shows that retrieving information strengthens memory—even more than repeated reviewing. It’s called the “testing effect.” Every time you actively try to remember something (even if you fail), you’re reinforcing those neural connections.

What Is Spaced Repetition?

Spaced repetition is all about reviewing material at increasing intervals so that your brain has to work a little harder each time until the information is safely stored in your long-term memory. That struggle? That’s what makes it stick.

Instead of cramming glycolysis three days in a row, you’d review it today, then again in 2 days, then in 5 days, then in 2 weeks—just before you’re about to forget it. And that’s what builds long-term memory.

Why It Works:

Your brain is wired to forget things. Spaced repetition counters the forgetting curve by hitting you with just the right amount of review at the right time. USMLE-style exams, which are case-based and detail-rich, are exactly the kind of test where these strategies shine.

Why They’re Essential for Step 1

Step 1 isn’t about rote memorization. It’s about recall, application, and integration. That means you need strong neural pathways, not just vague familiarity with First Aid.

Let’s be real: You might understand nephron physiology today, but if you don’t review it systematically, will you remember the role of the macula densa 6 months from now when it shows up in a vignette about a patient with renovascular hypertension?

That’s where active recall and spaced repetition come in—they’re your insurance policy.

Every year I encounter medical students that tell me they’ve learned the material so well the first time that they don’t need spaced repetition because they’ll never forget it. Don’t fall into this trap. In medical school, the material comes at you so fast that it doesn’t matter how well you learn it for the next exam, if you don’t continue to reinforce it, you’ll realize during your step 1 dedicated period that it’s gone and you need to start from scratch. 

Meet Your New Best Friend: Anki

If spaced repetition had a mascot, it would be Anki. Anki is a free flashcard app that uses spaced repetition algorithms to schedule your reviews just when you need them.

It’s basically your personal memory coach.

Why Anki Rocks:

• Customizable: You can create your own cards, use pre-made decks, and edit cards from pre-made decks.
• Smart scheduling: It tracks how fast and accurately you answer the cards and automatically shows you your harder cards more often and your easier ones less frequently.
• Synced access: Use it on your phone, tablet, or laptop—perfect for reviewing on the go.
• Thousands of pre-made cards: Like the famous AnKing Step 1 deck, which syncs with First Aid, Pathoma, and Boards & Beyond. My personal recommendation is to use these cards instead of spending hours making your own. 

How to Start Using Anki (Even If You’re New)

Starting can feel overwhelming, but here’s a step-by-step guide:

1. Choose a Deck

If you’re brand new, start with the AnKing Overhaul Step 1 deck. It’s organized by resources and already tagged by subject.

• Not ready for thousands of cards? Pick a subject-specific one (like Microbiology by Pepper).

2. Use Tags or Topics

Don’t try to do the entire deck at once. Use the browse feature to see how the cards are sorted into different categories. Start with:

• Organ systems (e.g., cardiology)
• Resources (e.g., “Boards and Beyond – cardio videos”)

3. Be Consistent

• Aim for at least 100 reviews per day, even during preclinical years.
• Mix in 10–30 new cards depending on your schedule.

4. Edit Cards Based on Questions You Get Wrong

Use your own words and add images or charts when helpful. For example, if you missed a question on the mechanism of acetazolamide, you could find the following card and edit to have all the details you want:

Front: What is the MOA of acetazolamide and where does it act?
Back: Carbonic anhydrase inhibitor – proximal tubule; ↓ reabsorption of HCO₃⁻

Make it active, short, and clear.

Active Recall Beyond Anki

While Anki is the best platform for spaced repitition, don’t limit active recall to flashcards. Try:

• Closed-book “brain dumps” – Before reviewing notes, write out everything you remember on a whiteboard.
• Teach someone else – Explaining nephrotic vs. nephritic syndromes to a study buddy is gold.
• Practice questions – Do 5–10 UWorld questions before you finish a topic to test recall and application.

Common Mistakes to Avoid

Passive Reviewing First Aid

It’s a reference, not a textbook. Don’t just highlight—create flashcards or test yourself out loud.

Overloading Yourself with New Cards

Anki burnout is real. Start small. Prioritize quality > quantity. Make sure you are not memorizing cards but actually thinking about the material each time. 

Skipping Review Days

Consistency is everything. If you can’t stick to completing your reviews every single day, then you might as well not even use anki at all. The algorithm only works if you complete your reviews daily. When I was preparing for step 1, I didn’t let myself go to bed at night until all my reviews were done. Sound intense? It is, but this is your full-time job and you’ll thank yourself later for putting in the hard work now. 

Bonus Tips: Making It Stick

• Connect topics. When learning diuretics, think through how they affect potassium, acid-base, and blood pressure.
• Make clinical connections. Turn every Anki card into a patient vignette in your head.
• Use images & diagrams. Flashcards with pictures (especially for micro, pharm, and anatomy) are more memorable.

In Summary: Mastery Is Built, Not Crammed

The best Step 1 scorers aren’t the ones with photographic memories – they’re the ones who learned how to study smarter, not harder.

Active recall + spaced repetition is that smarter way. It’s what separates the students who feel constantly behind from those who walk into their test day confident and calm.

So fire up Anki. Set your review goals. And trust that you’re building something solid – one spaced repetition at a time.