There are many different ways to learn information, but among my colleagues in medical school, flashcards are one of the most common ways to study. While making flashcards may seem simple straight forward, I have learned over time that the exact opposite is the case.

Flashcards are about the question

When I began college, I studied many tomes of scientific information, took pages of notes, only to find none of it of use during my practice problems. Even if I knew the information, I didn’t remember how to use it.  I achieved solidly mediocre grades. Then, I started using flashcards. As my grades began improving I attributed this simply to having a better memory, but I realized something else: the questions I was writing on the front of the flashcards filtered and shaped how I thought about the information I was studying. By asking a well-crafted question for each piece of information, I installed hooks from which to call on that information during tests.

What makes a great flashcard  

Specificity

There should be one and only one answer to your question. If there is more than one answer, it means that your question is not specific enough. There should only be one fact or bit of information being asked about in each question. If you can break the answer into multiple chunks, your question isn’t specific enough.

• Example One: what’s the treatment for pulmonary embolism?
  
  

This is a bad question because since there are a number of ways to treat a pulmonary embolism, how do I know which one to answer the question with?

• Example Two: What’s the immediate treatment for the gas exchange issue caused by a pulmonary embolism?
  
  

This is a good question, because there is one answer: give supplemental oxygen.

You can ask many specific questions about treating a pulmonary embolism, or how respiration works in general. The point is that when you can ask a more specific question, you should. Just be careful not to give away the answer in the question.

Size

Cards should be as small as possible in that questions should be as short as possible (while meeting all the other guidelines here). This means no extraneous information. There are two major reasons for this. The first is that by including less information in questions (and the answer), you making a strong and specific connection between the specific question and a specific answer. Extra details in questions (and answers) bring non-exclusive details together, which can lead to confusion on tests. Second, small size means speed, and speed means coverage. I can do a flashcard in about 5-6 seconds, meaning 10 cards/minute and 600 cards/hour. I spend 2-3 hours studying every day, which means I can cover 1200-1800 flashcards. A lot of what makes that possible is the small size of my cards.

(I know the numbers because I use an electronic flashcard program called Anki that keeps track. You should use it too, it takes advantage of something called Spaced Repetition which you can read about here at Sam’s post. I will write another post in the future about how to use Anki like a beast.)

Context

Part of having a specific question means putting the appropriate context in the question. This ties your knowledge not only to specific questions, but also to specific contexts, which is another useful hook for remembering information. Often, when I see a question on a medical school exam, I deduce the answer not only because I know a particular fact, but also because I know it’s relevant in a certain context.

For example, I know how the kidney behaves as a result of changes in hydration (knowledge), but in my cards about nephron physiology, I make sure to specify if it’s for a healthy or a diseased person (context), as that changes the possible correct answers.

Consistency

Many questions, even though they address different topics, are essentially the same type of question. Being consistent about how I ask questions increases the speed at which I can do my cards. For example, in asking how Furosemide works, I could ask the question in a variety of different ways:

• What’s the mechanism of Furosemide?
• How does Furosemide work?
• What’s the mechanism of action of Furosemide?
• What’s the MOA of Furosemide? (MOA=Mechanism of action) 
  
  

I always use the last option, because it’s the shortest. This allows me to shave off a few seconds every time I do a card of this type, which saves me hours in the long run. Also, use good grammar, spelling, and only standard abbreviations—this will also allow you to move swiftly through your cards.

Scale or level

There are different levels of knowledge for each specific topic. For example, you can ask about the body at the area level (gut), organ level (kidney), sub-structure (nephron), even smaller structure (Proximal Convoluted Tubule), or even smaller microscopic level (Na/K ATP pump). When making cards, it’s important to specify and limit the cards to specific levels as much as possible, this is so the information is structured in your memory and easier to recall. You may want to ask about the connection between two levels (where in the Nephron are Na/K ATP exchangers?) However, you should probably avoid questions spanning multiple levels, as that will lead to a long card. I recommend to breaking larger threads of information it into parts, and a great way to do that is by the scale or the level of information.

Related to this is the concept of top-down learning, where you learn large principles first, and then the details, which is a much more efficient way to learn, and how we are taught to learn in medical school. Stay tuned for a future post on that subject.

Relevance

As you are studying, you will begin asking yourself questions that could be on flashcards, however, many possible questions are possible for a flashcard that could not be asked on a test for either format or course-specific reasons. When writing questions, use the question as a chance to filter out non-testable information. This will lessen your study burden considerably. Also, make sure to ask questions about specific information in a way that’s relevant to how you will need it.

For example, asking yourself to “list the symptoms of Toxoplasmosis” is not something that you will see on a multiple-choice test, nor how a doctor will process information provided by a patient. However, you might be presented with the following “patient presents with intracranial calcifications, hydrocephalus, and chorioretinitis, which of the following is the most likely diagnosis?” For which the answer is toxoplasmosis. This allows you to draw one connection from the triad of symptoms to the diagnosis, as opposed to three separate connections from each symptom to the diagnosis.

Pictures

Whenever possible, you should put relevant (and hopefully simple) images on your cards. I also use random images if I need to tie things together that otherwise won’t stick. For example, on a card about Turner’s syndrome, I have a picture of Orlando bloom as Will Turner in the Pirates Movies. Humans have great visual memory (especially for people who look like Orlando Bloom) and you should take advantage of this fact. Obviously, this is easier if you are using an electronic flashcard program, which I highly recommend. 

Take away

Flashcards don’t work for every type of learning, but if you have to memorize lots of information (MCAT, Med school, AP US history etc.) then flashcards are an excellent method of doing that, and the above tips will help you to make excellent quality cards. 

Disclosures

I picked up these rules from my own experience and from doing a set of flashcards known as the Brosencephalon cards for the USMLE Step 1. Hat tip to the brilliant student who made that deck.