Background: Anki is an open-source flashcard program that employs spaced repetition and active recall to enhance long-term knowledge retention. Although Anki is widely used in medical education, limited evidence exists regarding how specific card formats, particularly “type-in-the-answer” cards, influence learning outcomes in visually intensive subjects such as histology. This study evaluates the impact of a standardized “type-in-the-answer” Anki histology deck on first-year medical student performance.
Methods: We conducted a cohort quasi-experimental study at Rocky Vista University–Montana College of Osteopathic Medicine during the 2025–2026 academic year. Following their first histology examination, first-year medical students (N = 133) completed a pre-study Qualtrics survey assessing prior histology exposure and Anki use. Participants were subsequently provided access to a pre-made, “type-in-the-answer” Histology Anki deck for the remaining Academic year. Anki usage metrics (time spent studying, cards reviewed, and review frequency) were collected via a custom Anki add-on, de-identified, and stored on a secure institutional server. Histology examination scores were de-identified by faculty and compared within the study cohort and against a control group (non-enrolled peers). Pre- and post-study survey responses will be analyzed using chi-square testing.
Results: Eighty students met study adherence criteria (i.e., Anki add-on installation and accurate entry of student identification numbers). Participants were stratified by average practical examination performance (<70%, 70–80%, 80–90%, >90%). Overall, the study cohort demonstrated a 0.81% higher average exam score compared with nonparticipants (n = 101). Students achieving average practical scores greater than 90% (n = 42) exhibited significant exam score improvement once they started using the provided Anki decks (p = 0.0004). Across all participants, exam performance showed a weak positive correlation with average daily study time (r = 0.23).
Conclusion: Use of standardized “type-in-the-answer” Anki decks was associated with improved histology performance, particularly among high-achieving first-year medical students. These findings highlight the potential value of structured, interactive flashcard formats and support further investigation into customizable digital learning tools and their role in promoting durable learning in medical education.
Methods: We conducted a cohort quasi-experimental study at Rocky Vista University–Montana College of Osteopathic Medicine during the 2025–2026 academic year. Following their first histology examination, first-year medical students (N = 133) completed a pre-study Qualtrics survey assessing prior histology exposure and Anki use. Participants were subsequently provided access to a pre-made, “type-in-the-answer” Histology Anki deck for the remaining Academic year. Anki usage metrics (time spent studying, cards reviewed, and review frequency) were collected via a custom Anki add-on, de-identified, and stored on a secure institutional server. Histology examination scores were de-identified by faculty and compared within the study cohort and against a control group (non-enrolled peers). Pre- and post-study survey responses will be analyzed using chi-square testing.
Results: Eighty students met study adherence criteria (i.e., Anki add-on installation and accurate entry of student identification numbers). Participants were stratified by average practical examination performance (<70%, 70–80%, 80–90%, >90%). Overall, the study cohort demonstrated a 0.81% higher average exam score compared with nonparticipants (n = 101). Students achieving average practical scores greater than 90% (n = 42) exhibited significant exam score improvement once they started using the provided Anki decks (p = 0.0004). Across all participants, exam performance showed a weak positive correlation with average daily study time (r = 0.23).
Conclusion: Use of standardized “type-in-the-answer” Anki decks was associated with improved histology performance, particularly among high-achieving first-year medical students. These findings highlight the potential value of structured, interactive flashcard formats and support further investigation into customizable digital learning tools and their role in promoting durable learning in medical education.