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The Perfect Spaced Repetition Algorithm: Anki Settings for Medics

Fix your Anki workload and boost scores: tune learning steps, graduating intervals, and ease to maximise efficiency and retention for medical exams.

Review date
2025-01-24
Reading time
10 min read
Author
Dr Kola Tytler MBBS CertHE MBA MSt MRCGP
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Key points

  • Default Anki settings often create unstable queues and false confidence.
  • Learning Steps, Graduating Interval, and Ease Factor are the highest-leverage controls.
  • Optimise for a sustainable daily review cap first, then push retention upward.

The Concept

Spaced repetition works because forgetting is rapid after first exposure, then slows after successful retrievals. Your aim is not to “see cards often”, but to schedule successful retrieval just before you would have forgotten. In Anki, most outcomes are driven by three parameters: Learning Steps (how new cards stabilise), Graduating Interval (how quickly a card becomes a true review), and Ease Factor (how fast intervals expand). For medical exams, the goal is predictable workload plus high retention: cap daily reviews, prevent punitive lapses, and keep cards precise.

Scientific Evidence

Distributed practice (spacing) and retrieval practice consistently improve long-term retention versus massed study. Reviews in educational psychology repeatedly rank spacing and practice testing as high-utility techniques. (Cepeda et al; Roediger & Karpicke; Dunlosky et al.)

Implementation Strategy

1

Phase 1: Choose sustainable daily constraints

Set a realistic daily ceiling (e.g., 150–300 reviews/day if working full-time). Then set New Cards/day so you can hit that ceiling for 60 consecutive days. Sustainability beats intensity.
2

Phase 2: Configure Learning Steps (new cards)

Use at least one short step and one next-day step to prevent same-day familiarity masquerading as learning. A practical baseline: Learning Steps = 10m 1d. If you forget quickly, add 3h between (10m 3h 1d).
3

Phase 3: Configure graduation to control the “tomorrow spike”

Graduating Interval determines how fast new cards become long-term reviews. Baseline: Graduating = 3d, Easy = 7d. If your exam is < 8 weeks away, shorten (2d/5d). If > 4 months, lengthen modestly (4d/10d).
4

Phase 4: Protect Ease Factor from needless collapse

Ease Factor governs interval growth. If you constantly hit “Hard/Again”, your deck becomes punitive and bloats. Strategy: reserve “Again” for true forgetting; use “Hard” when you retrieved with effort. If a topic is repeatedly missed, fix the card (too broad/ambiguous) before blaming your brain.
SourceRead the original paper (PubMed)
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  • Set a realistic daily ceiling (e.g., 150–300 reviews/day if working full-time). Then set New Cards/day so you can hit that ceiling for 60 consecutive days. Sustainability beats intensity.

    Return to this section

  • Use at least one short step and one next-day step to prevent same-day familiarity masquerading as learning. A practical baseline: Learning Steps = 10m 1d. If you forget quickly, add 3h between (10m 3h 1d).

    Return to this section

  • Graduating Interval determines how fast new cards become long-term reviews. Baseline: Graduating = 3d, Easy = 7d. If your exam is 4 months, lengthen modestly (4d/10d).

    Return to this section

  • Ease Factor governs interval growth. If you constantly hit “Hard/Again”, your deck becomes punitive and bloats. Strategy: reserve “Again” for true forgetting; use “Hard” when you retrieved with effort. If a topic is repeatedly missed, fix the card (too broad/ambiguous) before blaming your brain.

    Return to this section

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