Both are free. Both target the UKMLA. Both use spaced repetition. But they test fundamentally different cognitive skills — and understanding the difference determines how to use them together.
Spranki: The UKMLA Anki Deck
Spranki is a free, community-built Anki flashcard deck specifically designed for UK medical students preparing for the UKMLA. It leverages Anki's proven spaced repetition algorithm — one of the most evidence-backed learning tools in educational psychology.
What Spranki does well: Factual recall. Drug names, diagnostic criteria, anatomical relationships, investigation thresholds, classification systems — the discrete facts that underpin clinical reasoning. Anki's spaced repetition ensures these facts are retained long-term, not just crammed for an exam. Completely free. Works offline. Portable across devices.
What Spranki does not do: Clinical reasoning. Anki flashcards test whether you can recall a fact when prompted. They do not test whether you can apply that fact to a clinical scenario with competing diagnoses, comorbidities, and management trade-offs. The UKMLA increasingly tests the latter.
Setup friction: Anki requires installation, deck download, settings configuration (step intervals, new cards/day, review limits). Many students find this technically daunting — Anki's interface is functional rather than intuitive, and the settings significantly affect learning effectiveness. Misconfigured settings (too many new cards per day, too-short intervals, wrong ease factors) produce either overwhelm or inefficient repetition. The Spranki deck itself includes recommended settings, but configuring them correctly requires understanding how Anki's algorithm works.
For students who find Anki setup genuinely off-putting: the barrier is real but surmountable. Spend 30 minutes watching an Anki setup tutorial (AnKing's YouTube guides are the standard recommendation), configure the deck properly once, and the maintenance thereafter is minimal. The payoff — reliable long-term retention of thousands of medical facts — justifies the initial investment.
iatroX Quiz: The Adaptive Clinical Q-Bank
iatroX provides a free UKMLA Q-bank with AI-adaptive difficulty adjustment and built-in spaced repetition — at the platform level, not requiring separate software installation or configuration.
What iatroX does well: Clinical reasoning. SBA-format questions present clinical vignettes — a patient with specific symptoms, examination findings, investigation results, and comorbidities — requiring you to synthesise multiple pieces of information and select the best management from 5 options. This is the cognitive demand the UKMLA primarily tests: not "what is the first-line treatment for hypertension?" (a flashcard-level question) but "a 58-year-old Black African woman with CKD stage 3a, type 2 diabetes, and a QRISK3 of 14% presents with a BP of 162/94 — what is the most appropriate initial management?" (a clinical reasoning question requiring integration of NICE NG136, CKD considerations, ethnic prescribing differences, and CVD risk assessment).
The adaptive engine ensures you are always working at the edge of your competence — questions that are too easy (topics already mastered) are deprioritised, and questions in your weakest domains are served more frequently. This produces more efficient learning per minute than either Anki's uniform spacing or a static Q-bank's random rotation.
What iatroX does not do: Isolated factual recall. If you need to memorise that the half-life of warfarin is 36-42 hours, that the dermatomes of the hand are C6/C7/C8/T1, or that the side effects of methotrexate include bone marrow suppression and hepatotoxicity, a flashcard is more efficient than a clinical vignette. Different cognitive tool for a different cognitive task.
Setup friction: Zero. Open a browser or download the app. No configuration. No algorithm tuning. No deck management. Start answering questions immediately.
The Learning Science: Why Both Tools Exist
The distinction between Spranki and iatroX maps directly onto the distinction between two types of knowledge that the UKMLA tests.
Declarative knowledge is knowing facts: drug names, normal ranges, diagnostic criteria, classification systems, anatomical relationships. This is the knowledge that Anki flashcards train. The question format is simple — "what is X?" — and the answer is a discrete fact. Anki's spaced repetition algorithm is optimally designed for this: present the fact, test recall, space the next presentation based on recall success. Decades of research confirm that spaced flashcard practice produces superior retention of declarative knowledge compared to any other study method.
Procedural/applied knowledge is knowing what to do with the facts: clinical reasoning, differential diagnosis, management decision-making, investigation selection, risk-benefit analysis. This is the knowledge that clinical vignette Q-banks train. The question format is complex — "given this patient with these features, what is the best action?" — and the answer requires synthesising multiple facts and applying clinical judgment. Adaptive Q-banks like iatroX are designed for this: present a scenario, test reasoning, adjust difficulty based on performance, and space the re-testing of weak clinical domains.
The UKMLA tests both types simultaneously. A question about hypertension management requires declarative knowledge (what are the drug classes? what is the QRISK3 threshold?) and procedural knowledge (which drug for this specific patient? what interactions to consider? what monitoring to arrange?). Students who only use Anki know the facts but struggle to apply them under exam conditions. Students who only use Q-banks can apply the facts they happen to know but have gaps in the factual foundation that produce systematic errors.
The optimal approach uses both — and this is not a compromise. It is what the evidence predicts and what top-performing candidates consistently report.
Anki Settings That Matter for Spranki
If you decide to use Spranki, these Anki settings significantly affect learning effectiveness:
New cards per day: 20-30 for most students. Higher than 40 creates an unsustainable review burden within 2-3 weeks. Lower than 10 makes progress too slow for a 12-week revision timeline.
Maximum reviews per day: 150-200. This caps the daily review load and prevents Anki from consuming your entire study session on old cards at the expense of new learning.
Learning steps: 1m 10m (default) or 1m 10m 1d for better initial retention. Graduating interval: 1 day. Easy interval: 4 days.
Suspend cards for topics not yet studied: If you have not yet covered a body system in your course, suspend those cards until you have the foundational knowledge. Reviewing flashcards on a topic you have never been taught produces frustration without learning.
The Optimal Combination: Detailed Workflow
Morning (15-20 minutes, commute or breakfast): Spranki Anki reviews. These are your daily maintenance — reviewing previously-learned cards at their scheduled intervals. The review load is automatic; Anki decides which cards are due. On days when new cards are introduced, you will also learn 20-30 new facts. This is best done in short, focused sessions rather than marathon Anki grinds.
What to Anki: Pharmacology first (drug names, mechanisms, key side effects, interactions — the content that pure clinical reasoning cannot substitute for). Anatomy second (dermatomes, nerve roots, blood supply — spatial knowledge that flashcards encode well). Investigation thresholds third (when to refer, when to scan, normal ranges — the numerical facts that clinical vignettes assume you know).
Evening (20-30 minutes, post-study or before bed): iatroX adaptive questions. 15-20 clinical vignettes with the adaptive engine targeting your weakest MLA content areas. Read every explanation — even for questions you answer correctly, the NICE-cited explanation may contain guideline nuances you were not aware of. When an explanation raises a question, use Ask iatroX to explore further.
Weekly review (30 minutes, weekends): Check the iatroX performance dashboard. Identify the 2-3 clinical domains where your proficiency is lowest. Cross-reference with your Anki stats — are the factual gaps in those domains driving the clinical reasoning errors? If your cardiology clinical reasoning is weak because you do not know the drug classes, add more cardiology flashcards to your Anki new-card queue. If your cardiology facts are strong but your clinical reasoning is still weak, the problem is application — do more iatroX cardiology questions.
Two free tools. 35-50 minutes per day. Complementary cognitive demands. Zero cost.
When to Start Each Tool
Spranki: Start in Year 2-3 when you begin clinical teaching. The pharmacology and anatomy flashcards are most useful once you have encountered the content in lectures or placements — Anki reinforces existing knowledge, it does not teach from scratch. Begin with 20 new cards per day and build to your sustainable review load over 2-3 weeks.
iatroX: Start when you begin UKMLA-focused revision — typically Year 4-5. The clinical vignettes assume you have a baseline of clinical knowledge to apply. Starting iatroX too early (before you have sufficient clinical knowledge) produces frustration without learning. Starting it too late (final month before the exam) does not allow enough time for the spaced repetition algorithm to build durable retention.
The overlap period (Year 4-5) is when both tools are used simultaneously — Spranki maintaining your factual knowledge while iatroX builds your clinical reasoning. This 6-12 month overlap is the highest-value phase of the combined approach.
Verdict
Spranki for factual recall — the pharmacology, anatomy, and investigation thresholds that underpin clinical reasoning. iatroX for clinical reasoning — the applied decision-making that the UKMLA primarily tests. Use Spranki to build the knowledge blocks. Use iatroX to build the structures from those blocks. Neither alone is sufficient — but together, at zero combined cost, they provide a comprehensive UKMLA preparation strategy that covers both cognitive demands the exam assesses.