Anki Use and Academic Performance in Medical Education: A Systematic Review of Evidence and Learning Theory

Background: Anki, an open-source flashcard platform that integrates spaced repetition and retrieval practice, has become a widely used study tool among medical students. Despite its popularity, evidence regarding its academic impact remains limited and heterogeneous. Methods: We conducted a systematic review of PubMed, CINAHL, ERIC, PsychINFO, Scopus, Embase, and Web of Science to identify studies evaluating Anki use and academic performance in undergraduate medical education. Inclusion criteria required measurement of exam outcomes in medical students using Anki. Eleven eligible studies were qualitatively synthesized. Results: Three studies demonstrated a consistent positive association between regular Anki use and USMLE Step 1 performance. High-frequency users outperformed minimal users by 4-13 points, with one study identifying a dose-response effect based on total cards reviewed. Evidence for university-administered exams was more mixed: some studies found significant benefits with structured Anki programs, while others reported no measurable difference despite positive student perceptions. These discrepancies may reflect differences in deck quality, usage consistency, and shorter preparation timelines for in-course exams. Only one study assessed Step 2 CK and found no significant benefit. Included studies varied considerably in methodology, definitions of Anki "use," and outcome measures. Conclusion: Anki use is associated with higher performance on standardized examinations that emphasize foundational knowledge, including the USMLE Step 1. Findings for course-based examinations were mixed and may depend on contextual factors. Overall, the results are consistent with established learning theory, but evidence is largely observational. Future studies using longitudinal designs and objective measures of Anki use are needed to better define its educational impact. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-026-02643-5.