How to Use Anki Effectively for COMLEX

The right way to use Anki for COMLEX is to tie it directly to your question review. Download the AnKing deck and suspend every card in it. Then unsuspend one to three cards per question you missed or guessed on, based on what you actually need to remember. Drive new, learning, and review cards to zero every single day. Treat Anki as a memorization tool for facts you can't reason through. The students who plateau on COMSAEs are almost always the ones using Anki backwards or not using spaced repetition at all.

The number-one pitfall I see in med student study plans is not using spaced repetition or active recall at all. Anki happens to be the most efficient form of spaced repetition we have, which is why I keep coming back to it. The number-two pitfall is using Anki, but using it wrong. Hours of cards every day, scores still flat. The volume isn't the problem. The pairing is. Anki works when it reinforces something you just learned from a question. It doesn't work when it's propping up a topic you haven't actually understood.

If something makes sense to you, you don't need to memorize it. It just makes sense. The Philadelphia chromosome is a clean example of where memorization is the only path. You should understand the underlying translocation process. Beyond that, the facts are pure rote. The numbers 9 and 22 are the chromosomes involved. The translocation is named the Philadelphia chromosome. The Philadelphia chromosome is associated with chronic myeloid leukemia. There's nothing to reason your way to. Those facts get memorized, or they don't show up on test day. That's exactly the kind of card Anki is built for.

How do I set up Anki for COMLEX board prep?

The setup is five steps and takes about twenty minutes. The mistakes here usually compound into hours of wasted study later, so it's worth getting right the first time.

Download Anki from the official Anki site. Free on desktop, free on Android, paid on iPhone. Use the desktop version as your daily driver. Let the mobile app sync handle reviews on the go.
Download the AnKing deck from the AnkiHub site. AnKing is the gold standard for board prep. It has more than 30,000 premade cards. The cards cover essentially every fact tested on COMLEX and USMLE Step 1, with images, mnemonics, and topic tags. It's built and maintained by physicians, and it's the deck almost every high-scoring DO and MD student uses.
Suspend every card in the deck as soon as you import it. This is the step most students skip, and it's the most important one. In the desktop app, click the deck, then click Browse. Hit Cmd+A on Mac or Ctrl+A on Windows to highlight every card. Right-click and choose Toggle Suspend, or hit Cmd+J / Ctrl+J. The deck is now silent until you wake cards up intentionally.
Set your card options before you do anything else. The short version: 1-minute and 1-day learning steps, 10-minute relearning steps, FSRS off, auto-advance enabled. Full settings are covered below.
Start doing questions and unsuspending the cards that match. This is the daily loop. It is the entire point of the system.

When should I unsuspend an Anki card?

Unsuspend cards as part of question review, not before, not after, not separately. The trigger is always a missed or guessed question.

The default unsuspend pattern for a missed question:

One card on the correct answer choice. The fact you needed to remember to get the question right.
One card on the answer choice you picked. The reason you were drawn to the wrong answer, so you can recognize and reject the same trap next time.
Optionally a third card on whatever else will help you remember the main point. A mnemonic, a side effect, a buzzword.

Hard ceiling: fewer than three cards per missed or guessed question. More than that and the deck balloons faster than you can keep up. New cards push out reviews of cards you actually need to retain. Most missed questions only need one or two cards. Some need none if you already understand the concept and just got tripped up by phrasing.

For questions you got right for the right reason, ideally you don't unsuspend any new cards. The fact is already in your head. Adding a card to "make sure" creates work without adding learning.

If you guessed and got it right, treat it like a missed question. You didn't actually know the answer. Unsuspend cards on the correct answer and on whatever you'd have picked if you'd reasoned through it. A lucky guess on test day is fine. A lucky guess in dedicated is a hole in your knowledge that hasn't been patched yet.

The students who finish dedicated on time triage their Anki time toward the questions they got wrong and the ones they guessed on. The students who burn out are the ones unsuspending cards on questions they already knew cold.

How do I find the right premade card to unsuspend?

When you go to AnKing's Browse view to search for a card, be specific. Generic searches return hundreds of cards and none of them are quite what you want. Specific searches return the two or three cards that match exactly what you missed.

For example, if you missed a question on heart failure medications that reduce mortality, don't search "heart failure." Search CHF mort or CHF mortality or CHF beta. The card-tag system in AnKing rewards specific keywords. If the first search comes back empty, try a synonym or a related concept. Within two or three searches you'll find the right card every time.

When you can't find a card that matches the fact you needed, that's your signal to make your own.

When should I make my own Anki cards?

The premade AnKing deck covers most of what you need, but two situations call for your own cards.

The first: a premade card you simply can't remember after several reviews. Sometimes the wording doesn't click. Sometimes the picture isn't the picture your brain wants. Sometimes the mnemonic was built for someone else's associations.

When that happens, make your own card. Reword the fact the way you understand it. Draw your own picture. Write a mnemonic that actually sticks for you. Even just rewriting the original card in your own words can be enough to break the loop.

The second: facts that need to be remembered as a group. The classic example is "draw it out" cards. Say you're struggling with the gram-positive, catalase-negative bacteria. Instead of making five cards for five organisms, make one card that says "Draw out the gram-positive, catalase-negative bacteria." Take 20 to 60 seconds to draw the whole group from memory.

This works extraordinarily well for the bacteria flow chart from First Aid, for whole drug classes by generic name, and for management or diagnostic algorithms. One card replaces ten. The act of recalling the group reinforces the relationships between the items, not just the items themselves.

If your own cards start outnumbering your unsuspended AnKing cards, something is off. AnKing missing the material is rare for Step 1 and Level 1 content. The more likely explanation is that you're making cards for facts you don't actually need.

How long should I do Anki each day during COMLEX prep?

Plan on about 2 hours per day during dedicated. That's two of the eight 1-hour blocks in the standard daily structure. See our guide on how long to study for COMLEX Level 1 for the full daily layout. The exact time varies by where you are in dedicated. Two hours is the realistic average once new cards from question review are coming in steadily.

The non-negotiable rule is daily zero. All blue (new), red (learning), and green (review) cards must hit zero at least once every day. Consistency is the entire game. Anki works on spaced repetition. If you skip a day, the cards that were due that day pile onto the next day. The algorithm spaces the next review further out than it should. Your retention starts to drift. Two skipped days in a row is a 4-hour Anki day on day three. That's how students bury themselves.

Your weekly day off works a little differently. Reviews still run so the deck doesn't balloon. If you have leftover news cards from earlier in the week that you never got to, you can clear those too. What you shouldn't do on the day off is unsuspend any new cards from new question work. The point of the day off is to feel refreshed by tomorrow morning. Catch up on the queue, then close the laptop.

What Anki settings work best for COMLEX prep?

These are the settings I use with my 1-on-1 students. Open the deck, hover over the deck name, click the cog, click Options.

Learning Steps: 1 minute and 1 day, written as 1m 1d in the steps field. A new card shows once, then again 1 minute later. If you hit Good both times, you see it 1 day later. If you hit Good a third time, it graduates into reviews. Three exposures over about a day is enough to cement most board-prep facts into short-term memory.
Relearning Steps: 10 minutes, written as 10m. If you hit Again on a mature card, it comes back in 10 minutes for a quick re-exposure before re-entering the review cycle. Short enough to be useful without flooding the day with relearning.
New / Review Order: show news AFTER reviews. This is critical. If you only have 100 seconds before bed, you want to retain the 10 facts you already started learning, not learn one new one. Reviews always come first.
FSRS: off. FSRS is the newer scheduling algorithm. It has its uses for some learners, but it's buggy in places. It also requires more tuning than most students want to do during dedicated. Keep it simple and off until you're out of dedicated and have time to play with it.
Auto Advance: turn this on if you tend to spend more than 20 seconds per card. Set "show question" to 10 to 15 seconds and "show answer" to 20 to 30 seconds. Auto-advance keeps you honest on speed and prevents the "stare at a card while my brain wanders" failure mode.
Easy Days: this slider lets you reduce review cards on busy days. Use it on rotation days, on COMSAE days, or any day where you genuinely won't have time for a normal Anki load. Don't use it as a default. The deck only stays manageable if most days are normal.
Maximum Interval: the cap on how many days a review card can be spaced out. Some students set this to "days remaining until test day" so they see every mature card at least once before the exam. This drastically increases daily review load and is only realistic if you have plenty of slack in your schedule. Most students should leave this at the default.

After you change anything, save in the top right before closing the options panel. If you don't save, your changes silently disappear. You'll then spend three hours figuring out why your card load looks the same as before.

What are the most common Anki mistakes I see?

These are the patterns that turn 2 hours per day of Anki into wasted time. If you recognize yourself in any of them, the fix usually moves your scores within a week or two.

Random Anki without question pairing. Doing 200 cards a day from a deck that isn't tied to anything you're actively learning is a trap. You memorize facts in a vacuum. They won't stick because they have no context. And they won't transfer to questions because they aren't paired with question patterns. Always tie new cards to a question you just did.

Anki as content review. Some students try to substitute Anki for Pathoma, Sketchy, or content videos. Anki is a memorization tool, not a teaching tool. If you don't understand the underlying mechanism for a fact, no amount of Anki will fix that. Watch the video, do the question, then unsuspend the card.

Too many cards per question. Five cards per missed question feels thorough in the moment. By week three of dedicated it's a daily review load you can't finish. You start cutting corners or skipping days. Stay under three.

Skipping daily zero. Anki only works if it runs every day. Two days off and the algorithm starts breaking down. Plan for daily zero like you plan for sleep.

Using FSRS without understanding it. FSRS can work, but only if you tune it correctly. You also need to check that it's actually scheduling cards in a way that matches your retention. Most students who turn FSRS on and leave the defaults end up with worse retention than the default scheduler would give them. Either commit to learning FSRS properly or leave it off.

Frequently asked questions about Anki for COMLEX

How many Anki cards should I do per day for COMLEX?

It really depends. The rule is daily zero: all your new, learning, and review cards must hit zero every day. The number itself climbs over the course of dedicated as your unsuspended pool grows. In the first couple of weeks of dedicated, most students are doing somewhere between 200 and 400 cards a day. By the end of a 4-week dedicated period, most students are around 400 to 500 cards a day. By the end of an 8-week dedicated period, most are around 500 to 600 cards a day. The exact number depends on how strict you are with your unsuspending rules and how many cards you're unsuspending from videos. If your load is creeping well past those ranges and you aren't finishing daily zero, you're probably unsuspending too many cards per question.

Should I make my own Anki cards or use AnKing?

Use AnKing as your default deck. It's comprehensive, well-maintained, and built specifically for board prep. Make your own cards only in two situations. First: when a premade card isn't sticking after several reviews. Second: when you need a "draw it out" card to recall a group of facts together. If your homemade cards outnumber your unsuspended AnKing cards, something is wrong.

Should I use FSRS for COMLEX prep?

Generally no, unless you've already used FSRS successfully and understand how to tune it. The default Anki scheduler with 1m 1d learning steps and 10m relearning works reliably for dedicated and doesn't require ongoing tuning. FSRS can be better in theory but tends to produce worse retention than the default for students who don't actively monitor it.

Can I use Anki without doing questions?

You can, but it isn't how the system is designed for board prep. Anki cards work because they reinforce something you just learned from active engagement. Cards reviewed in isolation, without the context of a question, fade faster and transfer worse. Always pair Anki with question banks during dedicated.

How do I manage Anki on a day off?

Do your reviews in the morning so the deck stays current, then close the laptop. If you have leftover news cards from earlier in the week, you can clear those on the day off too. What you shouldn't do is unsuspend any new cards from new question work. The day off should leave you feeling refreshed, not grinding new material.

What Anki deck should I use for COMLEX?

AnKing. It's the gold standard for both COMLEX and USMLE board prep. It covers the full Step 1 / Level 1 blueprint and is built and maintained by physicians. Some students layer in smaller specialty decks like Sketchy Pharm, Sketchy Micro, or Pixorize. AnKing is still the foundation.

How do I handle Anki during clinical rotations?

Use the Easy Days slider to reduce review load on rotation days. Keep up with reviews on slower days and on weekends. Stop adding new cards aggressively unless the rotation is directly relevant to the boards you're studying for. The rotation will eat your Anki time, and that's fine; just protect the review queue.

Get the Anki cards Lucas uses with his 1-on-1 students

The free Premeducated Skool community includes cloze-deletion Anki cards transcribed directly from Lucas's video library. You also get weekly office hours with physician tutors who can answer Anki and study-plan questions, plus a 100-plus video library of question breakdowns. Free, no upgrade required.

Join the free Skool community