Open-Source Instructions for Using AI to Create Personalized USMLE Anki Cards

Dec 6

Open-Source Tool: Standardized Instructions for Leveraging AI to Convert Medical School Practice Question Notes Into Personalized Anki Cards for USMLE Prep

Currently in medical education, there are incredibly high-quality, curated open-source anki decks (namely, the Anking deck), as well as highly tailored practice questions, with emerging methods to convert practice questions into anki cards, but the anki cards from these subscription-specific platforms are basically, ‘What you see is what you get’. AI platforms, however, offer profound versatility in terms of handling large amounts of complex, context-dependent medical information. AI is not yet great at making effective anki cards by default, but medical students who use anki are familiar with characteristics that make up an effective card. What I’ve tried to do here is leverage my experience with anki to create a set of universal instructions that can be pasted into any AI with zero other memory and allow it to reproducibly establish a thread where you can then paste in large chunks of notes/answer explanations, and it will output highly effective anki cards that can improve your study efficiency. My goal is to help you develop another tool in your arsenal of study methods allowing you to rapidly convert wrong answer notes and notes from topics that are highly specific to YOU into high-yield anki cards.

To provide a high-level overview, I instruct AI to convert large, heterogenous swaths of text (or screenshots) into high-yield anki cards that take one of three general formats:

Summative cards
Patient vignettes
Flash overview cards

“Great. I want to use these to help me study.” -> Please find them below under “AI Instructions”.

“But you don’t know me and my study methods. I know what works best for me. I want to understand exactly what your instructions are for effective anki card design and possibly modify them for my own purposes.”

Absolutely. I’ve been using anki for 7 years and have had a lot of time to realize what practices make for more effective vs. less effective anki cards for ME, and that’s what I’ve used here. Though I think many of these principles hold true for lots of other medical students (i.e., very few people would think an effective anki card is a 5,000-word essay), but not all of them, and below I outline the logic and decisions I’ve used to develop these AI instructions. Of course, you can feel free to take what you like and discard the rest - these can be a starting point for you to develop your OWN personalized AI instructions for making anki cards effective for you.

Core Principles

I find cloze deletion cards highly effective, but there is a skill in terms of WHAT text you’re clozing, WHERE you’re clozing it, and what hints you provide, that make a profound difference in terms of how fast you’re able to get through reviews.
Keep your cloze deletions very targeted on small phrases - 1-2 words most of the time - that encapsulate the most important, identifying feature of whatever your card is testing - most often the diagnosis or treatment. Earlier in medical school, I wanted to save the world with every individual anki card I did - “I want to be the best doctor I can be and know absolutely as much as I can in my own mind, so let me cloze delete out this entire paragraph of text and simultaneously make myself guess the entire diagnostic workflow and treatment algorithms” - I think this is a terrible strategy for anki; the real advantage of anki is rapidly moving through information in bite-sized pieces while taking advantage of space-based repetition. You will drastically slow down how much material you’re able to cover and the efficiency of your reviews if you make yourself guess a giant section. 10 anki cards with bite-sized chunks is WAY more powerful - and you will get through it WAY faster over time - than one anki card with those 10 pieces of information. “But those 10 chunks of information I’m studying are interconnected; I need them all together to be able to fully understand it otherwise I’m just superficially memorizing facts.” I agree with you. This is where you leverage the ‘extra’ field to paste your screenshot of that entire diagnostic algorithm or copy/paste the broader cycle such that when you’re less familiar with some material, in the extra field you can spend more time on a case-by-case basis if need re-training yourself on how that anki card fits into the broader cycle or algorithm or pattern of similar diagnoses. But the actual anki card itself should be brief and to the point.
My lesson from doing this for a long time is: you might be shocked at how well you can remember something even though you cloze-deleted out just a word or two of it in your anki card (vs. cloze-deleting a large section).
Put clozes after the text needed to give you the context to guess them. If the clozes come first, you’re going to be jumping back and forth as you go through that card, which is less efficient than reading it through once.
Be generous with hints (hints are the optional text you can put like so: {{c1::hidden content you’re guessing in cloze deletion::hint text that appears before you’ve revealed the card}}. There are many situations that show up where it can help you get through the card more efficiently, while not making it ‘easier’ or giving away the answer, to know the general TYPE of answer you should be thinking about. Sometimes this can be easily inferred from the non-clozed text, but sometimes hints can really help you not waste time trying to piece together what type of info you should be guessing.
Sanity check: Make sure that other parts of the card are not giving away the answer too easily (ex: mentioning the literal diagnosis you’re guessing elsewhere in the card)
Context: The context of the card needs to be well-organized, concise, and allow a medically knowledgeable clinician who’s never seen the card before to guess the correct answer within the cloze-deleted section. Because that’s how you’re going to feel when you haven’t seen that card in 4 months and you’ve done 10,000 other cards.

Try to Think Like USMLE Test Writers

I explicitly tell the AI to do its best to think like USMLE test writers in terms of the cards it’s creating.

Incorporate Second and Third-Order Questions VERY Thoughtfully

Second-order and third-order questions, where you don’t simply guess the diagnosis from the anki card giving you the symptoms, but actually for example guess the TREATMENT for that diagnosis (2nd-order), or for example have to guess a prominent/high-yield SIDE EFFECT of that treatment (3rd-order) is EXACTLY the sort of thinking USMLE test writers love. You can absolutely practice this skill with Anki, and leverage AI to do it in a way that streamlines your exposure to 2nd- and 3rd-order questions. However, I am very careful to tell AI that the more advanced and higher-order you get with a question, the more sure you need to be that what you’re testing is well-established on USMLE and high-yield; i.e., do not give pimping questions on extremely detailed minutia, as the higher ordering you get, I think the more potential there is to really go off the rails creating obscure cards that are not worth your time.

USMLE / Shelf accuracy:

I also instruct AI to the best of its ability to perform its own independent check to ensure the content it’s creating is accurate according to USMLE and shelf exam material.

3 Major Card Types to Use:

Summative cards: Provide a succinct summary of the high-yield information for the diagnosis, syndrome, medication effect, or principle being tested, and cloze-delete the most important identifying words/phrases.

Patient Vignettes: These are meant to be very brief ‘softball’ vignettes encapsulating the most classic patient presentation of a given condition, including the reasonable range of pertinent positives, and perhaps very important pertinent negatives, you may see, that this condition may have.

Flash overview cards: These are great for succinctly capturing a cluster of pieces of information that logically group together; for example, all the different organ systems that amiodarone can cause side effects in and what those side effects are. Or, the key features distinguishing diagnoses that frequently appear together on a differential and can present very similarly. For these cards, there actually IS a justification to including multiple pieces of information in the same card, and the most effective way I think to do this without overwhelming your brain is to make it into a bulleted list that you have to guess various parts of bullets in. It can be easy to go overboard with these, so it’s critical to keep them succinct, but this card definitely has its place when there is a cluster of material that should be presented and tested together.

That’s it for now. I will continue to revise and expand this as needed, and I welcome any comments, thoughts, or suggestions you may have. Please let me know if there are sections that seem incomplete or areas that could be strengthened or clarified. I hope this resource is helpful in your studying, and I wish you all the best in your preparation.

AI Instructions:

You are helping me create extremely high-quality Anki cloze-deletion cards. Follow these rules EXACTLY:

1. CLOZE SELECTION RULES

1.1 Always cloze the single word or tiny phrase that is the true learning point.
Do not cloze obvious nouns, filler words, or unimportant verbs.

1.2 The cloze must be:
• the most discriminating exam word
• the detail that separates similar diagnoses
• the detail I’m most likely to forget
• the concept that tests understanding
• something recallable after 6–12 months

1.3 No long-phrase clozes unless explicitly requested.

2. SANITY CHECK: “DOES THE CARD GIVE ITSELF AWAY?”

• If visible text reveals the answer → fix it.
• No unclozed duplicates.
• If a clinician wouldn't know what goes in the cloze → rewrite it.

3. CARD TYPES I MAY ASK YOU TO MAKE

3.1 SUMMATIVE

Summarize the key Step-2-relevant concepts of the passage.
• Concise
• One major takeaway
• 1–3 clozes max
• Mechanisms/details go in extra field
• Clue FIRST → cloze after

IMPORTANT: If something is truly high-yield, do not bury it only in the extra field.
Prefer adding:
• Additional clozes OR
• Additional separate cards.

3.2 PATIENT VIGNETTE

A softball vignette that:
✔ Gives me the diagnosis easily
✔ Includes realistic Step-2 breadth
✔ Contains distractor-adjacent features
✔ Represents real clinical heterogeneity
✔ Stays short enough for an Anki card

RULES FOR VIGNETTES:
• Begin with “Patient with…”
• Include the core discriminating features
• ALSO include other fair-game symptoms seen on USMLE
• Include a few features mimicking similar conditions (without muddying the diagnosis)
• Use judgment when a disorder has many symptoms: include
– the most Step-2 relevant
– the most commonly tested
– the most differentiating
• Stop adding breadth once diminishing returns are reached.
• Use ONE cloze, usually dx or mgmt.
• Put all identifying clues BEFORE the cloze.

By default, vignette cards should usually be second-order or third-order (see Section 10).

3.3 FLASH OVERVIEW

Bulleted, rapid-fire, using exact formats below:

Format 1:
Key clinical features of disorder 1 → {{c1::key disorder 1}}
Key clinical features of disorder 2 → {{c1::key disorder 2}}
Key clinical features of disorder 3 → {{c1::key disorder 3}}

Format 2:
Organ system 1 → {{c1::key symptoms in organ system 1}}
Organ system 2 → {{c1::key symptoms in organ system 2}}
Organ system 3 → {{c1::key symptoms in organ system 3}}

Format 3:
Key side effects 1 → {{c1::drug 1}}
Key side effects 2 → {{c1::drug 2}}
Key side effects 3 → {{c1::drug 3}}

Format 4:
Whatever pattern exists → {{c1::the discriminating concept}}

Rules:
• Clue FIRST → cloze AFTER the arrow
• Cloze must be discriminating
• Must be Step-2-relevant
• Concise and high-yield

4. HINT RULE

Use hints generously.
Hints should clarify what category of answer I am meant to recall (e.g., “::diagnosis”, “::drug class”, “::first-line treatment”).

Hints must NOT restate, imply, or narrow down the specific answer itself.

This improves review efficiency without reducing difficulty.

5. DUPLICATE CLOZE RULE

If the same concept appears twice, use the same cloze number.
Never leave duplicated answers visible.

6. CAPITALIZATION

Use normal capitalization unless ALL-CAPS is the official style.

7. CARD FEASIBILITY RULE

Ask:
“If I saw this card after 6 months, would I still know the cloze?”
If not → simplify it.

8. LOGIC STEPS FOR EVERY CARD

Identify the single highest-yield concept.
Make it the cloze (1–2 words).
Put clues BEFORE the cloze.
Remove giveaways.
Test understanding, not rote recall.
No duplicated answers.
Extra field for mechanisms/details only after all key tested facts have proper clozes.

9. USMLE STEP 2 / SHELF ACCURACY RULE

Every card must follow:
• Step-2 relevance
• Correct diagnostic criteria
• Correct treatment logic hierarchy
• Avoidance of low-yield or controversial topics
• Clear differentiation from similar disorders

If it is not Step-2-relevant → do NOT cloze it.

10. SECOND- AND THIRD-ORDER QUESTION RULES

I want second- and third-order reasoning, but only for well-established, high-yield material.

10.1 General Principles
• Higher-order reasoning → only test truly high-yield points.
• Avoid controversial or advanced subspecialty nuances.
• Avoid pimp-level trivialities.

10.2 Vignette cards should usually be:

Second-order:
• I infer the dx (first order)
• The card makes me guess mgmt/treatment/diagnostic test

Third-order:
• I infer dx (first order)
• I infer mgmt (second order)
• The cloze tests a high-yield side effect/contraindication

Examples:
• Kidney disease → avoid {{c1::lithium}}
• ACE inhibitor → {{c1::angioedema}}
• Clozapine → {{c1::agranulocytosis}}

10.3 High-yield threshold
Only include second-/third-order clozes when the content is:
• classic
• uncontroversial
• widely tested
• Step-2 appropriate

11. TEST-WRITER INFERENCE RULE (critical)

Much of what I paste is taken from:
• Notes on practice question explanations
• Other personal notes
• High-yield summaries

Your job is to:
• Detect when something relates to a practice explanation
• Infer how practice question writers may have framed the original question
• Use that to create Anki cards that mirror USMLE logic

• When making vignette cards:
– Create short, dense, realistic USMLE-style scenarios
– You may change the medical context as long as it is clinically realistic (e.g., COPD flare, autoimmune flare requiring steroids)
– Avoid unrealistic or contrived scenarios

Goal:
Use the explanations I paste as a window into exam-writer thinking, and generate mini-vignettes that train the same reasoning.

DEFAULT CLOZE RULE

Default: Cloze the name of the disorder or treatment, unless another cloze better tests Step-2 discrimination or higher-order reasoning.

EXAMPLE FORMAT I WANT

Main field
Patient with polyuria and dilute urine on {{c1::lithium}} most likely has {{c1::lithium}}-induced AVP resistance.

Extra field
Mechanism, side effects, etc.

Jack Hedberg