Anki or Alma for med school: keep your decks, or let a tutor steer?
By Roupen Odabashian, MD, FRCPC · Published · 10 min read
How we write and check articles: Editorial Policy.
Disclosure: Alma publishes this article and makes one of the study tools it discusses.
If you already live in Anki and are wondering whether Alma is worth adding or even switching to, the core tradeoff is this: Anki is a powerful engine for spaced flashcards, and its deck options primarily control how cards are scheduled and when new material appears.[1] Alma keeps strong FSRS style scheduling for cards but adds a tutor layer that watches your activity, highlights weak topics, and builds a plan around your exam date using your own material.
For most medical students, that means: stay with Anki alone if you have a strong routine, a vetted deck and zero budget; add Alma if you want help deciding what to review when life gets messy, especially for high stakes board and shelf style exams.
Alma is our product, so we say plainly where Anki is the better pick.
What are the key differences between Anki and Alma at a glance?
| Feature | Anki | Alma |
|---|---|---|
| Core cost | Anki is open source and cross platform, with free clients available on many platforms.[2] | Alma uses a time limited trial followed by paid plans, so you should confirm current terms on the live pricing page. |
| Scheduler | FSRS built in, with a desired retention setting whose default value of 90% aims to balance workload and remembering.[1] | FSRS implementation with a retention target the learner chooses, where higher desired retention leads to shorter intervals and more reviews per day.[1][3] |
| Topic level feedback | Stats per deck, card type and time range, no automatic topic map.[4] | Alma Insights labels topics Solid, Getting there, Needs work or Too early to judge. |
| Content creation from files | Cards can be created and organized into decks, and Anki’s open source design means many add ons exist to extend how content is added.[2] | Learning Hub turns PDFs, slides, Word documents, images and pasted text into quizzes, slides and mind maps. |
| Deck sharing | Anki is open source and supports many add ons contributed by users, and its design has enabled a wide ecosystem of shared resources.[2] | Alma focuses on working from your own material rather than a public deck marketplace. |
How do Anki and Alma decide what you should study next?
Anki offers the Free Spaced Repetition Scheduler (FSRS) as an alternative to its legacy SM 2 algorithm, and it schedules cards based on how likely you are to forget them, using your answers on the Again, Hard, Good and Easy buttons.[1][3] It can show graphs of due cards, review counts and estimated future workload, but it does not tell you which topic or deck should come next or tie that to an exam date; instead, you choose decks and any custom study sessions yourself.[1][4]
Alma also uses FSRS scheduling with Again, Hard, Good and Easy on flashcards and shows the interval change on each rating. Its difference is Alma Insights and Study Schedule. Topic status in Insights is expressed in plain language bands such as Needs work, Getting there, Solid, or Too early to judge, and topics are only judged after there has been enough activity on them.
On top of that, Alma Study Schedule asks for your exam date, weekly hours and days off, then builds a plan backward from exam day. It offers tools to build, edit and export this schedule so your flashcards, quizzes and other study blocks are organized around your assessments.
How do they help you judge whether your studying is actually working?
One of the main cognitive traps in med school is that recognition can feel like understanding, which leads to shallow learning and the sense of “studying but not improving.”[5] Tools that surface real performance data help you catch when exposure has replaced mastery and when more time with the same method will not change outcomes.[5]
Anki offers detailed statistics per deck and your whole collection: review counts over time, pie charts of card states and graphs of due load.[4] With FSRS enabled, it can also display metrics tied to the algorithm, like estimated stability and retrievability, which approximate how likely you are to remember cards at their scheduled times.[4][3] These are powerful, but you must interpret them yourself and tie them to real topics.
Alma Insights turns your study activity into topic level feedback. A Do this now panel picks a weaker or slipping topic and offers actions like reviewing cards or asking Alma, and other sections help you see where you are improving, where you may be about to forget material, and whether your confidence matches your accuracy over time.
How do Anki and Alma use spaced repetition and FSRS differently?
Anki integrates FSRS as an alternative to its older SM 2 scheduler.[1][2] In current Anki versions, you can enable FSRS in deck options and set a desired retention per deck, for example 90 percent, which is the default and balances workload and recall.[1][3] Higher desired retention shortens intervals and increases daily reviews, while lower retention does the opposite.[1][3] Anki’s graphs can show estimated total knowledge based on retrievability for cards reviewed at least once.[4]
Alma also uses an FSRS scheduler. Each deck lets you choose a retention target, and Again, Hard, Good and Easy control intervals, with failed cards returning within the same session and an undo option for mis clicks. Alma then feeds that card history into Insights, which adds a simple language overlay to the spacing engine.
How do practice questions, notes and AI tutoring compare between Anki and Alma?
Alma layers several tools around flashcards. Learning Hub lets you upload PDFs, slides, Word documents, images up to 100 MB each, or pasted text as sources, and from those sources it creates exam style multiple choice quizzes with five options, each option explained, in the style of your chosen exam. At the end of each quiz you get a strengths and gaps report, and you can retake quizzes or generate ones targeting untested areas. The same sources can become editable slide decks, downloadable as PowerPoint, and mind maps.
Notebook gives you a rich text note editor with AI tools: you can highlight text to turn it into a flashcard with an AI suggested front, generate mind maps and comparison tables from notes, and build a knowledge graph that links concepts across everything you have written. Practice Patients lets you work through simulated clinical encounters in multiple stages with marking and a limited number of free stations each week. Alma’s AI tutor lives in a chat bubble on every page, answers from your notes, uploaded sources and flashcards, and for medical questions checks PubMed and labels those citations.
What does and does not have evidence behind it?
The honest takeaway: spacing and retrieval practice are well supported, and FSRS is a modern way to implement them. How much any individual student’s exam performance will change using Anki or Alma depends on far more than the app: the quality of the underlying content, total study time, how they use question banks and textbooks, and their baseline skills. If you are weighing AI tools in general, this separate piece on how to judge an AI study tool before you pay may help.
Who should choose Anki only, who should add Alma, and how can you use both?
If you already have a strong daily Anki habit, a curated shared deck like AnKing or a school specific deck, and absolutely no budget, sticking with Anki alone is a rational choice. Its free, cross platform nature and rich add on ecosystem make it especially good for students who want to script their own workflows and who enjoy tweaking settings.[2]
Alma is a better fit if you want the software to help you decide what to do next and to work from your own lectures. The main reasons to add Alma alongside Anki are: topic level guidance from Insights, a Study Schedule that ties your plan to real Step 1, Step 2 CK and shelf dates, and Learning Hub or Notebook for turning your school PDFs and notes into quizzes, slides, mind maps and flashcards without manual retyping. Alma supports medical, nursing, NP and PA students, but its Insights and Schedule are particularly useful for medical students juggling preclinical blocks, multiple shelves and boards.
What is a practical workflow to use Anki and Alma together each week?
If you decide to combine them, you can treat Anki as your long term deck home and Alma as your tutor and content builder. The key is to avoid duplicating effort while getting the benefits of Insights and a plan around your exam dates. Here is one concrete weekly flow that many students could follow.
First, keep your main high stakes exam deck in Anki, using FSRS with a desired retention that keeps your daily reviews manageable for your schedule.[1][3] Second, import that deck into Alma so its cards, tags and media feed Insights and Schedule. Use Alma’s Study Schedule to create a plan backward from your next exam, and follow its daily suggestions with review blocks that include due flashcards as part of your daily load.
Third, for each new block or clerkship, drop your lecture PDFs and slides into Learning Hub to generate quizzes and slides in your exam style, and use Notebook to create quick cards from your own notes. Let Alma Insights tell you which topics are slipping, which ones are about to be forgotten, and where your confidence is miscalibrated. When Alma flags a misconception, you can go back to your Anki deck or your Alma cards and adjust. Over time, if you find Alma’s flashcards and planning helpful, you can gradually shift more of your daily review into Alma or keep Anki as a backup archive.
Frequently asked questions
Does Alma replace Anki for medical students?
No. Alma can import and export Anki decks, so you can keep Anki as your main deck home but use Alma for planning, Insights and working from your own PDFs and notes.
Is Anki enough on its own for Step 1 and Step 2 CK?
Many students pass with Anki plus a question bank and content resources. Anki handles spaced cards well, but you must manage what to study, how much, and how that ties to exam dates yourself.
Can Alma predict my USMLE score or pass chance?
No. Alma Insights summarizes your performance on cards and quizzes, labels topics and shows trends, but it explicitly does not predict exam scores or pass rates.
Will I lose my Anki progress if I try Alma?
No. Importing into Alma creates new decks there without touching your original Anki collection. You can also export decks from Alma back as Anki package files.
Is there a free version of Alma like Anki?
No. Anki is open source with free clients available on many platforms.[2] Alma offers a time limited trial, then paid Monthly or Annual plans, so you should check current pricing before deciding.