Toronto Notes Anki Flashcard

Deck (The Ottawa Deck)

2024 (From 2022 version)
Why do this?
● Anki is an evidence based method of retaining vast amounts of information
○ Passively reading a textbook is one of the LEAST effective methods
○ Learning from question banks leads to knowledge gaps
○ You can’t possibly see everything during clerkship
● Anki utilization continues to increase in medical education
○ Mostly at undergraduate level (Makus 2023) but some evidence in post-graduate (Myself 2024)
● To my knowledge (2024) there exists no comprehensive both knowledge and
clinical information focused Anki deck specific to Canadian content
○ This is now partially solved this
● Really, there exists no clinically focused clerkship Anki deck
○ Anking Step 2 CK decks have significant gaps e.g. GOLD criteria
● Student made resources only exist if people make them
Why the Ottawa deck?
● uOttawa has a very strong Anki culture with multiple preclerkship and
clerkship decks to choose from
○ The most popular are based off a condensed note deck which was condensed from
another note deck that was originally from Toronto Notes
● However these are “locally focused” and not designed for overall medical
knowledge
What areas are covered?
● The entire Medicine book (492 p.) is included in exhaustive detail
○ This includes all classic medicine subspecialties as well as Neurology
● The Primary book is partially covered (WIP*)
○ Areas covered: Anesthesia, Emergency Medicine, Family Medicine, Palliative Medicine,
Psychiatry
○ Not covered: Dermatology, Medical Genetics, Medical Imaging, Pediatrics, Clinical
Pharmacology, Public Health, Ethics, legal, organizational medicine
● The Surgery book (WIP*) has the least comprehensive coverage, it
includes only:
○ Areas covered: General and Thoracic surgery, Urology, Cardiac surgery (in Cardiology)
○ Not covered: Gynaecology, Obstetrics, Neurosurgery, Vascular surgery, Ophthalmology,
Orthopaedic Surgery, Otolaryngology, Plastic Surgery
Why are some content areas not included?
● This project was designed first and foremost to assist my fourth year
elective strategy focused on Internal Medicine
○ I heavily utilized the medicine deck for this reason
● A conservative estimate for the total editing time for the Medicine booklet
alone is 150+ hours
○ It generally takes 2-3 hours to do 10 pages depending on content density
○ It took about 6 months to do this over 3rd to 4th year
○ Also takes time to proofread and fix mistakes
● Given the time and energy required to complete all areas it is simply not
realistic to complete those specialties if not interested in the material
○ I would need to be bribed (paid) to do this
What is the design philosophy?
● The goal is to cover every single piece of information in the textbook
and it is up to the individual users to determine what they feel is
extraneous and what is worth completing
● Decks are complementary in that many areas are covered in multiple
subspecialties and so each specialty deck will only present information
from that section
● Text content is preferred over screenshots due to searchability however
tables/diagrams are inserted as IO cards where appropriate
● Tagging and screenshot tools are designed to be easily updated and
searchable in the future
● As a (hopeful) future General Internist key subspecialty topics were tagged
“zGeneralInternalMedicineHighYield” for this specialty ~ 9,000 cards
Principles for Card Making Utilized
● Standardized zoom at 150%, utilize cloze + IO for graphics/tables
○ IO shapes are to be generic (no hints to underlying answer) - usually hide all guess one
but context dependant - grouped where appropriate or utilizing hide one guess one
○ For flow charts hide one guess one is more commonly utilized
● For text large text cards are to be avoided - cards should be read in <3
seconds
○ Where possible long lists are summarized in a big cloze card by category and each
category becomes it’s own cloze card
● Where necessary, cloze hints are provided
● Toronto Notes screenshots are limited to the individual section and tags
follow the naming convention of the chapter
● Typos common - copy-paste doesn’t like “I” and “l”
Card Design Principles
● The goal is to have all cards mutually discernable
○ This means additional clarifying items where needed since some cards may be unclear if you
don’t know which deck it’s from
○ E.g. avoid {{c1::warfarin}} in pregnancy due to teratogenicity, avoid {{c1::DOAC}} in
pregnancy (due to lack of data) and if breastfeeding in postpartum period
■ Would be unclear if the first cloze is a DOAC, Warfarin, AEDs, or ACEi/ARB if you didn’t
know this was from Heme
● Generally tried to avoid acronym usage unless basic medical knowledge
(ACEi, ACS, etc…) but difficult to do (see above)
● Have added comments in the “Extra” field where helpful or clinical
experience adds value
● Have added DermNet images where useful e.g. Gottron’s papules
Samples
Samples
Advantages and Disadvantages
What this deck does NOT do well
What this deck does well
● Not comprehensive in regards to physical
● Comprehensive exam findings, imaging, history taking, or
● Excellent clinical pearls anatomy
● Exhaustive tagging system ○ Alternative decks exist for some of these
● Real time integrated Toronto Notes ● Large (over 15,000 cards) with questionable
references for every text based card yield cards
○ Also enables usage of UpToDate and ● The format of the investigations sections for
Amboss Anki addons many conditions does not easily copy into Anki
● Medicine deck has been field tested ○ Long lists of things - I tried
successfully ● Toronto Notes often makes references to other
sections (Respirology to Thoracics one of the
worst) meaning you need to carefully check for
multi-section concepts
● Treatment options are surface level - will still
require point of care tool such as UptoDate
● Definitely some errors
Who should use this deck?
● Senior* Medical students and junior residents seeking a comprehensive medical
knowledge resource
○ Particularly relevant to particular subspecialty rotations
● Could be used by preclerks to supplement but would be hesitant to recommend
replacing home school curriculum with it
● Someone who wants to have the foundational knowledge to excel

Who should NOT use this deck?

● Someone seeking an initial exposure to clinical medicine
○ Too complicated as first pass resource
● Those seeking a MCCQE study resource (unless seeking maximal scores)
○ It is possible a further “high yield” version might be a great resource
● Unable to sustain Anki for more than a few weeks
How can I use this deck?
● To prepare for subspecialty electives
○ Generally each subspecialty is ~1,800 cards (many
smaller, some larger) - can be completed in 4 weeks
○ Would still recommend using a question bank alongside
- worked very well for me for electives
● To prepare broadly for 3rd/4th year
○ Will require a much longer preparation period
● For specific knowledge gaps
● For general medical knowledge
● For MCCQE
○ Generally not recommended unless pursuing maximal
score
● Pro tip: Anki + remote (8BitDo Zero 2 or Lite) +
Exercise
What settings
should I use?
● Depends entirely on your goal
○ Long term retention vs. elective
cramming
○ Tolerance for card load
■ Newcomers might struggle
to do 200-300 a day
whereas Anki Veterans can
comfortably do 100s a day
○ Balance of new vs. old
■ Mature decks are much,
much, faster
○ Would recommend dynamic
daily limits
Where do we go from here?
● As Toronto Notes gets updated cards that are
outdated can be replaced easily using the tag system
and the Toronto Notes change log
○ Note we are not going to personally perform any updates -
our involvement is over
● While I personally have zero interest in it, someone
could likely create a smaller “high yield” version
● I would be willing to briefly (<30 minutes) meet with
someone willing to finish one or more LARGE missing
decks (e.g. Pediatrics/OB/GYN) prior to June 2024
● If you have interest in Anki and Medical Education
research I have published in this area and am
interested in future collaboration
○ [Link]@[Link]