Unboxing Electronic Flashcards: An Introduction to the Design Elements of Anki for Medical Education (DEAME) Framework

Electronic flashcards (EFs) have rapidly ascended in popularity as an active learning resource among medical learners. Despite their significant popularity, no unifying terminologies exist to support clear practices and communication about the design of EFs between learners, educators, and researchers. This study proposes a framework extending <i>The New Taxonomy of Educational Objectives</i> (<i>NT</i>) to offer a robust terminology for describing EF design. Thirteen hundred EFs from six popular undergraduate medical education decks were sampled and qualitatively analyzed using a multi-phase design and flexible approach to thematic analysis. Through an iterative process of induction, deduction, and reconciliation, general design dimensions ("categories") and specific design elements ("codes") of EFs were identified. These categories and codes were organized into a unifying framework with accompanying definitions, examples, and possible implications for student-centered design. The Design Elements of Anki for Medical Education (DEAME) Framework contains seven categories and 48 codes that provide a robust foundation for conceptualizing EF design. Two categories describe the multimedia and metadata elements in EFs. Three categories describe how EFs formulate questions and answers. Two categories extend the <i>NT</i> to describe the types of knowledge and ways of thinking EFs can elicit. The DEAME Framework provides a much-needed terminology to describe the significant design variety in EFs for medical education. This terminology enables future educators, researchers, and learners to better develop and communicate best practices for creating high-quality EFs that align with medical curricula.