Institute-created electronic flashcards, associated development effort, and exam performance in pharmacology education in human medicine

Abstract Electronic flashcards are popular among medical students, although their real-world effectiveness, and staff resources required to develop tailored decks, is not well understood. The Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products at the Ulm University Medical Center, Germany, created 1007 flashcards on 228 drugs aligned to the local and national curriculum using the Anki flashcard software. The time needed for card development was documented. Medical students participated in an observational study over four semesters and were encouraged to use the cards alongside established study materials for exam preparation in clinical pharmacology. Exams concluded either a lecture-based course focusing on declarative knowledge, or concluded a seminar-based course focusing on case-based application. A survey assessed usage patterns and helpfulness of flashcards and other study materials, demographics, and self-rated general academic performance. Pseudonymous codes linked survey responses to individual exam scores. Flashcard use was reported by 38.4% of participants overall, with higher use when preparing for lecture-based exams than for seminar-based exams. In total, 83.3% of users considered the cards helpful. Participants with lower self-rated general academic performance were more likely to use flashcards. Flashcard users scored lower in the exam than non-users, but this association was no longer significant after adjusting for self-rated general academic performance. Flashcard development took on average 7 min per card. These findings suggest that academically weaker students, and students preparing for exams testing declarative knowledge, may prefer flashcards. Given the substantial staff time required, and the lacking benefit of our flashcard-decks, the decision to tailor curriculum-aligned flashcards should be made cautiously.