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Objective: Anki is a free open-source program for shareable digital flashcards. Using evidence-based learning methods, such as active recall and spaced repetition, it has become a widely used learning tool for medical students around the globe. In recent years, multiple community-based approaches to writing and maintaining medical flashcards have emerged worldwide, establishing large medical decks focused on contents of national examinations, such as the USMLE or the German Staatsexamen. The Ankizin project of the German Medical Students’ Association was officially founded in mid 2022 and is releasing its eponymous Ankizin deck and its updates since late 2022.

Project description: Ankizin was initially founded by five students in 2020 and has since grown to more than 100 active students in 18 local groups in Germany and Switzerland. The current Ankizin deck consists of around 50.000 individual cards, covering the full spectrum of the clinical section with preclinical content (year 1-2) currently being added. Using a system of hierarchical hashtags, all cards are individually sorted based on established online learning platforms, their Staatsexamen study plans and the local curriculum of 14 medical schools in the DACH region.

Parallel to the Ankizin deck, we created a website and an accompanying wiki at https://www.ankizin.de, as well as tutorials and community spaces using social media. Ankizin is additionally hosted on AnkiHub. This allows users to suggest updates to existing cards and maintainers to approve or deny them, effectively utilizing a peer-review based control system.

To further guarantee uniform card design and quality, we created a 140-page guideline derived from scientific evidence, community feedback and expert consensus.

Results: The Ankizin deck is currently utilized by at least 20.000 people, with 2,784 subscribers on Ankihub. Using AnkiHub data from 2023 onwards, approx. 150.000 suggestions from non-maintaining users were approved. Another 340.000 suggestions from maintaining users were approved.

A total of 38 students from 19 different faculties created more than 50.000 cards.

From 12/2023 onward, more than 75% of all clinical topics have undergone updates or revisions, following changes in the Ankizin or medical guidelines.

Discussion: User data, community feedback and continuous student engagement show wide acceptance and willingness to not only use, but also volunteer in student-led creation and maintenance of digital learning materials. A low-threshold for feedback suggestions encourages participation and strengthens the effects of peer review on quality control.

Due to our non-commercial intentions, continuous editorial work constitutes the primary workload inside such projects and heightens the threshold for in-depth participation.

Need of institutional and financial support: Further institutional and financial support would accelerate the project's growth and ensure ongoing up-to-dateness with medical guidelines.