The Effectiveness of Spaced Repetition in Medical Education: A Systematic Review and Meta-Analysis

Spaced repetition studying techniques such as Anki are increasingly prevalent in undergraduate and postgraduate medical education. However, the evidence base for the effectiveness of these techniques in a medical education setting is unclear. This meta-analysis investigates the effect of spaced repetition use in medical education on learner performance in objective tests.

The systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Electronic databases were searched in February 2025 for relevant articles, assessed using predefined eligibility criteria. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). Effect sizes, heterogeneity and publication bias estimates were calculated using the R programming language.

Of the 542 records identified, 14 studies were included in the systematic review, of which 13 were included in the meta-analysis. A meta-analysis including 21,415 learners showed an overall significant effect in favour of spaced repetition study compared to standard studying techniques (standardised mean difference = 0.78; 95% CI 0.56-0.99; p < 0.0001). Spaced repetition interventions included faculty-created or third-party flash cards, MCQs delivered via email or as part of a continuing medical education framework, and spaced classroom quizzes.

Spaced repetition is an effective study method in medical education. Further work is required to investigate the optimal design and delivery of spaced repetition interventions, as well as to assess the impact of spaced repetition on longer term performance and continuing medical education.