If one is of a certain age, of course they studied for step I without it

and the classic method was the inspiration for Anki to begin with: making your own flashcards on index cards! You could do a version of spaced repetition by shuffling the deck.

Not sure the digital version is actually easier or more effective

Step 1 is pass/fail now. If I had to redo it and just pass, I don't think it would be necessary to use anki now (except maybe for something Sketchy).

Amboss