What actually changed
Under scored Step 1, the rational strategy was a brutal peak: maximise recall on one specific morning, and accept that much of it would evaporate afterwards. That is a terrible way to build a doctor, and everybody knew it.
Pass/fail removes that incentive. You need to clear a threshold with margin, and — far more importantly — you need to *still know this material* in eighteen months, when Step 2 arrives and the wards start asking. That is a retention problem, and retention problems have a well-known solution.
Why spaced repetition dominates here
Step 1 is a volume problem. Thousands of discrete, individually easy facts, all of which must be simultaneously retrievable, any of which can be asked. That is the canonical use case for FSRS, and it is why the medical community adopted spaced repetition long before anyone else.
The gap in the standard approach is the deck. A huge community deck is someone else's curriculum, with someone else's errors and someone else's emphasis, drilled into you by an algorithm specifically designed to make things permanent. Cards generated from *your* faculty's material carry your school's emphasis and cite the page — so a card that looks wrong can be checked rather than argued about on a forum.
A structure that works
- Questions from day one, not saved for the end. Practice questions are the study method, not the assessment of it.
- Every wrong answer becomes a card. Your deck is then, by construction, your weak areas.
- Review daily, without exception. The scheduler collapses if you binge and abandon; the compounding is the whole point.
- Categorise your errors — content gap, reasoning, misread — because only one of those is fixed by more review.