Why I Built NtTie: A Medical Student's Journey Through Note-Taking Hell

Let me start by saying this: Anki is an awesome application. It really is. The spaced repetition algorithm is brilliant, and it works incredibly well for certain use cases. Language learning? Perfect. Long-term retention for massive exams like the USMLE? Absolutely. There's a reason why popular decks like Anking and Lightyear exist and why so many medical students swear by them.

If you use Anki correctly (reviewing daily, finishing your cards every single day, building the habit over months or years), it's genuinely a game-changer. I know people who've used it successfully throughout medical school and crushed their board exams.

But here's the thing: I could never make it work for me. Not because Anki is bad, but because my situation was different. And I suspect a lot of students are in the same boat.

The Problem with Anki (For Short-Term Learning)

During medical school, most of my learning wasn't long-term preparation for a big exam. It was short-term: a few weeks to learn material for an upcoming test, sometimes multiple tests in the same week or month. Different courses, different subjects, constant rotation.

Here's what I needed: to go through all the material at least once, get a general understanding, and then review it again and again until the exam. I didn't need to know everything perfectly. That would be ideal, sure, but unrealistic when you're juggling multiple courses.

Anki actively fought against this.

There's this thing called the "Anki loop of death." With default settings, Anki shows you the same cards over and over until you've mastered them before moving on. If you have 500 cards to review and you keep getting some wrong, you might spend an entire study session on just 50 cards while the other 450 sit there untouched.

Yes, you can configure Anki to behave differently. But here's the problem: medical students aren't Anki experts. Anki just falls into their lap because everyone recommends it, and they try to make it work. By the time they realize it's not ideal for their situation, they've already invested significant time.

I constantly felt like I was fighting with the app:

• I couldn't easily skip cards and come back to them later
• I couldn't control which cards I'd review next
• There was no way to just scroll through everything sequentially for a last-minute review
• When cramming (let's be honest, we all do it), Anki was basically useless

One thing I did love about Anki, though: when it worked, it was brain-dead simple. You didn't have to think. Just review, answer, next card. That simplicity is genuinely valuable when you're exhausted.

The Microsoft Word Hack

Since Anki wasn't cutting it for short-term studying, I got creative. I built a flashcard system in Microsoft Word.

Here's how it worked: I used headings for questions and wrote the answers below each heading. Then I created a table of contents at the beginning of the document. The TOC showed all my questions, and clicking any heading would jump me to the answer.

I even added a color-coding system, coloring the headings to track which questions I knew well and which needed more work. The colors synced to the table of contents, so I could see my progress at a glance.

This actually worked pretty well. Everything was ordered. I could print it out and review with real paper and colored pens (I'm a visual learner who draws a lot). I could go through all the material once, then again, then again.

But it had problems:

• Fatigue: Constantly jumping back to the first page to find the next question, then clicking to the answer, then back to the TOC... it wore me down
• Performance: Once the document got big enough, Word became laggy as hell
• Drawing issues: I tried drawing diagrams directly in Word. It worked great at first, but after enough drawings, the document became unbearably slow

The lag was the main reason I eventually abandoned this method.

OneNote & Notability: Great for Drawing, Terrible for Flashcards

Since I draw a lot to remember things (rough sketches of anatomical structures, visual mnemonics, diagrams), I started using OneNote and Notability alongside whatever flashcard system I was using at the time.

OneNote was great because it synced across devices. I could draw on my tablet and immediately access it on my computer. Notability was fantastic for taking notes during lectures and creating clean visual content.

But neither was designed for flashcards. Using them for that purpose was too hacky. So I used them separately: one app for drawings, another for flashcards.

The big problem: my drawings were completely disconnected from my flashcards.

Every time I wanted to include a drawing in a flashcard, I had to:

1. Draw it in OneNote or Notability
2. Take a screenshot
3. Paste it into my flashcard
4. If I ever updated the drawing, repeat the whole process

Changes never synced. If I improved a diagram in OneNote, my flashcard still had the old version. I'd have to manually delete and re-paste.

Even worse: over time, I completely lost track of which drawings went with which notes. When I later tried to share my study materials with my brother, I couldn't figure out the context for half my drawings. Total disassociation between content that was supposed to be connected.

Obsidian + Anki: So Close to Perfect

Then I discovered Obsidian with Anki integration. For a while, this felt like the solution to everything.

Obsidian is a note-taking app that uses Markdown files. With the right add-ons (one for Obsidian, one for Anki, plus the Anki Connect API), you could write flashcards in Obsidian and sync them to Anki.

This solved my biggest problem: I could have ordered notes that were reviewable at a glance. I could scroll through everything from start to finish in Obsidian for last-minute cramming, but also use Anki when I had more time for proper spaced repetition.

I structured my notes with collapsible sections. The section title was the question, and expanding it revealed the answer. Pseudo-flashcards within Obsidian itself. When I wanted "real" flashcard review, I'd sync to Anki.

Edit in Obsidian, sync to Anki. Best of both worlds, right?

Wrong. This solution was a nightmare to maintain.

The Add-On Hell

The setup required multiple add-ons that all had to work together. Versions had to match. When one updated, things broke. I remember using an outdated version of Obsidian for months because a breaking change had destroyed my sync functionality.

Strict Formatting Requirements

The add-on I used required extremely specific formatting. No empty lines between flashcard content. Certain special characters would break the sync entirely.

Imagine having a page with 200 flashcards, and syncing fails because somewhere (you don't know where) there's a formatting issue. I'd spend hours doing binary search through my notes trying to find which flashcard was breaking everything.

It drove me absolutely nuts.

Unusable for Non-Technical People

I studied with someone who wasn't technically inclined (which is normal for medical students). Explaining how to format flashcards correctly was nearly impossible. They'd create cards, and I'd have to go through and fix them all so they'd actually sync.

Manual Syncing

Every time I made changes in Obsidian, I had to manually trigger a sync to Anki. Forget to sync? Your changes aren't in Anki. Sync at the wrong time? Hope nothing breaks.

I eventually found a better Obsidian add-on that allowed empty lines and had cleaner formatting. But it only showed flashcards one at a time. I couldn't see them all on one page anymore. It solved one problem while creating another.

Why I Built NtTie

After years of fighting with these tools, I realized what I actually needed:

• A way to review flashcards in order, or go through everything at once
• A simple review system that doesn't require a PhD to understand
• Drawings that live inside my notes, not in a separate app
• No manual syncing, everything in one place
• Formatting that just works, no matter what I type
• Something my non-technical study partners could actually use

So I built it.

NtTie isn't trying to replace Anki for long-term spaced repetition learners. If Anki works for you, genuinely, keep using it. But if you've ever felt like you're fighting against your tools instead of learning with them, NtTie might be what you're looking for.

In my next post, I'll explain exactly how NtTie solves each of these problems. Stay tuned.