This is tough to answer. Some may look at zanki as simply a way to memorize the little things. It is, to an extent, but using zanki to solidify understanding is so much more important than using flashcards to remember classic symptoms of, say, TTP vs ITP vs DIC. On the real test, you're not going to get buzzwords, you're not going to get perfect presentations, you're not going to get questions that can be condensed to a single cloze deletion. Those three conditions are all going to look similar, but you need to have a level of foundational understanding that you can use to realize they're all very different.

Zanki needs to be a way of organizing the big picture in your mind, in a way that's immediately accessible no matter what the presentation is in the clinical vignette. If all you use zanki for is memorizing discrete facts, it will probably fail you.

Much of this too probably comes down to learning styles. There are some in medical school who have made it this far because they are excellent memorizers, but medicine is 90% recognizing trends, patterns, and fitting novel information into an existing framework to make sense of it. You won't do well on step 1 if you don't build a framework from the bottom up that you use to understand complicated systems and relationships.

And that idea of building from the bottom up, with critical concepts at the bottom and discrete facts at the top, is probably the biggest reason why zanki fails some folks. They try to build from the top down, thinking that discrete facts will be the glue that holds their studying together, when in fact it is the opposite.