What strategies balance new cards with reviewing old ones in medical boards?

[Isabella_H]

I'm a medical resident trying to master a massive volume of information for my board exams, and I've started using a spaced repetition system with Anki. While the concept makes sense, I'm struggling with the practical implementation, specifically how to create effective cards that test understanding rather than just rote memorization of facts. My decks are becoming unwieldy, and I'm unsure how to balance reviewing old material with adding new cards daily. For others who have used spaced repetition for complex, conceptual subjects, what strategies did you use for card design and deck organization? How did you determine optimal intervals and manage your daily review load to keep it sustainable over many months?