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

At one time I had more than 20,000 cards that I had >85% recall on after 21 days... Hard to do that without the digital version.