Med student here. I probably would’ve failed a lot of in house exams/step 1 if I didn’t use anki. IMO it’s best for solidifying knowledge and quick recall of facts, but doing a shitload of practice questions is the best way to apply what you’ve memorized through anki (this last bit is most applicable to med school/mcat prep).

Really the main cost with it is your time. If you miss a day or two it can be daunting to get back in the groove and work on your review backlog. I usually have enough downtime during the day and time on the shitter to get through my reviews + whatever new cards I add. Anki itself is free but they do have a paid iOS app that I got just to use whenever I had a few mins of spare time.

As for the learning curve, this will vary if you’re making your own cards vs using a premade deck for a large standardized exam. Once you know the formatting it isn’t that difficult to make cloze cards for what you’re trying to learn.