What Anki does that paper does not
Anki's real function is scheduling. It tracks how well you recalled each card and decides when to show it again, which removes the hardest part of spaced repetition from your hands. That scales: two thousand medical terms are unmanageable on paper and routine in software, because you never have to decide what today should contain. It also syncs across devices, so the queue is available in the gaps of a day rather than only at a desk. The costs are real too. Setting it up takes an evening, the interface is unapologetically utilitarian, and a large deck someone else built is easy to accumulate and slow to actually work through.
What paper does that Anki does not
Writing a card by hand is itself a study act, and it is slow in a way that forces you to decide what the question is. That editorial decision is where much of the value sits, which is why a deck you made almost always outperforms a deck you downloaded regardless of format. Paper is also immediate: no account, no sync, no configuration evening, and no phone in your hand with everything else on it. Sorting cards into a pile you know and a pile you do not is a crude scheduling system, and across eighty cards over two weeks it is entirely adequate. Above a few hundred cards it stops being adequate, and that is the honest boundary.
The thing that actually decides it
Neither format teaches anything by itself. What produces the memory is attempting to retrieve the answer before you see it, and both formats let you skip that step: flipping a card quickly while assuming you knew it, or pressing Good because the answer looked familiar. That is rereading with extra ceremony, and it feels productive for the same reason rereading always does. The practical rule is to say or write the answer before revealing it, every time, and to be honest with yourself when you could not. Choose paper if the set is small and you want to start within ten minutes. Choose Anki if the set is large, the exam is months away, or you want the scheduling handled for you.