The note-taking app question gets asked on r/medicalschool about once a week. The threads always splinter into the same three camps — the Notability loyalists, the Notion organizers, and the “I still use a notebook” minority — and never actually answer the question. This post is a serious attempt at the answer.
The actual answer depends on what you’re trying to accomplish, which the threads almost never make explicit. So we’ll start with that question and work down from there.
The note-taking question every medical student faces
There are three sub-questions hiding inside “what note-taking app should I use.”
1. Hardware: laptop, iPad, or paper notebook? The laptop is fastest at capture but worst at retention. The iPad is slowest at capture but best at retention with handwriting. Paper is best in some ways and worst in others (no search, no sync, but no distractions either).
2. Format: linear pages, knowledge graph, or canvas? This is the category question almost no one frames explicitly, and it’s the most important one. Notability is a linear-pages app. Notion is a knowledge-graph app. Fluera is a canvas app. They’re different species of tool, not different brands of the same species.
3. Workflow: am I capturing lectures, summarizing for review, or building a long-term knowledge base? Each of these is a different cognitive task, and the right tool varies. Capturing lectures rewards speed (paper or laptop). Summarizing rewards integration (canvas or knowledge graph). Long-term knowledge base rewards linking (knowledge graph).
The reason the Reddit threads splinter is that everyone is answering a different sub-question and assuming the others. Get the questions clear and the comparison gets clearer.
What the research says about note-taking and learning
There is a substantial literature on whether and how note-taking improves learning. Two findings dominate.
Handwriting beats typing for conceptual retention. The Mueller-Oppenheimer 2014 paper [Mueller & Oppenheimer, 2014] View in bibliography → compared students who took notes by hand versus laptop in college lectures. Both groups did roughly equally well on factual recall, but the handwriting group did substantially better on conceptual questions — the kind that require integration rather than verbatim recall. The mechanism the authors proposed: laptop notes tend toward verbatim transcription, which doesn’t force the encoding work. Handwriting is slow enough that you have to summarize and integrate as you go, which is the encoding work.
This finding has been replicated multiple times, and a 2020 fMRI study by Audrey van der Meer and colleagues [van der Meer et al., 2020] View in bibliography → showed measurably different brain activation patterns between handwriting and typing — handwriting activates broader networks associated with memory consolidation. For medical school, where conceptual integration is most of the content, this has a clear implication: typed notes during lecture are likely a net negative for retention, even though they feel more productive.
Note-taking matters more for review than for capture. A second strand of the literature shows that reviewing your notes produces more learning than the original act of taking them. The implication: notes are worth taking primarily because they create something to retrieve from later, and the act of retrieval is what produces durable memory. Notes that look great but never get reviewed are mostly performative.
Combined, the two findings: handwrite if you can, and design the system so that the notes get reviewed actively (not just re-read passively).
The popular apps, honestly evaluated
Notability. The default for iPad-based medical students for a decade. Strong handwriting, audio sync that lets you tap a note and jump to the moment in lecture audio when you wrote it (genuinely useful for review), reasonable PDF annotation. Cost: $14.99/year (was free historically — older students still grandfathered). Weakness: search is OK but not great for handwritten content; organization is page-based with no concept linking; iPad-only really (the Mac version is an afterthought). Best for: M1/M2 lecture capture if you have an iPad.
GoodNotes 6. The other default for iPad-based medical students. Comparable to Notability on handwriting and PDF annotation. AI-based handwriting search added in version 6 (2024) is meaningfully better than Notability’s. Cost: $9.99/year or $29.99 lifetime (lifetime is the steal). Weakness: same as Notability — page-based, no linking, iPad-centric. Best for: same audience as Notability; GoodNotes wins on search and price, Notability wins on audio sync.
OneNote. Microsoft’s note-taking app. Free with a Microsoft account. Cross-platform (Mac, Windows, iPad, Android, Web). Handwriting is supported on touch devices but weaker than dedicated iPad apps. Page-based with a notebook → section → page hierarchy that’s flexible but easy to over-engineer. Search is excellent including handwritten content. Best for: Windows-primary med students, especially those who already use Microsoft 365.
Notion. A knowledge-graph app marketed as a note app. Database-driven, with backlinks, page hierarchies, and templates. Strong for organizing semester-level information (lecture index, course summaries, rotation prep). Weak for actual note-taking — no real handwriting, no canvas, typing-only. The trap is that the organizational power of Notion encourages people to spend more time on the database structure than on the studying. Best for: building a long-term reference base across years 1-4; weak for in-lecture capture.
Obsidian. A markdown-based knowledge graph with very strong backlinking. Free. Local-first by default. Plugin ecosystem is enormous. Strong for the “second brain” workflow popular with knowledge workers (Tiago Forte audience). Weak for the same reasons as Notion: no handwriting, no canvas, organization-heavy. Best for: M3+ students building integrated review notes across rotations.
Apple Notes. Free, built-in, surprisingly capable since 2024 updates. Handwriting, OCR, simple tables, cross-Apple sync. No knowledge-graph features, no advanced PDF annotation. Best for: students who want the absolute minimum-friction option and are willing to trade features for simplicity.
RemNote. A note app with built-in spaced repetition (cards live inside notes). Free tier limited. Strong for the workflow where you outline lectures and turn portions into flashcards in the same session. Weak handwriting. Best for: students who want their flashcards and notes in one tool and outline heavily.
The category split nobody articulates
The reason these apps don’t compare cleanly is that they’re not the same kind of tool. Three categories worth naming.
Linear-notebook apps (Notability, GoodNotes, OneNote, Apple Notes). The mental model is a notebook with pages. You write top-to-bottom, advance pages, organize into sections. Optimized for capturing chronologically. Search works fine for finding a specific page; integration across pages is essentially manual.
Knowledge-graph apps (Notion, Obsidian, RemNote). The mental model is a database of pages that link to each other. You build relationships explicitly via tags, backlinks, or queries. Optimized for organizing reference material. The cost is overhead — the structure does not maintain itself.
Infinite canvas apps (Fluera, tldraw, Excalidraw for whiteboarding). The mental model is a 2D canvas you can pan and zoom forever. You arrange content spatially. Optimized for synthesis — putting related ideas next to each other and seeing the structure emerge. Newer category, less mature, less widely adopted.
Medical students who try to use a linear-notebook app for the synthesis task (integrating across systems for boards review) find it doesn’t work — the page metaphor fights the integration. Students who try to use a knowledge-graph app for the lecture-capture task find it doesn’t work — the structure overhead overwhelms the speed they need. The right tool depends on the task, and most students are using one tool for everything.
Comparison table
| App | Category | Handwriting | OCR/Search | Audio | Mobile/Desktop | Price |
|---|---|---|---|---|---|---|
| Notability | Linear notebook | Excellent | Good | Yes (sync) | iPad/Mac | $14.99/yr |
| GoodNotes 6 | Linear notebook | Excellent | Excellent (AI) | No | iPad/Mac/iOS | $9.99/yr or $29.99 lifetime |
| OneNote | Linear notebook | Good | Excellent | Limited | Cross-platform | Free |
| Notion | Knowledge graph | None | Good (typed) | No | Cross-platform | Free / $10mo |
| Obsidian | Knowledge graph | None | Excellent (text) | No | Cross-platform | Free / $5mo sync |
| Apple Notes | Linear notebook | Good | Good | No | Apple-only | Free |
| RemNote | Knowledge graph + SRS | Limited | Good | No | Cross-platform | Free / $8mo |
| Fluera | Infinite canvas | Excellent | Yes | Yes (sync, Pro) | Cross-platform | Free + €5.99/€11.99 |
Where Fluera fits
The argument for the canvas category is not that linear notebooks and knowledge graphs are bad — they’re optimized for the tasks they do well. The argument is that there’s a third task that neither one does, and that task is spatial synthesis: arranging related material visually and seeing how it connects, in a way that page-flipping and link-clicking can’t replicate.
For medical school, the spatial-synthesis case is strongest for content where relationships matter as much as facts. The renin-angiotensin loop is the canonical example: ten facts about ten molecules, but the value is in the loop, not in any individual fact. A linear notebook gives you the facts on a page; a knowledge graph gives you the facts in a database with backlinks; a canvas lets you draw the loop and see it.
Concretely with Fluera:
- The canvas is the surface. Handwriting, drawing, importing PDFs, placing them spatially — everything lives on an infinite 2D surface that you pan and zoom. The mental model matches how you’d use a whiteboard, not a notebook.
- Cross-Zone Bridges is the AI feature that finds connections between concepts you’ve placed on different parts of the canvas. The integration you’d do manually in a knowledge graph happens passively as you draw.
- Ghost Map tracks what you used to know and don’t anymore — closer to the metacognitive feedback that page-based notebooks structurally cannot give.
- Spaced repetition with FSRS-5 is integrated, not bolted on. The retrieval practice happens on the canvas concepts, not on stripped-down cards.
We’ve covered the comparison with Anki and the underlying science of spaced repetition in detail elsewhere. The relationship to note-taking apps is similar: Fluera is not optimizing for the task Notability optimizes for, and we’re honest about that. If you want a digital notebook for lecture capture, Notability or GoodNotes is the right answer. If you want to build a long-term reference base across years, Notion or Obsidian is the right answer. If you want to synthesize across systems and have your notes also drive your spaced retrieval, the canvas category is what you’re looking for, and we’re the most opinionated implementation of it.
See Fluera’s canvas approach free — 100 AI credits/month, no card required →
How to decide
Four questions, in order:
1. Do you do most of your studying on an iPad or a laptop? iPad with Apple Pencil → handwriting-first apps are an option (Notability, GoodNotes, Fluera). Laptop primary → typed apps (Notion, Obsidian, OneNote, Apple Notes on Mac).
2. What’s the dominant task you need solved? Lecture capture → linear notebook. Long-term reference and organization → knowledge graph. Synthesis across systems and review-driven study → canvas.
3. Are you willing to maintain the system, or do you want it to mostly maintain itself? Notion and Obsidian require ongoing organizational discipline. Linear notebooks require almost none. Canvas tools are in between (you arrange things, but there’s no schema to maintain).
4. Is your studying mostly retrieval-driven or reference-driven? If you mostly look things up, you need search and links (knowledge graph). If you mostly retrieve from memory and use notes as a backup, you need a system that supports active recall (canvas, or linear notebook + Anki).
There’s no universally right answer. There’s a right answer for the task you’re actually doing, and the failure mode is using one tool for everything.
What this comes down to
Most students pick a note-taking app at the beginning of M1 and live with it for four years. The pick is usually based on what their friends use, which is usually based on what their friends used, and so on back to roughly 2017 when Notability was the only serious option.
The landscape has changed. The serious options now include linear notebooks with AI search (GoodNotes 6), knowledge graphs with strong linking (Notion, Obsidian), and infinite canvas tools (Fluera, others) that didn’t exist as a category until recently. The right tool depends on what task you’re actually trying to solve, and most students never explicitly ask themselves which task that is.
Ask the question. Pick the tool that fits the answer. Reconsider after a year. Notes are infrastructure — use the infrastructure that matches the work you’re doing.