How Do You Handle Pre-examination Stress?

Question
I often panic before an exam because I am so worried about my performance. This makes it even harder to do well. What should I do?


Response from Sohil H. Patel, MD
Sohil H. Patel, MD, Intern, St. Vincent's Hospital, New York, NY


There is an obvious answer to this question: prepare well for the examination. But of course, it is hard to find anyone who would actually claim to be well prepared in the days before an exam. This is particularly true for exams that encompass a vast amount of information. No student knows every detail about the topic being tested. That is why it may always seem like you need more time to study, and why you never feel fully prepared.

The examinations themselves can generate anxiety as well, whether because of the time limits for finishing or perhaps because of an oral performance component. Of course, no two people handle stress in the same way, but here are some things that helped me.

The first step in destressing involves gaining some perspective. Having been in the clinical setting for a few years now, I have been exposed to life and death situations that legitimately stress people out. Given those experiences, I now find it hard to believe that I ever stressed out over my medical school examinations to the extent that I did.
In fact, I remember developing a different (and more healthy) attitude toward studying and exams after I started my clinical rotations, which made me realize just how insulating the pre-clinical years can be. So, if you are a first- or second-year medical student, shadowing a physician in the hospital might help put your exams in proper perspective.

Another way to gain perspective is to remember why you chose to attend medical school (hopefully, doing well on medical school examinations was not the reason). Studying really should be viewed as a means to a much larger goal than just passing a test. Exams should never be treated as ends in themselves. They are really just little check marks of approval on your way to becoming a physician -- nothing more.

Certain study techniques may also be effective in reducing your stress level. Cramming facts into your brain at random is not effective; if your mind goes blank during an exam, you won't have any broader framework on which to anchor your thoughts. Before memorizing details, I always tried to build a framework.
Take pulmonology, for example. Instead of learning pulmonary diseases at random, learn the basic categories of disease (eg, obstructive, restrictive), then learn the common features within each category, and finally, fill in the categories with particular diseases. This way, if the answer to an examination question is not immediately obvious, you have a systematic way of proceeding and narrowing your choices.

Another helpful method, particularly for oral exams involving standardized patients, is to develop routine practices. Before the exam, run through common scenarios or complaints you might encounter and think of the basic steps you should always take in those scenarios. Do this a few times so that, if a similar situation is encountered in the exam, your brain can run on auto-pilot as you follow through with your prepared steps.
Of course, there are many ways to address the stress itself, and what works for one person may not work for another.

For me, it seemed to help if I stuck with my workout schedule regardless of how close I was to an examination; this helped me set aside some time when I was not thinking about the exam. I also had the peculiar habit of taking a shower if I thought I was getting overly stressed out and I needed a break. But these methods vary for everyone. In general, it is probably a good policy to keep your life as close to normal as possible before an exam. This avoids giving the examination undue significance.

Finally, it is important to be confident. Medicine is not the single most complicated field of study, and most minds are similarly suited to learning it (unlike, perhaps, philosophy or some other fields that some people seem more inherently suited for than others). It means that there is a good correlation between how much effort a person puts into learning medicine and how well that person masters the subject.

It is less a matter of "getting it" and more a matter of "knowing it," and almost anyone can learn the material with a certain amount of effort. So, work hard and take confidence that your honest effort will pay off!

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