For students with test stress, medical schools leave a void  

I’m writing this for my tribe of worriers and self-doubters, people for whom ever-present test stress is inextricable to the med school experience.  Sure, every medical student becomes preoccupied fretting over exams to some degree.  That’s part of what you sign up for.  But our preoccupation is something greater than that—it towers over us and bullies us.  It makes us cower in the corner, begging to be spared from harm.

We’re the chronic re-readers—no sooner do we reach the end of a paragraph then, sigh, we need to read it all over again.  We’re the obsessive note-takers—showing up to class early to grab that one, perfect seat in the lecture hall, scribbling furiously, terrified of missing the point that will be on the upcoming test.  Rather than focus on one or two study resources, we’re the ones who obsess over review books, routinely acquiring more than we can possibly use.  As though the very act of getting our hands on another book will confer upon us the certainty we seek.

We’re the ones trying to hide how envious we are of the naturally gifted test takers.  And in medical school and residency, there are plenty of them.

Despite the nearly twenty years that have passed, I still remember my first med school exam with flop sweat-inducing clarity.  If you gave me one word to sum up that experience, it would be dread.  I dreaded doing poorly.  I dreaded being thought of as dumb.  Most of all, I dreaded proving that I wasn’t as smart or as worthy of being a doctor as my peers.

For so long, I had aspired to get into medical school, and I was comfortable identifying with that goal.  Maybe I’d get in, maybe I wouldn’t—but I’d give it my level best and see what happened.  That identity was comfortable for me.

But when I actually got to medical school, and especially when I started to get to know my new classmates, I immediately felt like … an imposter.

My inner critic kept telling me the admissions office had obviously made a mistake letting me in—that I didn’t deserve to be there.  And I was terrified of being found out.

As a result, my first med school exam took on a life of its own.  For me, it wasn’t just a test.  It was an adversary that threatened my wellbeing.

Even when I would have good moments during lectures or small-groups, my insecurities were off in the next room doing push-ups.  Invariably, they would show up every time I sat down to study, fueling intrusive thoughts that distracted me incessantly.

Pain is an unavoidable part of the medical school experience, especially when it comes to exams.  That’s not necessarily a bad thing.  Every med student is either introduced to or re-acquainted with the pains of sacrifice, discipline, rigor, standards, and expectations.  These virtues constitute the crucible that melts away the layperson and reveals the doctor.  Pain is necessary.  But suffering isn’t.

And suffering as a result of all the exams one needs to do well on is most pronounced for those of us whose test stress fully emerges only after we’ve started medical school.  It catches us off guard.  We don’t know how to deal with it.

For students with test stress, the medical school curriculum leaves a void in our training.  It demands that we apply ourselves fully to preparing for every exam without teaching us how to develop the attributes needed to do so: psychological resilience, personality hardiness, mindfulness, and a willingness to find the humor in everything.

It’s hard to be overly critical of medical schools in this regard.  Between the sheer volume of information related to the basic and clinical sciences that must be covered and the number of naturally gifted test takers that make up each med school class, teaching how to overcome test stress doesn’t make the cut.

But that doesn’t mean you can’t learn these things.  You can, and, in fact, must.  For our tribe, skills, strategies, and techniques that allow us to overcome test stress aren’t a nice-to-have; they’re a need-to-have.

Here’s the good news: Learning these critical skills, strategies, and techniques are easier and less time-consuming than you think.

If you’re currently in med school or residency, find a mentor.  If the idea of talking to a professor or an attending about dealing with test stress makes you think yeeeaaahno, then find someone who has dealt with it successfully and gotten to where you want to go.

Here are three proven strategies:

1. Inhale the future, exhale the past. Want to break the surge of fight-or-flight biochemicals that greet you as soon as you sit down to crack the books?  Close your eyes and take 3-5 deep breaths, inhaling through your nose and exhaling through your mouth.  Make sure to exhale hard enough to make and audible sound.  Force the air across your hard palate.  This will activate the vagus nerve and recalibrate your hypothalamic-pituitary-adrenal axis.  Other controlled breath exercises like box breathing work great on exam day, too.

2. The brain loves color. One sure-fire way to lighten your mood is to draw with plenty of color.  Whether you’re a visual learner or not, when you start to feel yourself getting anxious during study time, use that as a cue to draw simple representations of the concepts you’re reviewing.  Make them silly and outrageous.  Think cartoons more than text-book diagrams.  Be sure to use a variety of colors—the brain loves color.  It will not only calm you down and make you feel more productive, but it will make what you’re studying easier to remember, too.

3. Get dramatic (in a good way).  Laughing at yourself is liberating, especially during stressful times, like studying for an exam.  Another way to short-circuit the fear spiral is to read out loud to yourself in a dramatic voice.  I mean full-on Shakespearean actor dramatic.  Be loud, ham it up.  Yes, you will sound insane (in fact, that’s the point!), so you may want to reserve this strategy for when there’s no one else around.  After a few minutes, you’ll feel more lighthearted and playful, and your mind will be primed to absorb the complex information you’re studying.

You’re not alone.  Find someone you trust who’s been where you are now and has had the success you want to achieve.  Learn from them and model them, and you’ll be amazed how quickly you can transform self-doubt into deep-seated confidence!

Steve Blatt is an ophthalmologist and founder, Face It and Ace It in 90 Days.

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