Overcoming Testing Anxiety — Setting Systems (not goals)
The dreaded board exams. From day one of medical school, we are told (or warned rather) that school is going to be tough. “Drinking water from a fire hydrant” is what I remember one of my professors telling my class. There is so much we learn in so little time — from micro to pharmacology to pathology to reading CT scans, there is really never a moment in the first two years of medical school where there isn’t something more you could be learning.
Everyone comes up with a unique way to tackle this information with one goal in mind: to score well on the USMLE Step 1, Comlex Level 1, or both. We ask for advice from upperclassmen and we read reddit blog posts, and it seems like every student swears by their method to success, so we pick one and follow it hoping to follow in their footsteps. We set a goal and for two years we work towards it. We trust it’s fool proof.
My plan of action during the first two years was to tackle each exam as it came so I could have time to workout, socialize, and explore the new city I had just moved to. My school had an exam every two weeks, so I decided to focus on the information that was only pertinent to that exam instead of studying for boards as well. I was pretty content with my scores, so when spring break of my 2nd year came along, I was confident about my study plan going into my dedicated boards study time.
…until I failed my first NBME practice exam.
I was shocked. I felt so defeated because I thought I knew so much more than what my score portrayed. I thought my score essentially meant I knew nothing, so I decided to start from scratch and did what every med student does when they want advice but don’t want to seem vulnerable…I searched reddit.
Now, I have come to the conclusion that reddit can be a very inspiring and motivating place, IF and ONLY IF I have the right mindset going in. If I go in looking for suggestions and ideas, I can come out with some pretty great insight. The problem is most of us search reddit when we are at a point of desperation, looking for answers, support and solutions, and unfortunately there are just not as many people sharing their struggles as there are sharing their triumphs.
I came out of that reddit search aiming for a new target goal score, a more “realistic” score. I took a deep breath, wiped my tears, and started studying with full force again the next morning. A week went by and I was feeling super confident with my strategy
…until I failed my second NBME practice exam.
This brought me down to the lowest point I have ever been in medical school. Passing these exams felt impossible, and I began to assess my self worth according to the scores I was getting…so I felt pretty worthless.
A million thoughts ran through my mind..should I postpone my exams? Can I even get into residency? What happens if I fail? Has everything I’ve worked for been for nothing? Why can’t I make progress when it feels like all of my friends are? These thoughts became so overwhelming that every time I sat down to study I wasn’t even learning because all I could think about is whether or not I was getting the question right.
I decided to take the weekend off and reassess my approach come Monday. I had been dying to read the book Atomic Habits by James Clear after one of my favorite YouTubers EVER Rowena Tsai recommended it on her channel, so I dove into it that weekend. What I thought would be a little light reading ended up changing my entire approach, and more importantly, my entire mindset regarding standardized exams. All of the quotes below are from Atomic Habits by James Clear.
Here is how I overcame my testing anxiety –
Realizing “[we] don’t rise to the level of our goals, [we] fall to the level of [our] systems.”– Atomic Habits by James Clear
“A goal is a result you want to achieve, a system is a process that leads to those results.” In this case, my goal was to hit my target score, and the system I had implemented was reading through First Aid, watching Sketchy and B&B videos, and doing UWorld practice questions. However, every question I attempted was a source of anxiety for me because I was so preoccupied with getting the answer right and hitting my target score than I was with learning from the question. Moreover, as much as I appreciate UWorld, the constant reminder of the proportion of students who got the correct answer fueled my anxiety even more. My mind was set on rising to reach my goal, while in the meantime my actions were incongruent with the system I had set in place.
“The purpose of setting goals is to win the game. The purpose of building systems is to continue playing the game. True long-term thinking is goal-less thinking. It’s not about any single accomplishment. It is about the cycle of endless refinement and continuous improvement. Ultimately, it is your commitment to the process that will determine your progress.”
This really hit home for me. Medical students are overachievers by nature, but we never seem to be content with our own achievements. We tell ourselves we will be happy when we accomplish something…a high GPA, a high MCAT score, getting into medical school, scoring high on STEP1/Comlex, get into our dream residency..the list is never ending. I had put so much weight on the outcome of these exams that it became too much for me to handle the uncertainty. So, I decided to trust in myself and shift my focus to completing my daily tasks to the best of my ability, rather than expecting my effort to correlate to a numerical score. I stopped aiming for a particular % correct, and shifted my mindset to learning from each and every question I came across. Some people work very well with a disciplined and rigid schedule, but I found that I worked best with flexible guidelines that helped me get through the day. Every day, I wanted to get better — and I defined better as:
- focusing on one task at a time, the task at hand, and being mindful of the task I was completing
- prioritizing 1 hour mindless (or mindful) rest every day
- moving for 15–30 minutes a day
- sleeping 7–8 hours
- forgiving myself for not being on top of my game 100% of the time
I made each of these tasks a part of my system and measured my success based on the number of days I was able to follow through. Some days I did all of the above, other days I did a few that felt good. Pretty soon I noticed by accomplishing all of the above, I was able to increase my focus and I found joy in studying again. I realized productivity was not about studying for 12+ hours a day, skipping meals and neglecting my sleep; it was about studying smarter during my most focused hours and leaving room to enjoy my day and recharge when I could. Over time, all the items on the list above became habitual.
“The effect of one-off experiences tends to fade away while the effect of habits gets reinforced with time, which means your habits contribute most of the evidence that shapes your identity. In this way, the process of building habits is actually the process of becoming yourself.”
Studying to reach a goal score meant too much was out of my control. I could not promise myself a score. What I could promise myself was persistence. “The most practical way to change who you are is to change what you do.” So every time I sat down to study, I sat down to learn with the idea that some day that knowledge might help my patients live to be who they want to be. I also found a repertoire of self care habits that helped me recharge, feel like myself, and stay present throughout the day.
“It is a simple two-step process:
- Decide the type of person you want to be.
- Prove it to yourself with small wins.”
…and that is exactly what I did. I worked for the small wins, and I celebrated my small wins. The early mornings, the extra practice questions, the quick workouts, the failures followed by positive affirmations…I celebrated all my small wins. And so did my loved ones who saw me struggle through. Board exam studying (and med school in general) can feel isolating, but just because you feel lonely does not mean you are alone. You are never alone. That is the purpose of this post and this blog as a whole — to highlight the journey and the struggles and use it to uncover the beauty that is in medicine.
If you’re looking for a light, but life-changing read, I highly recommend Atomic Habits by James Clear. Medical School is an investment. It is a financial investment, but more importantly it’s an investment in ourselves. Choose who you want to be, and what habits you want to follow. Your habits, and not some one-off score, will dictate the kind of student you will be, and what kind of doctor you will be. Set your habits and work towards them every day, and you will reap the rewards. Consistent dedication to my habits allowed me to meet and exceed my target scores. When I got my score reports, I couldn’t help but feel that my scores were a reflection of the times I pushed through and stuck to my system, rather than a measure of my medical knowledge. So with that, you will get through this and you will be great.
Well…thanks for making it through to the end!
Much love,
Spandana
