April 13, 2018
Written by Dr Yashant Aswani
How often are you unable to have a sound sleep the night before the exam, when was it last that you felt palpitations and got drenched by sweating on your test day, do you recollect the feeling when you turn blank while writing the exam in spite of working hard, is the exam fear controlling your life…well, if you have ever experienced any of these, read on.
Your USMLE block time starts now. 59: 59, 59: 58, 59: 57…and as you see the time clock ticking backward, questions with a long stem and numerous options, questions with a trap- you are likely to panic. The harsh reality is it is still the first block and there will be a couple of more blocks with a similar level of difficulty. Losing your calm mists your reasoning and judgment in an exam that tests you heavily on decision-making potential. And then you start reading the question and options over and over while the time bar is growing shorter and shorter. A poor recall of even easy and basic pieces of information becomes a necessary accompaniment. Finally comes a point when you assume a particular option to be correct simply because it ‘just appears good’ without any logic or scientific rationale marking the point of a deadly handshake when the exam has taken full control over you. If you are not mentally prepared, each block that passes or for that matter each exam that you take or have been taking reinforces the phobic response. All the hard work, in essence, goes waste. Some of us resort to tackling the phobic response pharmacologically but the question is until how long?
Gradual and repeated exposures to the phobic stimulus help modify your response to situations that you fear. Over time you learn to better manage your reactions, thoughts and even feelings and sensations. Anxiety and fear are then no longer in control of your life. Further, relaxation in the form of deep breathing adds to the benefit.
So the key question is how to integrate solutions from Psychiatry into our schedules to ward-off the fear factor. Fortunately, the answer is simple- taking practice tests frequently…well, what I meant was taking timed tests frequently and if possible daily. Solving questions on a non-timed mode prevents you from assessing your speed and ability to recall. Moreover, you do not experience the pressure of a real-time exam and hence this technique is a big ‘No-No’.
Remember the more you practice timed tests (repeated exposures), the lesser is your stress level (response modification) and better you score. Each time you take a test, incorporate it as a habit to see the timer frequently, try to read fast and preferably only once but not at the cost of comprehension, learn to skip and mark a question for later rather than lingering on, refrain from sipping your tea or coffee while taking a test (because beverages are not allowed in the exam room), focus on the current block rather than a question you probably marked wrong in the previous block- all in a fixed time slot of 60 minutes. The first time you get this tough on yourself, you might feel like running away but hold on…the first time you ever rode your bicycle…or the first time you did bungee jumping and later you could master your fear. Gradually, you can increase the number of USMLE blocks/practice test you solve each day. Solving the blocks back to back helps train oneself to think coherently in cases of fatigue as well as planning the interim break-time. If you do this repeatedly, the real exam day will no more be a phobic stimulus and you would be much more relaxed.
After all, this exam is all about preparing future physicians who would remain calm even during periods of stress and manage patients effectively.
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