Dr. Brian Radvansky and Dr. David Delnegro contributed to this post.
At some point in our lives, we’ll feel anxious. It’s part of being human. The ability to think about the future gives us the power (or burden) to reflect upon what might happen. And—as survival instincts have led to our evolution over millions of years— we’re always prepared for the worst.
For medical students, that’s not always a bad thing. Some stress can actually help at times. It’s the little extra something that allows for the upper echelons of human performance, like getting a good score on the USMLEs.
We call this beneficial stress “eustress,” and juxtapose it against distress—the feeling that something is wrong, that we’re failing. Distress is especially destructive when it spirals, and becomes our primary focus. We wonder why we’re worrying, and this makes us worry more. And when 90% of your mind is dwelling on these negative feelings, there’s not much of it left to focus on things like how to do well on Step 1 or Step 2 CK.
So how can you manage USMLE test anxiety, focus your mind, and triumph on exam day? How can you avoid falling into the spiral of distress that can negatively impact your USMLE performance? Here are some tips from Blueprint tutors!
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4 Ways to Manage USMLE Anxiety on Exam Day
I can’t help but recall a certain memory when I think about the USMLEs. I remember sitting at the test center computer, with ear plugs tickling my tympanic membranes and the Prometric leaf blower style headphones on. A cardiology question involving heart sounds came up and all of a sudden, there I was, with my own heartbeat reverberating in my head. Everything became too loud, and I lost focus. Valuable time was lost thinking about thinking, outcomes, scores, residencies, and the time I was losing.
The following techniques (many of which are borrowed from cognitive-behavioral therapy) helped me collect myself during the exam:
1. Think of a stop sign.
Close your eyes for a moment and visualize the word “STOP” taking up your entire field of view. Take a breath, then think of something positive (success, puppies, the person you love most). Smile at the thought of the pleasantry, and when you’re ready, get back to work with a refocused mind.
2. Combat test anxiety with deep breathing.
Pump the brakes on all thinking related to the exam and direct the entirety of your focus to your breath. Take two or three long, deep breaths, taking about five seconds to inhale, and five seconds to exhale. Even if this “costs” you 30 seconds, finding your center and going to the next question with focus will be worth it.
3. Gather yourself.
It’s so easy to let the mind wander during dark times at the test center. It’s important not to fill your head with thoughts like “I need to not fail this test,” “I should have studied more,” or “Why can’t I do this?”
Negative self-talk is the enemy. Don’t try to answer questions with half of your mind on medicine and the other half on negative thoughts. You have to stop and gather yourself.
Besides deep breathing, another technique involves putting all of your negative thoughts into a tiny cardboard box in your mind, and throwing it out of your mind’s eye. Not only will this visualization help you overcome the thoughts, it’ll stop you from trying to answer questions with a compromised mind.
4. Use progressive muscle relaxation to focus on your test.
This is another great way to bring things to a halt and de-stress. Starting with your head and progressing inferiorly, violently tense every muscle in your body, then allow it to completely relax.
Flex your forehead, jaw, chest, arms, lumbricals, abdomen, buttocks, thighs, calves, toes, etc. You’ll be much more relaxed after you channel some of that stress into muscular action, and release it from your body.
5 Anxiety Management Techniques Before Exam Day
Of course, the best thing would be to avoid anxiety during the exam altogether. Here are five things you can do during your USMLE prep that (may) prevent exam anxiety from ever happening:
1. Remember the USMLE is an opportunity, not a hurdle.
Let’s start with a general reframing of the entire situation. If you put in the dogged effort required to do well, if you prepare with every ounce of energy, and if you’re confident you couldn’t have worked any harder to succeed, then your exam will be a chance to excel.
You’ve got to squelch the idea that the exam is a big, bad entity looking to destroy you. Instead, remind yourself the exam is an objective collection of questions, and it’s your job (and has been your job) to answer them, one by one.
2. Meditate.
Sit in total focus and allow thoughts, both good and bad, to float through your mind like clouds in the sky. By relaxing your mind and strengthening your focus in non-testing situations, you’ll be in a better spot during the test as well.
You needn’t be a reclusive yogi. Sitting for 10 minutes per day in distraction-free silence is a great place to start.
3. Emulate the USMLE testing environment.
It’s important that you do enough practice tests—both NBME practice tests and full-length mock exams—to mimic the thoughts, feelings, and stress of important testing situations. Regular question blocks are too easy to coast through. You need something you identify as important and different.
How many is enough? While it’s definitely a different number for everyone, Step 1 students should get through at least two or three NBMEs and one full-length practice test before the real deal. For Step 2, one or two NBMEs and the often forgotten full-length practice test should suffice.
For the real go-getter, you can purposely put yourself in a jam. Let 5-7 minutes tick off your Qbank block before beginning so you’re forced to work a little more quickly than usual and answer the last few questions with very limited time. That way, if it happens during the real test, you can have the positive thought, “I’ve been here before, and I know how to handle this situation.”
4. See a professional.
If you identify as someone who struggles with anxiety, there’s tremendous value in seeing a mental health professional who can help you build a framework for tackling any test-related stress.
Many medical schools have expert mental health services to help you in situations just like this. They’ve seen anxiety before and know how to help students cope. Therapy exists for a reason, and while it’s not something everyone is comfortable talking about, there’s absolutely no shame in getting help when you need it.
If it means a better score, more residency opportunities, and an improvement in other areas of your life, then you should absolutely see a professional. Many of our students have done this, and have seen tremendous improvements after getting their testing anxiety under control.
5. Go easy on your eyes (and brain) leading up to the exam.
Taking a USMLE exam means staring at a computer screen for over eight hours and racking your brain to recall trivial factoids you’ll never use in real life. All that while synthesizing answers based on complex physiology and pathology!
Any way you slice it, it’s not an exam (or day) you’ll look back on fondly.
Here’s what you should (and shouldn’t) do the day or two before the exam:
💡Don’t do a ton of studying.
💡 Do some basic review work on your trivia factoid flashcards, and then get out into the sun and exercise so you’re able to sleep the night before.
💡 Maybe do something fun with your loved ones and take some stress off!
💡 Minimize your screen time so that when it’s time to burn the USMLE software into your retinas, they’ve had a chance to rest.
Feeling better and a bit rested will go a long way in keeping your anxiety at a manageable level on test day.
Final Thoughts
To close, I want to remind you that you’re not alone. A recent study found that 22% of second-year medical students experienced moderate to extremely high test anxiety! Remember, everyone will experience anxiety. The difference comes in how you process it. Use some of the above techniques, make sure your preparation is as solid as possible, desire success more than you fear failure, and you’ll be on your way to your best score. Our Blueprint tutors wish you the best of luck!
