The path to practicing as a physician is filled with exams, from the Medical College Admissions Test to Step 3 of the medical licensing boards. They can be challenging hurdles to surpass, so it’s no wonder that these exams fill so many students with dread. If you are experiencing test-taking anxiety about any of these long multiple-choice exams, there are plenty of strategies that can help. 

Implement Individual Lifestyle Changes

You likely already know that common anxiety reduction habits and behaviors revolve around healthy lifestyle practices, such as regular aerobic exercise, healthy meals and snacks, and a consistent sleep schedule. If you are already following these suggestions or can easily implement all of them at once, that’s great!

Work on one habit at a time. By implementing one change at a time, you make the broad goal of a healthier lifestyle forming particular habits that are most helpful for you on a daily basis!

However, drastic lifestyle changes can be incredibly difficult for many people: not everyone can turn ingrained habits around in just a day. If that reality resonates with you, you can work on one habit at a time. During your first few days, you might commit to starting an exercise routine by walking for forty minutes a day. The following days, you may focus on incorporating more fruits, vegetables, nuts, and fish into your diet than you usually eat. By implementing one change at a time, you make the broad goal of a “healthier lifestyle” more achievable and allow yourself to notice the particular habits that are most helpful for you on a daily basis.

Create a Plan

In addition to lifestyle changes, you need to work on the root cause of the anxiety: the exam itself. Check out our blog post on optimizing the stress/anxiety curve. It is essential to develop a comprehensive plan for how you will approach the exam. In order to break that vague, momentous first step into smaller, achievable tasks, start by writing down a prospective list of what you need to do in the coming weeks and months in order to feel confident and prepared on Test Day. For example, a student studying for Step 1 might:

• Complete a UWorld question bank twice
• Learn from six practice tests
• Learn the First Aid textbook

Then, that student would break up the:

• UWorld question bank into a certain number of questions
• Six practice tests into six days of studying
• First Aid textbook into a certain number of chapters

Next, retrospectively plan. Starting from your scheduled test date, move backwards and assign your individual tasks to individual days. Many students find it helpful to be granular and, for example, assign a certain number of First Aid pages and question bank questions for each day.

Once you have developed this comprehensive plan, evaluate whether it is feasible. Try comparing your schedule with classmates, friends, tutors, or online examples, especially right after you’ve created the first draft. However, the best way to know if your schedule fits your needs is to give it a try! Because you took the time to be so detail-oriented and plan it out day by day, you’ll learn whether the schedule works for you within the first few days of using it, and you can adjust it accordingly as you go along.

Now, you might be wondering if you’ve been tricked into studying, rather than getting tips on managing test anxiety, but study plans can do just that. First of all, it provides a tangible reassurance that you CAN conquer such a tough exam. Whenever you find yourself doubting your overall abilities, remember that you’ve already made yourself a roadmap for test day success. As you study each day, you don’t need to worry about whether you are reading the recommended number of chapters or finishing as many questions as your friends; justo do your best to accomplish the tasks you have already laid out for yourself.  

Focus on Questions, Not Exams

During a long multiple choice exam such as Step 1, it is common for students to recall certain questions that confused them in prior blocks, or get increasingly anxious as they progress from block to block. But approaching each individual question with a fresh perspective is essential! If you’re confused by the first of forty questions, don’t let that one question make you feel stressed during the entire block. For each question, spend a pretending that it is the only question that exists, and do your best to complete it. If you utilize this approach during practice exams, you’ll find it much easier to stay calm and focused as you take the actual exam, question by question.

If you’re confused by the first of forty questions, don’t let that one question make you feel stressed during the entire block.

Practice Testing Conditions

Take all of your practice tests under actual testing conditions. For Step 1 or Step 2 practice tests, this involves giving yourself precisely the amount of break time that the NBME permits on test day, and only eating, drinking, or using the restroom during this scheduled break time. Limit yourself to one page of scrap paper and refrain from looking at answers or checking your email in-between blocks. By practicing these logistical details, you can avoid unnecessary distractions during the actual exam. Then, the test day process will be more familiar, and hopefully less nerve-wracking. Check out on post on ways to use practice tests in your study plan. 

Practice tests are also key opportunities to acclimate yourself with testing anxiety. Act like it is an actual exam. You’ll probably naturally feel some anxious nerves spring up, but this is actually a good thing: you now get to practice focusing on question stems and narrowing down answer choices even when your mind is distracted by stress. With practice, students can mold anxiety into a motivational tool to hone in on important details in question stems, and maintain alertness to all possible answer choices. You may even get those nerves to quiet down to manageable butterflies during the real exam. 

Develop Testing Habits

Try different anxiety-reducing techniques or behaviors during your practice tests and incorporate your favorite tips on test day. Here are a few examples:

1) Alter your breathing in specific ways. Breathing from your diaphragm and prolonging exhalations can reduce anxiety. However, just “taking deep breaths” and prolonging inhalations is not always helpful. Different timing and patterns can make a world of difference. Practice different breathing techniques to discover what works best for you.

2) Highlight key clues as you go through the question stem. This helps you stay engaged and focused as you read each sentence.

3) Close your eyes, put your head down, or write “try your best” on your paper if you feel very overwhelmed. Taking a moment to disengage and restart a question with renewed vigor can be very worthwhile!  

As you implement these suggestions, don’t expect to be perfect at adopting these changes all at once! Give yourself grace as you adapt over time and stay connected to your social and medical networks of support as you go through the process.