As med students, you’re entering new territory when it comes to high-stakes exams. The days of retaking exams for a higher score are behind you, and the pressure to pass your USMLE and shelf exams on the first try can sometimes be overwhelming! Here’s some advice from psychology expert and guest author Joeseph Buonanno.
Performance Pressure
In “My Cousin Vinny,” Joe Pesci plays a lawyer trying to free two innocent young men accused of murder. It’s his first case, and—to say the least—it’s not going well. If he can’t get them acquitted, the boys will get the death penalty.
He’s under enormous pressure when his fiancee (Marisa Tomei) reminds him he promised they would get married after he won his first case. But she’s starting to think that won’t happen.
Vinny can’t take the pressure anymore, and goes into an epic rant, asking what else besides the lives of the two young men, his career, and their relationship could come down to the outcome of the case?
After looking at Pesci for a moment, Tomei—with perfect comedic timing—says maybe it was a bad time to bring it up, and lets the matter drop.
I mention the scene because it’s a great example of what’s called performance pressure, which is the anxiety people feel when there’s a lot riding on the outcome of a particular task. It’s commonly experienced by anyone for whom a single bad performance can have real consequences.
In Medical School
As medical students, you know what performance pressure is all about, especially when it comes to studying for high-stakes exams like Step 1 or Step 2 CK. Of course, doing well on Step exams is easier said than done, especially if you get stressed out and can’t focus on studying! To make sure your mind stays sharp while preparing for your exam, we’ll show you how to attack performance pressure in two ways.
First, how to prevent it by adopting a long-term plan that’ll help you remember what you’re studying despite the stress you’re under. This approach—rooted in cognitive science—is much better for your long-term retention than cramming (which may have worked in undergrad, but this is a whole new ball game now!)
Second, we’ll give you some tips on how to handle anxiety if you do develop it during your preparation for Step exams. The good news is that anxiety is among the most treatable psychiatric conditions, so if it does arise, there are things you can do about it.
To put our discussion in the right context, let’s begin with a bit of information about how stress impacts memory. As we’ll see, a little stress when it comes to your USMLE prep isn’t such a terrible thing!
How Stress Impacts Memory
For intellectually demanding tasks (like preparing for Step exams) there’s a sweet spot when it comes to stress and performance. It’s good to have some stress (as this motivates you to focus), but not too much, as that’ll have a negative impact on your memory.
The relationship between stress and performance can be seen in the well-known Yerkes-Dodson curve:
Although the curve is based on older data, modern research shows that a moderate, controllable level of stress benefits cognitive performance.
The bottom line is it’s alright to have some stress as you prepare for Step exams. For med students preparing for the USMLEs, just knowing how important the exams are probably provides you with the right amount of it. Especially if you feel like you’re in control of the preparation process!
A great way to give yourself that sense of control is to adopt a long-term strategy that’ll help you get ready for exam day. Here’s an approach that’ll put you in the driver’s seat when it comes to preparing for the USMLEs.
A Long-Term Strategy to Prepare for the USMLEs
As future doctors, you no doubt appreciate Ben Franklin’s adage “An ounce of prevention is worth a pound of cure.” This logic applies to performance pressure as well. We’re going to review some strategies that’ll give you a sense of control, and hopefully reduce the amount of stress you feel as you prepare for your first USMLE.
To put yourself in control of your USMLE prep, we recommend the following:
#1) Start early.
This is obvious, but it’s also probably the best thing you can do to prevent USMLE-related stress from getting out of control. It just takes a lot of the pressure off. The earlier you start, the less you’ll have to review each day/week/month leading up to your Step exam.
According to the American Medical Association, it’s best to start studying 12 months before your exam. A good way to get started is taking a baseline practice exam, so you can see where your strengths and weaknesses are.
If you struggle with procrastination, check out this blog post. (Or get around to it later if you don’t feel like it!)
#2) Create a study schedule.
The earlier you start your exam prep, the sooner you can set up a study schedule. Blueprint’s Med School Study Planner is free, lets you create a personalized study schedule using your choice of materials, schedule in time off, and rebalance the schedule if life interferes with your studying. Which, of course, it inevitably will!
#3) Use techniques proven to boost your memory.
You may have been able to cram your way through all the intro to whatever courses you took in college, but your days of cramming for your art history midterm are behind you! You’ll want to build a base of knowledge throughout your time in medical school, and avoid the pressure that comes with cramming for career-defining exams.
So how do you make sure you’re retaining information, despite any normal USMLE-related pressure you may be experiencing? Let cognitive science be your guide, and do what works!
Here are some techniques proven to improve your memory:
Spaced Repetition
This is a big one, and many study tools like Anki incorporate it. The basic idea is that as you learn material, you review it at increasing intervals of time. This means you end up refreshing your memory for things before you’d normally forget them. Every time you do that, it becomes less and less likely they’ll be forgotten!
Retrieval Practice
This is trying to recall what you’re learning, instead of just recognizing it. For example, as you’re doing flashcards, try to remember what’s on the other side of the card, instead of just turning it around and reading it. You want to get to the point where you can recall the material instead of just recognizing it when you see it.
Another good example of retrieval practice is self-testing. Quiz yourself on topics you’re having trouble with to make sure you can remember the material on your own, without any assistance.
Method of Loci
Also known as the memory palace technique, this is an ancient and highly effective mnemonic in which you connect things you need to remember to a place you’re familiar with (i.e., your bedroom). For example, is there a list of things you need to memorize? Connect each item to a different location in your room. Then imagine you’re in the room and ask yourself what was on the dresser, the bed, etc.
Here’s a study in which the Method of Loci was used to help medical students learn endocrinology!
Reading Out Loud
It may make you feel silly, but this really does work. Reading out loud will help you remember what you’re studying and build a base of knowledge.
#4) Use techniques that boost memory and comprehension.
Especially in medicine, it’s incredibly important to truly understand the material and draw connections among pieces of knowledge instead of simply memorizing facts. When trying to develop expertise, it’s better to comprehend the material, rather than just memorize it.
Here are some techniques that can help you understand what you’re studying, as opposed to simply memorizing it:
Elaboration Techniques
This is a broad category of learning strategies that involves connecting new information to information you already have stored in memory.
Examples of elaboration include:
1. Self-Explanation
This type of elaboration occurs when you put something you’re learning into your own words, or explain something new by pointing out how it connects with something you already know. Work at doing these things while you’re studying. When you’re making notes, rephrase things so they’re in your own words. Go out of your way to see if what you’re learning connects with something you already have filed away in memory.
Comparing two things by way of metaphor or analogy can be a form of self-explanation. If you can, make explicit connections between something you know (the base) and what you’re learning (the target).
2. Elaborative Interrogation
You can do this by asking yourself how and why questions that require you to find explanations. For example, “How are type 1 and type 2 diabetes different from each other? Or “Why does someone get type 2 diabetes?”
3. Elaborative Discussion
Going over a topic with other students improves the retention and comprehension of new material. This is true even for students that don’t understand the subject going into the discussion.
4. Learning By Teaching
Teaching a topic can actually help you understand it much better. Are you having trouble with something in particular? Prepare a talk on it. Invite your friends, and be ready for some tough questions. They will highlight what you’re missing, so you can fill in the gaps in your knowledge.
5. Dual Coding
This is another elaboration technique that’s been proven to help medical students. To use it, combine words with some visual representation, such as pictures, diagrams, graphs, etc. The aim is to provide both a verbal and a visual representation of the material. To be effective, the visuals should be meaningful and you need to give yourself enough time to integrate the words and images.
A great way to do this is by creating a concept map, which is a visual representation of ideas and the relationships they have to one another.
Interleaving
Interleaving (or mixed practice) involves studying multiple related topics at the same time, rather than sequentially. This means not waiting until you’ve mastered one topic before moving to the next. It’s great for improving your understanding of similar concepts.
So, how does it work? Let’s say you have three brain-related subjects you’re studying during the week, A, B, and C. Instead of mastering A, then moving to B, and then to C, plan study sessions in which you spend an equal amount of time on all three (ABC). If you want, you can make the next session BCA, then the next CAB, and so on. The sessions should be short, but repeated periodically until the material is mastered.
This method is not only superior to massed practice (study A for a long time, B for a long time, C for a long time), it’ll foster deeper comprehension because it forces you to distinguish among similar but different ideas.
#5) Take mock exams.
You’ll want to do lots of practice questions throughout your prep period. But once you’ve managed to build up a base of knowledge, it’s time to start taking mock exams!
Be sure to take some full-length exams under conditions similar to what you’ll experience on exam day. This includes setting a time limit for each question block like you’ll have at the testing center. Some of our experts even suggest starting practice question blocks a few minutes late, so you’ll get some experience working under time pressure if that happens on exam day.
Looking for a Qbank to help out with USMLE studying this year? Blueprint has got you covered with practice questions, detailed explanations, performance analytics, and more! 💙
🌟 Step 1 Practice Bundle – Includes 2 full-length USMLE practice exams with a total of 560 NBME®-formatted practice questions, plus 500 additional questions in a Qbank
🌟 Step 2 & Shelf Exams Qbank – Includes 5,500+ practice questions (1,500 Step 2 questions and 4,000 shelf questions across 8 specialties), plus 8 mock shelf exams!
#6) Have fun!
You need to have a life outside of your USMLE prep. Keep up with your family, friends, and don’t ignore your hobbies. Taking days off is a must. If that means some days or weeks you can’t do a lot of USMLE prep, so be it. If you started early, it won’t be that big of a deal. When you’re ready to get back to it, you can easily reset your free Blueprint Med School Study Planner and set up a new schedule.
How to Manage Anxiety When it Arises
Prevention may be worth a pound of cure, but what should you do if despite setting up a long-term plan to prevent or minimize USMLE anxiety, you develop it anyway? As we mentioned in the beginning, the good news is that anxiety is almost always treatable. And many medical schools have people on staff who can help you with any USMLE-related stress you’re dealing with. Anxiety is unfortunately common among medical students, so they’ve treated many people in your situation before. They can help. Don’t hesitate to reach out to them.
Seeking assistance doesn’t mean going into psychotherapy per se, but if you decide therapy is the right option for you, cognitive-behavioral therapy and psychodynamic psychotherapy are proven to reduce anxiety symptoms.
Final Thoughts
Some performance pressure related to your USMLE exams is inevitable, but as we’ve seen, that’s not necessarily a bad thing! It’s important to stay in the sweet spot though, and not let anxiety derail your preparation.
Follow these steps, use prep techniques that are proven to work, and you’ll boost your memory while reducing stress. Good luck, and remember: you still get to have fun once in a while, even while in med school!
