Dealing With Test Anxiety During Medical School

Tips to Combat Test Anxiety in Medical School

Test anxiety in medical school is probably the single most common problem students report to me, and it can be a real bear to deal with. If you have testing anxiety, you know how disheartening it can be: You’ve put in hours and hours on topic review, you’ve done practice question after practice question, and then suddenly you take a practice test and all that hard-earned knowledge is buried under a slab of nerves. It sucks, and let me tell you – I have been there. 

Before we get into a specific discussion on techniques you can use to reduce stress, let’s talk about an important fact: low levels of stress contribute to memory formation both on a neurobiological level (we can visualize increased synaptic connectivity in brain regions associated with memory consolidation) and on a practical level (we can see better results from students who memorize in the context of low-levels stressors)., Importantly, higher levels of stress actively detract from memory formation. 

We’ve also seen that surface-level learning is often associated with fear-based motivation: “I can’t score low on this test or I’ll fail!” Deeper learning is more often associated with intrinsic motivation and a desire to learn the material rather than a fear of not learning it. Medical students skew strongly towards surface learning, which is detrimental to their knowledge. 

What does this mean for you? Well, there are few practical changes to your studying that we recommend you make because of these data because let’s be honest, most of us are stressed out enough while we’re studying that we don’t need to add any more in the interest of improving memory. I’ve used all of the following techniques with my students at some point in time to help coach them through test anxiety in medical school. Everyone will resonate more with some techniques than with others, so it’s worth trying a number of them out until you find what works for you:

1. Try the “Skip 10” Approach.

When going through 40- or 50-question test blocks or practice tests, start with question 11 on each section, go through to 40, and then finish out with the remaining 10. Of course this doesn’t change the number of questions you actually need to finish, but if you start on question 11 it can trick the anxious parts of your brain into thinking “oh, this is great! We’ve got so much time and only 30 questions. No need to stress out.” By the time you circle back to question 1 you’re close enough to the end that it similarly seems manageable.

2. Skip Questions

When you see an enormous question stem in a topic you’re not too confident about, skip it to come back later. This accomplishes two goals: First, you won’t waste time that you could be spending on questions that are more in your wheelhouse. Second, you won’t spend several minutes drilling yourself into an anxiety hole as your brain says “ahhh! I don’t know this! Do I even know anything?”

3. Remind yourself of the good stuff

At the end of every day write down at least three cool things you’ve learned during studying. These don’t have to be high yield; the point is that they’re a reminder that test stress aside, there are presumably still things you like about this field.

*This can absolutely be expanded to other situations where you experience test anxiety in medical school as well as your life!

4. Remind yourself that your test stress may be helping you remember things

This is not to say that test stress is fun, but I’ve found that it’s helped some students frame their stress in a more benign way. This can help you feel like you have power over your anxiety, rather than it having all the power over you.

5. Speak with your primary care provider or other medical provider about propranolol or another beta blocker.

These medications are often prescribed in low doses (generally 10mg PRN) for phobias like a fear of public speaking, as they reduce the autonomic activation like tachycardia that signal to your body that it’s stressed out.

If you find that your anxiety extends beyond just the domain of test-taking, speak with your primary care provider or other medical provider about an SSRI or a similar medication to reduce anxiety. There is no shame in admitting that you have anxiety (or depression) that’s interfering with your life, your schoolwork, both, or more; it’s all too common in our medical community. (And if you’re feeling too overwhelmed or like your anxiety is depression is reaching a breaking point, please reach out to the SAMHSA national hotline or local mental health support for help!)

Joëls M, Pu Z, Wiegert O, Oitzl MS, Krugers HJ. Learning under stress: how does it work?. Trends in cognitive sciences. 2006 Apr 1;10(4):152-8.

Friedlander MJ, Andrews L, Armstrong EG, Aschenbrenner C, Kass JS, Ogden P, Schwartzstein R, Viggiano TR. What can medical education learn from the neurobiology of learning?. Academic Medicine. 2011 Apr 1;86(4):415-20.

Cazakoff BN, Howland JG. Acute stress disrupts paired pulse facilitation and long‐term potentiation in rat dorsal hippocampus through activation of glucocorticoid receptors. Hippocampus. 2010 Dec;20(12):1327-31.

Papinczak T, Young L, Groves M, Haynes M. Effects of a metacognitive intervention on students’ approaches to learning and self-efficacy in a first year medical course. Advances in Health Sciences Education. 2008 May 1;13(2):213-32.