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Perhaps one of the most intimidating components of medical school’s curriculum is exam-taking. This could be the USMLE Board Exam or an exam for your courses. Regardless, the following are effective steps in mitigating anxiety and poor decision-making skills for exams.
Some nervousness is normal before an exam. In fact, moderate levels of anxiety have been found to be beneficial to exam performance. However, at very high levels, anxiety can impair your learning and negatively impact your exam performance. This high, deleterious level of anxiety is what will subsequently be referred to as test anxiety.
A great deal of test anxiety can be reduced with confidence in your exam preparation, so first make sure you are using effective learning techniques. Then try the strategies below, to help bring your test anxiety down to a manageable level. You will most likely need to utilize a combination of techniques, to combat both the cognitive (worry) and physiological components of test anxiety.
Prioritize self-care to prevent burnout. Get adequate sleep, exercise regularly, and maintain a healthy diet.
Learn relaxation techniques and practice one or more daily. We tend to perform in the manner we practice, so practicing these while you’re studying can help you utilize them more easily during an exam.
Study and socialize with people around whom you feel calm, rather than stressed.
Timeline of the Exam
Days Before the Exam
Study! Being well prepared is the most effective way to reduce test anxiety. If you routinely find yourself cramming for exams, begin to study further in advance to avoid procrastination.
If you worry about being able to finish an exam in time, do timed practice exams or sets of questions.
Put things into perspective.
Don't give a test the power to define you. An exam won't tell you whether you're brilliant or stupid and it can't predict your future success.
Remind yourself that your entire future doesn't depend on this exam. There will be other exams and other courses. Many students fail an exam or two but go on to graduate from ATSU and have successful careers.
Get a good night's sleep. With adequate sleep, your ability to think and to deal with anxiety will both improve. When you are sleep-deprived, your brain does not function as well, and you may not be able to recall information as quickly or easily.
Try to avoid talking with other students right before the exam because their anxieties may rub off on you. Instead, arrive a little early and take a walk as you give yourself a positive self- talk.
Day of, prior to the exam
Avoid review on the morning of the exam, especially within 60 minutes of exam time.
Eat a light, healthy breakfast.
Perhaps get a bit of aerobic exercise (e.g., brisk walk) to relieve stress and oxygenate your brain.
Avoid speaking with classmates if doing so may trigger anxiety.
Try journaling. Research (Ramirez and Beilock, 2011) has shown that habitually test-anxious students who spend just 10 minutes writing about their worries before an exam score higher than those who write about something else or who write nothing.
Visualize your success. Imagine yourself calmly and confidently completing the exam. Be specific. Create detailed pictures, actions, and even sounds as part of your success visualization.
During the Exam - Alleviate Anxiety
Eliminate or at least reduce distractions - Consider using ear plugs to reduce distractions. Do your best to tune out what other students are doing and don't worry if they finish early. Often, some of the worst exams are turned in early.
Take breaks, if allowed - Excuse yourself to go to the restroom, just to get up and out of the testing room. Take a quick walk and do some deep, belly breathing.
Do not try to figure your exam score as you go. Your estimate is not likely to be correct anyway, and it will waste time and mental energy.
Do not obsess about running out of time on the test. Check the time periodically (say after you've finished a third of the test), but avoid checking too frequently, as this will only distract you and make you more anxious.
During the Exam - Test-Taking Strategies
Preview the test - Begin by reading the directions and jotting down any formulas and memory devices you might forget.
To build your confidence, start with the easiest questions. Skip any that you are unsure about but do not flag them (red flags may have a negative connotation associated with them and therefore may increase anxiety).
Understand what the question is asking. The single most frequent error students make in a multiple-choice examination is to misread, and therefore misinterpret, the question. If possible, circle or underline key words that you need to answer the question. You can also skip straight to the question mark to see what the question is asking. This way you will pay attention to only the information that is required and not any irrelevant information.
Paraphrase the question stem by saying to yourself, "I see, I'm looking for...". If the stem provides enough direction, try to anticipate the answer, and then look for it.
Read all the choices and keep an open mind. Even when the first or second choice looks correct, don't simply read the other choices with the intent of dismissing them. Consider them carefully. Watch for “all of the above”!
Think of multiple choice as a series of true/false statements. When an exam gives you choices like “a and b”, “a, b and c”, “a and d” or “all of the above”, take each individual choice and determine whether the statement is true or false for that individual choice. Put a “t” by each statement that is true. Then count all the “t’s” and select the appropriate answer.
Many students can narrow their answers down to two choices and then have problems selecting the correct answer.
Look at each choice and try to determine the word or words that make the choices different. You can also try to put the response choices into your own words and try to answer the question by “matching” your answer with the closest related answer choice.
If two choices overlap or mean essentially the same thing, both are probably incorrect (unless there is a choice of all the above or both B & C).
Notice partner choices (two choices that are opposites or have a difference of one or two words). Often, the correct answer will be one of these options.
Go back and answer questions that you’ve skipped. Now that you have gone through the entire test and read each question, later questions may help you to answer earlier ones. For example, question #30 may trigger an answer to #2.
How to Approach Each Exam Item:
Read the question carefully
To prompt recall, cover the answer choices and then read the question stem carefully and thoroughly to determine exactly what the question is. For exam items with lengthy question stems (i.e., vignettes or detailed descriptions), find and read the actual question first. Then read the entire stem with the goal of answering that question.
Think Think about all that you know about the topic in question. Try to come up with the answer on your own BEFORE looking at the answer choices.
Select the best answer If you find your answer among the choices, go for it! But read all the answer choices first. Never pick an answer without first reading all the choices, no matter how sure you are.
If your answer is not among the answer choices, reread the stem again and think some more. Then, read each answer choice and ask yourself this question: Can I eliminate this option as the correct answer? Look for key words that make an option wrong. On each question, your goal is to narrow it down to no more than two (if you can't narrow it down to just two, skip it and come back later). Now, pick the option that most closely resembles the answer you came up.
How to Move Through the Exam:
1st pass – "easy" questions Make a quick first pass through the exam, answering all those you can with one reading of the question. Skip the others.
2nd pass – "harder" questions On the second pass, answer the items pertaining to topics you know something about. Reread the stem, break it down into parts, and ask yourself what you know about each piece of info given to trigger recall. Eliminate some distractors and reread the stem. Pick the option that best fits the info provided and answers the question. If you still don't know it, skip it again.
3rd pass – "guessing" On the third pass, answer all the remaining items, the ones you couldn't figure out before or know nothing about the topic. See some strategies for guessing below.
When guessing is your only alternative, here are some strategies which may help:
Pick the most general answer choice.
Pick the longest answer choice.
Avoid grammar disagreement – stem and correct answer should agree grammatically (singular vs plural, verb tense agreement, etc.).
Avoid absolutes (always, never, must, none, only, etc.); answer choices that permit exception (usually, generally, sometimes, often, etc.) are more often correct.
Funny or silly answer choices are usually wrong.
Regarding numeric answer choices, pick a middle of the range option.
Pick the answer choice that includes key words/phrases almost exactly as in the stem.
Be alert for answer choices that are identical in meaning (usually both incorrect), or opposite in meaning (often one is correct).
Trust your gut and go with your first instinct. If the stem and one answer choice just naturally flow smoothly together in your mind, follow your hunch.
Research has shown that changing answers on multiple-choice exams is generally beneficial; students who change answers usually change from wrong to right. Do change your answer if you have an epiphany and can prove to yourself that your first selection is incorrect. Also, go ahead and change your answer if you discover you've misread or misunderstood the question.
However, don't change an answer:
based on low self-confidence and second-guessing (you need evidence on which to base your second selection, not just a feeling),
due to over-thinking (take the question at face value),
or, if you have truly guessed.
Other Things to Consider:
Do not allow yourself to "read into" a question. The question stem sets the task. Take the most literal, obvious meaning of the question. Try to avoid imagining detailed scenarios in which each answer choice could be true.
Manage your time. Set a timer for the half-way point. When it dings, you should have answered at least half the items. If you haven't, pick up your pace.
Day(s) before the exam
Anxiety and feeling overwhelmed often go hand in hand. To reduce your feeling of overwhelm, make a study plan, and stick to it. Prioritize your material to be reviewed and then plan to tackle it one chunk at a time. Try setting time limits for your blocks of study and work on the most important material first, so that if you run out of time, you'll have utilized your time most efficiently. If you start feeling anxious during study, practice relaxation, counteract worrisome thoughts with positive coping statements (e.g., “I can feel anxious and think at the same time”, “I can get through this”, “If I breathe deeply, I can keep my mind on the task”), and then re-focus on your present task.
Get at least 30 minutes of exercise on most days, especially if you have an upcoming exam. Exercise is highly effective at reducing anxiety, so it’s worth it to reduce your study time by 30 minutes to get in some physical activity.
Get adequate sleep, at least 6 hours the night before an exam. Even if you have trouble sleeping, at least lie down and do some deep abdominal breathing. Do not continue studying! You’ll do yourself more harm than good with more study in lieu of adequate rest.
During the exam
Utilize good general test-taking strategies, and multiple-choice question strategies, if pertinent.
Use shortened versions of the relaxation techniques you’ve been practicing (i.e., abdominal breathing, muscle relaxation, visualization) to respond to physical sensations of anxiety.
Test anxiety tends to escalate as a student’s focus shifts away from the actual exam questions to a negative internal monologue. Therefore, strive to keep your focus on answering the test questions themselves, and do not let your mind wander into negative “what-if thinking”. Be prepared ahead of time with scripted comments that you can use to prevent or control your negative self-talk, such as: “I reviewed all the material”, “I used effective study techniques”, “I prepared well for this exam”, “I am willing to face each question while experiencing some anxiety”, and “I can remain calm and relaxed”.
The goal is to remain focused on the exam questions rather than on worry or physiological sensations.
After the Exam
Review your answers before submitting the exam. This is the time to check for silly mistakes that you may have made. Some students will inadvertently click an answer they did not mean to select or read through a question so quickly that they didn’t read it thoroughly and may have missed a key detail.
However, DO NOT change your answer unless you are 100% positive that the change is warranted. Many students tend to “second guess” or doubt themselves and this leads them to change answers. Research shows that you should change your answer only when you can prove to yourself that your original choice is incorrect. Never change an answer just because of a feeling; that feeling is often simply nervousness.
Focus on making an objective assessment of your study plan. Determine what went well and what can still be improved. Also, evaluate your anti-anxiety strategies. Practice and maintain those that worked well.
Remind yourself that this exam was not a measure of your worth as a human being, but only a snapshot of your knowledge on one given day. Getting less than an A+ will not bring the world to an end. While there might be undesirable consequences, you can carry on.