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Test Anxiety Advice

Keeping Anxiety Normal

The question is not whether you will face anxiety as you take your USMLE exam. You will. For some this anxiety will be a mild passing inconvenience.  For others, the anxiety can be enduring and debilitating. For everyone the question is: How will you handle the anxiety when it occurs?

Anxiety is basically unharnessed physiological arousal. Left unchecked, this arousal tends to escalate. When high enough, anxiety interferes with cognitive functions such as concentration and comprehension. However, if used effectively, anxiety can actually give you an advantage.  A moderate level of anxiety will actually increase your attention to detail and speed up your decision-making. The secret lies not in eliminating anxiety, but keeping it under control. Anxiety, psychological arousal, is like water on a farmer’s field.  Just enough will help you to a good cognitive harvest.  Too much will become a flood that washes everything away.

Pharmacology is not the answer to test anxiety for most people.  Taking drugs can reduce arousal, yes, but will not give you the control you need to harness it to do your best. The best ways to handle anxiety are by practicing a good question answering routine and by a behavioral strategy called “time-out.” 

Anxiety is what happens when your brain is not sure what to do next. Physiological arousal is present, but you are not sure how to channel it.  The solution lies in a simple behavioral principle--arousal tends to facilitate the dominant response of the organism.  If you have a question answering procedure outlined, and you have practiced this strategy repeatedly, then this behavioral strategy should be your dominant response when faced with questions in the exam. Instead of disrupting your exam performance, anxiety will actually help you to execute your exam strategy! Once your behavior for approaching questions has become habitual, anxiety simply serves as an impetus to move you more efficiently along your practiced routine. Practicing your question answering routine repeatedly before the actual exam means you will never have a question as to what to do next. This advance preparation not only trains you cognitively for thinking about questions, but also provides a routine to harness anxiety during the real exam.

Sometimes, even with a practiced routine, anxiety rises too high during the exam.  When this occurs, the correct strategy is the “time-out”. Time out works by removing you from all stimuli until the undesired response, in this case high anxiety, is extinguished.  The wrong solution when anxiety rises is to bear down and try to concentrate harder. This only increases anxiety and panic. The correct strategy is to push back from the exam completely, let the physiological arousal fade, and then re-engage the exam on better, more controlled terms.  Most people would benefit from a time out at least once in every block of questions. To take a time out, simple take your hand off the mouse, sit back in your chair and close your eyes.  Count to twenty, sing a song to yourself, or pray. Do anything for about 30 seconds but think about the exam or focus on the question on your computer screen.  When you open your eyes and look at the question before you again, you’ll be amazed how much clearer everything seems.  Your arousal will be down to manageable levels, and questions that seemed impossible a moment before will suddenly seem, not only possible, but even obvious.  Now, take anxiety you have left, harness to your question answering routine and move on through the exam.

Remember, anxiety happens to everyone.  The question is not how to avoid it, but how to harness it to give you the boost you need to propel you through the exam.  With a practiced question answering strategy to guide you and time-outs as you need them to bring you back in line, you can convert anxiety from a feared impediment to a valued friend.

Steven R. Daugherty, Ph.D.


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