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Test Anxiety, Ain’t She a B!@#*

The title pretty much captures my fondness for test anxiety. Unfortunately, this has been something I have struggled with intermittently, being more crippling at particular times in my life. In retrospect, text anxiety plagued me throughout high school and college, however in those settings the subject matter is much more limited than medical school. Don’t get me wrong, upper level college courses are challenging, but you can bust your ass for exams and not be thrown too many curve balls. In essence, you can know virtually everything that will be tested. This was my subconscious defense mechanism. In these academic realms, it worked, keeping my anxiety at bay and propelling me to excel in school. However, this reality was shattered by the MCAT.

The MCAT is different than anything most premeds have been exposed to for a couple of reasons. First, the subject matter is infinitely vast. To put it simply, you could study for a year and still not know everything that is testable cold. Second, it pushes your critical thinking/test taking skills to the extreme. It is one thing to know a concept, but then to be able to apply it to an entirely different scenario is a different ballgame. Moreover, you have to be able to interpret complex passages. Third, because of the aforementioned facets, you feel like s!@# when you are taking the exam. There are perhaps 50% of questions you know outright, if that. The remainder consists of eliminating choices and taking educated guesses. Ultimately, this experience is a nightmare and perhaps even a ticking time bomb for someone with test anxiety, especially if it is unbeknownst to them.

My first attempt at the MCAT was in January of the my junior year. My studying left much to be desired (see my blog and video detailing how I ultimately jumped to the 90thpercentile), being wayyyy too heavy on the content review and severely lacking in exposure to practice questions. Nonetheless, my practice test scores, while not great, encouraged me to continue with my exam date. It is worth mentioning that I did have issues completing a few tests. I really, really struggled with the ambiguity while going through passages. I wanted to understand every detail of the passage and know with certainty what the correct answer was. This is just laughable and not plausible, but was a byproduct of my test anxiety.

On test day, this reality reared its ugly head again. The first passage already had me in fits because of this. I spent way too much time on it and couldn’t shake prior questions as I moved forward. This spiraled me into a full on panic attack. For those of you who have not had the pleasure of experiencing one of these, it is basically your sympathetic nervous system on overdrive. I was breathing rapidly and sweating profusely, my heart was racing, and as a result, my thinking was foggy and clouded. This might help you escape pursuit by a tiger, but is not amenable to taking the MCAT. Ultimately, I simply could not calm down and went on the void my test. I was slightly relieved, but also incredibly defeated. I felt like a failure. I had put a solid month of 10 hour days into studying for this exam and I couldn’t even sit through the whole damn thing. To make matters worse, I took the test the same day as my then girlfriend (now wife :). So, while I waited for her to finish, which was several hours, I got to ruminate on my disappointment.

Rather than get to the root of what went wrong, ie my test anxiety, I decided I just needed to mentally push through this road block. Brilliant, right? So the first thing I did was reschedule my test date for that April. My studying tactics did not change significantly, meaning I did not incorporate more practice problems and less content review, despite the fact that I had already done a butt load of content review for my first attempt. Moreover, I still struggled to complete practice tests because of my spiraling anxiety once the timer started. For whatever reason, I ignored this and thought it would be a good idea to plunge ahead. When test day 2.0 rolled around I was definitely no better off from a studying standpoint and especially not from a mental standpoint. While I did actually get through the test this time, it was a struggle. Anxiety and doubt plagued me the entire way through and I really couldn’t think clearly. Overall, it was an especially horrible experience, even for the MCAT. My score, which was average, reflected this. To those who are not familiar with the MCAT scaling, average, while not bad since you are taking a really hard test and being compared to equally motivated students, will not help you matriculate into medical school. The sick thing is that the average for matriculated students is a full standard deviation above the average for those who simply take the test.

Sadly, I had my application all teed up and typed out in the online centralized application. I was simply waiting on my MCAT score. Given my unsatisfactory score, I withdrew my application since I did not want to waste thousands of dollars on a less than stellar application. The rest of my application was solid, but my MCAT was definitely not going to carry me across the finish line. So, how do you think I reacted this time? Well, once again, instead of fixing the foundational issue, I scheduled a repeat exam for later that summer. Bullheaded once again. Noticing a theme here?

Not surprisingly, this test was a disaster as well. My studying tactics did not improve much, and my mental fortitude was still in shambles. To make matters worse, I was putting extra pressure on myself since I knew I really needed to crush this sitting to make up for the last average one. This exam went just like my first one. I quickly spiraled into an unrecoverable panic attack. I voided the exam and once again felt like a complete failure.

Only now did I start to think about how to fix this issue. I swallowed my pride and went to my school’s counseling center to speak openly and candidly about this. With their help, as well as tons of introspection, I was ultimately able to identify the core issue. My whole life, like many premeds unfortunately, I had equated test results to self-worth. After all, it is how you secure praise and advancement, ultimately matriculating to medical school. It doesn’t stop there either, as Step 1 can have a strong impact on your future. So, I was afraid to do poorly because I was afraid for the hit to my ego. This led me to fixate on every little detail and be fearful of educated guesses, a necessary reality on the MCAT. Ultimately, my defense mechanism, which was certainly not productive, was to not finish tests. This left me without a score report and without a bruise to my ego.

The first step was recognizing what the core issue was, but this was the “easy” part. Actually overcoming this mental hurdle was a real B!@#*. My next attempt at the MCAT was in January of my senior year. Very importantly, I revamped my studying tactics. This has actually been elaborated on in depth here and here. To surmise though, I hit practice problems incredibly hard, finetuning my critical thinking skills. To any skeptics out there, this is actually a learnable skill. Moreover, I worked incredibly hard to separate my self-worth from my scores. This was certainly not easy, but telling myself to have confidence and just do my best went a long way. As I sat for what I hoped would be my final attempt, I was calm, cool, and collected. A far cry from the nervous wreck I had been for the previous two attempts. I really believe this was because I had squashed the core issue. I was not going to let this score determine my personal worth. It allowed me to just relax and do my best. When I got my score back, I was ecstatic. I had jumped 6 points to the 90thpercentile. I was also vindicated, I had conquered this mental obstacle and the monkey was off my back.

Fast forward to medical school. I wish I could say that I don’t deal with this issue, but it still bothers me from time to time. The difference though is that I have the defense mechanisms and wherewithal to confidently tackle it. First, I have almost entirely separated my identify from test scores. I say almost entirely because I would be lying if I said I still didn’t hold them slightly near and dear haha. More importantly though, the things I used to tell myself when I was faking it until I made it, I actually believe now. I have confidence in my abilities, looking at my prior test taking experiences over the past 2 years of medical school, and I am content with “just doing my best.” The irrationalities of test anxiety are funny though. Even with no track record of failed exams or poor performances, your mind can still trick you into thinking that this test will be the one you fail. Additionally, I talked to my primary care doctor about pre-exam beta blockers. I don’t always pop them, but it is nice to know they are there in the case of emergencies. In short, this is not an issue I have entirely grown out of or in fact may never entirely grown out of, but I am able to successfully and confidently manage it.

To those of you who have experienced similar at any point in your careers, I urge you to reach out for help. I stupidly did not and you can see where that got me: two painfully voided MCATS and a ton of mental anguish. You can avoid this! There is a solution! Talk to a counselor or your primary care physician! Moreover, you need to do some introspection and identify what is at the root of the problem. This will be slightly different for everyone, but unearthing it personally made a massive difference and is what I attribute to my continued success, despite loads of prior failures. If you don’t feel like you have anyone to talk to, hit me up! Test anxiety by no means has to define you! You are capable and worthy.

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