Understanding and Overcoming Test Anxiety 

What is Test Anxiety?

Test anxiety is a type of performance anxiety.  When there is pressure because of high expectations or the stakes are high, people can become so anxious that they are hindered from doing their best. 

It is sometimes helpful and normal to have nervousness around testing.  The energy can keep our minds alert and the arousal can help with focus.  However, there is a threshold and sometimes too much anxiety can begin to impair brain functioning.  When our emotional brain starts to feel fear and get activated, it can make it hard to remember what was studied and to maximize our prefrontal cortex functioning.

Symptoms of Test Anxiety

Test anxiety symptoms can range from mild to severe.  It is possible to have mild symptoms of test anxiety and still perform well on exams.  Others can feel so overwhelmed that they encounter panic attacks before or during exams.  The Anxiety and Depression Association of America describes symptoms of test anxiety as physical, behavioral, cognitive, and emotional.

Physical Symptoms
Physical symptoms can range from increased heart rate, sweating, dry mouth, to shaking, fainting, panic attacks, vomiting and nausea. 

Cognitive and Behavioral Symptoms
Cognitive and behavioral symptoms can include negative self-talk and cognitive distortions that lead students to avoid studying or testing situations.  Challenges with focus and concentration as well as racing thoughts or rumination can be common.

Emotional Symptoms
Emotional symptoms can include low self-esteem, depressive symptoms, frustration, irritability, feeling overwhelmed and a sense of hopelessness.

Causes of Test Anxiety

In the medical student population, test anxiety can be heightened due to the intense nature of the academic environment.  Often times it is a combination of reasons that contribute to test anxiety. Here are some potential causes:

  • Perfectionistic tendencies/fear of failure.  Maladaptive perfectionism is prevalent amongst the medical student population.  Connecting one’s sense of worth and identity to performance can cause test anxiety. 
  • Stress around testing history.  If previous test experiences have been anxiety-provoking or led to unexpected poor outcomes, this can add more anxiety with each additional testing experience. 
  • Underlying anxiety. Often times, students have a history of anxiety that can be exacerbated around testing experiences.  This anxiety can contribute to one feeling like they haven’t studied enough, and it can cloud the academic journey leading to a sense of dread around studying and testing.

Overcoming Test Anxiety

Thankfully there are tools to support students in addressing and overcoming test anxiety. Each person’s needs will be different based on the reasons for test anxiety.  Here are some strategies:

Physical Strategies

  • Get enough restful sleep, especially before the test
  • Reduce caffeine intake
  • Consume nutritious foods
  • Get exercise and movement throughout the week
  • Spend time outdoors in nature
  • Take meaningful regular breaks while studying (not mindlessly scrolling through news, social media or YouTube)
  • Practice mindfulness or meditation at least once a day (Headspace is a helpful app to get started)
  • Practice progressive muscle relaxation

Cognitive, Behavioral and Emotional Strategies

  • Understand and address cognitive distortions
  • Remember your strengths and remind yourself of why you want to become a physician
  • Take a step back and reflect on who you are outside of being a medical student
  • Reconnect with hobbies you enjoy
  • Make time for social connection and reach out for social support
  • Ask for support and testing if you think you might have a learning disability (like ADHD)
  • Connect with a professional clinician who can help you come up with a successful plan, reduce negative self-talk, and feel more hopeful before exams
  • Reach out to faculty to better understand how to prepare
  • Get tutoring support from our learning specialist

Support Services 

We are here to support you in your medical school journey and want you to succeed.  Sometimes it is helpful to consult with a psychiatrist and/or to meet with a licensed therapist. We have many professional clinicians on campus and as well as in the community who are preferred providers for the Student Health Plan who are ready to support you.  See the Student Affairs webpage for counseling resources.  Student may make medical and counseling appointments without a referral or without involving the School of Medicine Dean’s Office or any faculty.  If you choose, you may contact Dr. Lamberton’s office for suggestions for counselors.

Cherry, K. (2020) Test anxiety symptoms, causes, and treatments.  https://www.verywellmind.com/what-is-test-anxiety-2795368