Overcoming Test Anxiety

Definitions & Key takeaways

Test anxiety is a feeling of nervousness or anxiety before or during a test. This can be due to a lack of proper preparation, a fear of failure, or a negative experience with tests. Whatever the reason is, test anxiety can interfere with a person's ability to perform to their full potential on a test and affect performance.

Several strategies can help overcome test anxiety: Prepare for the test: Make sure to study and review the material beforehand. Also, don't ignore having some practice with sample questions or past exams if available. Taking breaks: It's important to take breaks while studying to give your brain a rest and help reduce stress. Get a good night's sleep: Make sure to get enough rest the night before the test to help improve focus and concentration during the test. Eat a healthy breakfast: Fueling your body with a healthy breakfast can help to improve energy and focus. Practice relaxation techniques: Try deep breathing, meditation, or other relaxation techniques to help reduce anxiety. Use positive self-talk: Remind yourself that you are prepared and that it is normal to feel anxious before a test.

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Hi, everyone. My name is uh Marina Hoti.

I am the content manager for questions here at osmosis and um I am so excited to have all of you joining today. We have an unprecedented number of people.

Um I think we had over 2000 people register for this webinar, which just goes to show how common test anxiety is. And we're gonna actually get into some of the numbers of that in a little bit.

Um This is a two part webinar series and this is part one where we're gonna talk about structured studying and part two is gonna be coming at you um in early September.

So be sure to check back in for part two and that's gonna be about test taking. OK.

So we'll go ahead and jump right in. Um as the question um content manager here at osmosis, I always love to start presentations with a question.

Um And I'm actually gonna go ahead and read this case presentation aloud. Um I know it's a lot of text but just bear with me.

Um I think this is a really interesting case to start us off here. So we have a 24 year old woman who presents to the clinic with a complaint of recurrent episodes of nausea and vomiting.

The episodes are accompanied by crampy abdominal pain, sweating and occasional bouts of nonbloody diarrhea. She denies headaches or visual changes.

The patient is a medical student and she states that the episodes tend to occur in the days leading up to and during exams during the exams.

She also reports difficulty concentrating and trouble with recalling information. Despite preparing extensively and knowing the material.

Well, the patient frequently needs to leave examinations to vomit and therefore she's having a hard time finishing the exams.

Her grades have declined significantly as a result, vital signs are within normal limits. The patient appears anxious, physical exam, demonstrates the abdomen to be nontender, bowel sounds are hyperactive fundoscopic exam is normal, ecg reveals normal sinus rhythm and cardiac enzymes are within normal limits.

So our question is, what is the next best step in managing this patient's condition? So I wanna highlight a couple of sections of this question for us here.

Firstly, we noticed that this patient is experiencing both cognitive and somatic symptoms. So she has these symptoms of vomiting, abdominal pain, sweating, diarrhea.

Um but then she also has the cognitive symptoms with trouble with her memory difficulty concentrating. Um and we see a significant impact of this um in her inability to finish exams and her declining grades.

Um So as you can probably guess, this patient likely suffers from Test Anxiety, um which you also might have been able to deduce from the title of this presentation.

But we're not here. Um Just to recognize Test Anxiety, we wanna know what we can do about it.

So that's what this, this question is great. And that is like, I love a multistep question.

Not only does it require you to know that the student probably suffers from test anxiety, but it wants to know well, how do we fix it?

And that gets us into the presentation. I wanna go into just a quick overview of what exactly we're gonna go over in this talk.

First, we're gonna get into the weeds a little and really characterize test anxiety with some definitions for you. Next, we're gonna go over some high yield study strategies that you can utilize in studying for your exam.

I also wanna briefly touch on mental health because I think this is an absolutely critical piece of uh the puzzle whenever we're thinking about test anxiety and then we'll go into some next steps from there.

So first, what is test anxiety? Officially, it's defined as a special form of anxiety which is characterized by somatic cognitive and behavioral symptoms of anxiety before or during test taking situations that interferes with performance.

Now, we saw all of these in our patient, we saw the somatic symptoms, the cognitive symptoms, we saw that they were in the test taking situations or before.

And we saw that it was interfering with her performance on the exams. And I'm actually gonna get into some of those behavioral symptoms in a little bit that we'll talk about those.

Um, something that I wanna say here is that studies have demonstrated that at least 25% of undergraduate students suffer from test anxiety 25%.

And that number is estimated to be significantly higher in graduate students and significantly higher still in health profession, students.

Why is that? Well, it is documented as well that healthcare students perceive a higher level of stress, anxiety, including test anxiety and depression.

When compared to students of other fields or other similar academic levels. This is a huge huge deal because in health care, in preparing for these health professions, there's a huge reliance on performance during exams.

So this is an extremely critical area and it can have some severe consequences. Not only like we saw on our patient, can there be distraction during exams?

It can lead to longer periods of studying. The student mentioned that she prepared extensively for this exam and still wasn't able to remember the material very well.

So for the next exam, she might prepare even more extensively and possibly to no avail. There's also been documented association with your lower usm le and other standardized exam scores.

When they're correlated with test anxiety, test anxiety is also associated with exam failures and increased dropout rates at the university level.

In addition to physical and psychological impairments such as burnout or the physical symptoms that this patient was experiencing.

We all know the sequelae of repeated episodes of vomiting and bloody diarrhea. There can also be delays in graduation, resulting in delays in income.

So this is a serious issue. Let's go back to our patient.

What are we going to do about it? What are we going to do to manage this patient?

Well, that's why we're all here. We can prepare for it.

Um So this webinar is actually gonna cover ways to prepare not only your structured study period where you're getting ready for your exam, that's what we're covering today, but also preparing for test day with keeping in mind, test anxiety.

You've got test at tips and tricks which are gonna be coming to you on September 2nd, stay tuned. So let's get into it.

So this is gonna be our kind of roadmap for our structured studying techniques. We've got these high yield study strategies and I'm gonna go over each of them in detail.

The first is making a study schedule and setting realistic goals. And I'm gonna actually touch on something called academic procrastination.

When we think about study schedules, this gets into the behavioral stuff. Um The next is called the Pomodoro technique.

And we're gonna go over the importance of taking breaks during studying third, we're talking about time practice questions and that is where you really simulate a testing environment in your studying next, we're gonna talk about self efficacy.

We're gonna make a case for positive self talk. Yes, I literally want you to talk to yourselves.

Um And finally, we're gonna talk about um learning disabilities and the importance of recognizing these vulnerabilities.

Um So let's get into it starting with making a study schedule. How do we do this?

Firstly, you start early. Um If you're not leaving enough time, you can imagine you're cramming all of the material in right before the exam and that just increases anxiety and it increases the likelihood that you're not gonna get through everything next.

We wanna make sure that we're setting realistic goals. Um It's really important to be able to recognize what you can feasibly get through.

So that not only are you able to actually make it through all of the material that you set for yourself, you're also not constantly failing to achieve your small goals that you set in studying, which might lead you to failing in achieving your big goals of a in the exam.

That's incredibly important. Next, you wanna make sure that you're building days off and catch up time.

First of all, reality happens and it's going to disrupt your study schedule sometimes. So you have to build in contingency plans within your study schedule so that you can be as realistic as possible.

Another helpful trick is called interleaving. A lot of you might have heard of this in some of our other webinars.

This is where you spread out topics and you come back to them here and there so that you're re jogging your memory and really crystallizing that information and actually osmosis on the tool um that I'm gonna go over in just a second of how it'll actually create a study schedule for you and it will automatically interleave topics for you.

Now, let's just talk about something called academic procrastination as it sounds, this is defined as the tendency for students to delay important actions or decisions despite knowing the negative consequences of the delay.

This has a strong association with test anxiety. Students with test anxiety are more likely to delay and delay and delay their studying because it increases their feelings of being in an exam, which is exactly what makes them anxious.

So it makes sense, but it can have some these severe consequences because not only are you not meeting your study schedule, you're setting yourself up for a self propagating cycle of test anxiety.

So how do we make a really good study schedule keeping in mind these ideas that if I have chest anxiety, I really might not want to study and recognizing that while that's not OK, that's reality.

And we have to prepare for that within osmosis. We have this really fantastic tool that I really like.

Um And that I actually used when I was studying in medical school um where you can build a study schedule based on the resources that you think that you want to be able to utilize during your studying.

So over here, you can see, I can add osmosis videos and flash cards. I could do boards style questions and I can also incorporate some outside resources like sketching medical or patho.

Then it'll automatically generate a schedule for me and I can uh tailor the topics within that schedule based on my curriculum in medical school.

So as this example is stating maybe the student had is going over the anatomy of the heart on Friday. So they're gonna move that topic to Saturday.

So they can really cover it right after the material expression in their mind. And you can also tailor how you use and study your different resources during your study period.

You might have a lighter day where you um are able to get through much more material or you have a really, really busy day with school and life.

And so you wanna move things around, everything is completely customizable, which is really important. OK, moving right along, we're gonna talk about something called the Pomodoro technique and I'm gonna really stress to you the importance of breaks.

So the Pomodoro technique is actually named for a Pomodoro, which is a tomato in Italian. Um And the idea behind this technique is that you break down your studying your huge goal into small manageable little bits or little tomatoes.

Um So you need bite size amounts of material that you can get through in 25 minutes. So that's what we're gonna define a Pomodoro as is a 25 minute block of time that you set a specific goal for yourself.

And in 25 minutes you put a check mark. Ok, congratulations.

You have spent 25 uninterrupted minutes studying after 25 minutes, you take a break and what's important is even if you haven't perfectly accomplished what you set out to accomplish in 25 minutes.

Um, and then you, um, set out and do another 25 minute pa check off 25 minutes. Uninterrupted.

Fantastic. You build in another five minute break for yourself.

All of these breaks are gonna be five minutes. You can get a cup of coffee, you can do a little bit of meditation.

You can um, go for a little walk stretch, um, whatever you do just five minutes. And it's really important that you keep doing these 25 minutes on five minutes off, 25 minutes on.

And then once you've done four Pomodoro, you take a longer break at that point and you might take 25 35 minutes and you make a meal, you call up a friend, you go for a long walk or anything just to really, um, get your mind relaxed and cleared before you start on that next Pomodoro for another 25 minutes.

Now, why do we do this? The importance here is the fact that your brain is naturally going to get distracted, it naturally needs breaks.

And this might be even more prevalent if you have a condition such as like adhd where you are more prone to distractions.

So within that, if you build in those distraction breaks for your brain, you're less likely to, if you were to say, spend all 100 minutes, try to power through 100 minutes at a time, you're gonna end up scrolling through social media, watching random videos on youtube and getting a little bit distracted.

Um Whereas if you build in those breaks for yourself, your brain is less inclined to pull you away from what you've been working on.

And that's what's gonna lead you to actually being successful within these small blocks of time. And you'd be surprised trying this technique out is so cool.

It enables you to actually get done way more than you might have been able to get done if you just set out to do 100 minutes by yourself.

So I really like this one that we're gonna talk about simulating a test environment. And the way that we're gonna do this is with time to practice questions, which is something that obviously is one of my favorite things to talk about as the question manager here.

So first we wanna talk about how on earth are we going to simulate a testing environment so that we can go from this student on the left here to this first things first, if you wanna think about location, location, location and that is gonna involve cleaning up your study space.

So you can also clear out your mind and stay organized in your thoughts. What you wanna do is you wanna create an environment that's as similar to testing day as possible so that you can really allow your body to get comfortable settling in to test day.

The next thing is you wanna do practice questions, that's the best way to continuously expose yourself to board style questions so that you are preparing your body to get into the mindset of answering questions and acing exams.

And it's really important when you're doing this to time yourself because once you're under a clock, everything gets a little bit more heightened and it, this helps you be able to feel comfortable being under a clock and it also helps you to recognize, ok, sometimes I spend a really long time on questions.

Sometimes I spend a little bit less time on questions. Um And how can I modulate that?

So I'm making sure that I'm finishing my exams. Despite how anxious I might be feeling, we're gonna go over a little bit more about timing and testing whenever we have our second webinar.

The last thing is just taking from the Poo technique build in some breaks to your quote exams that you're simulating. Um whether that's taking a couple of deep breaths every 25 minutes um or whatever you need to do with within your exam practice that while you're doing these little simulated exam sessions, as you're doing your practice questions in your study time.

One thing I wanna highlight about um making that perfect study location to simulate A is actually on osmosis. We have some resources that are specifically geared to creating a good location to study during quarantined.

So this first um blog post that you can search for online is how to stay focused and avoid distractions while studying during quarantine.

And this has some really, really great hacks um about kind of turning off the rest of the world and really honing in and creating a testing environment for yourself while you're studying.

Um The second thing is how to maintain productivity in the midst of uncertainty. And this um blog post actually talks about really creating and separating off a workspace for yourself so that you can metaphorically close the door or literally close the door on the rest of the world and just be in your testing environment, which is gonna be similar to how exam day is gonna feel.

So just moving on from here, we talk about something called self efficacy in the case for positive self talk. So this nursing student here has what I would say, fantastic self efficacy.

What does that mean? Self efficacy is the appraisal of one's own capabilities to accomplish a specific task.

This is about your belief that you can do it. And this is related to test anxiety through something called the value control theory.

What that means is we as students will place certain value on achievements such as testing achievements, academic achievements.

And so a student with test anxiety might recognize that a test is a very high value um situation. But what's important is the control that we assess of our ability to influence the outcome of these high-value situations.

Test anxiety is, is associated with a low control feeling, which means that I might not believe that I have very much control at all over the outcome um of this test because I'm just so anxious about it.

Um And I feel like I'm just gonna throw up during the whole thing like our patient did. Um So the way that we combat that is we have to change the narrative, we have to be able to teach ourselves.

I believe that I will pass and this might involve literally walking around and talking to yourself. You can even say it to the beat of your steps.

I believe that I will pass. I believe that I will pass.

You have to be able to believe in yourself because it will actually influence your performance. Lastly, I wanna talk about the importance of recognizing learning disabilities.

If you are someone who is feeling like when you're reading, everything is upside down and backwards, or if you're someone who suffers from something like ADHD or any other learning disability that is influencing your ability to effectively study for or take your exams.

You have to recognize that it's extremely difficult as physicians to recognize our own times when we might actually be patients and need some help.

Um But you have to recognize that this is gonna influence your performance and it's gonna influence your ability to treat patients in the future.

So recognizing, you know, you have these learning disabilities and seeking help for them is extremely, extremely important, get the care that you need so that you can give yourself the best shot to perform well.

So that is all for our study strategies. We've gone over making a study schedule, studying realistic goals.

We've talked about the little Pomodoro the 25 minutes on five minutes off and taking some really good mindful breaks. We've talked about doing time practice questions and really simulating um the the testing environment.

And we've talked about self efficacy in the case for really positive self talk and just believing that you will succeed.

And we've also talked about the importance of recognizing learning disabilities. Let's go back to our patient really briefly.

So we've diagnosed her chest anxiety. We've given her all of these strategies to use while she's studying.

But what would you actually say to her specifically? What would you say to her?

So this was me, this was in my second year of medical school and I was seriously struggling with my ability to take exams and it was influencing my ability to study.

It was influencing my ability to sit through an exam. I literally was running to the bathroom about it during tests and I wasn't finishing my test on time.

Fortunately, I was able to sit down with a learning specialist at my medical school and I was able to get the help that I needed.

And I was really able to focus on my mental health and focus on some key strategies that I've gone over with you that I tried and true.

Um And I was able to get control of my test anxiety. And obviously, it's brought me where I am today.

I now have performed very well on exams and I'm in charge of our assessments and question writing here at osmosis. So this is a success story.

You can get through chest anxiety because this patient definitely did. And that brings me to my next point about mental health.

It is extremely important that as providers, we recognize that sometimes we're vulnerable ourselves. So even though we might like to think that um we're just doing all of these preparations that we can help our patients, we sometimes have to recognize that occasionally we're the patient and we need to make sure that we're taking care of ourselves.

How do we do that? Well, firstly, counseling is a fantastic resource that I highly recommend utilizing during your study period.

Um It's been shown that psychological and educational counseling can significantly decrease test anxiety and it's been associated with a statistically significant increase in self esteem and your GPA.

Another strategy that I found very helpful in myself is something called box breathing. And this is something that you can use during your exams or during your studying while you're taking those five minute breaks.

Um You might have heard of this. Basically, you breathe in 123 and you hold for three and then you breathe out 123 and then you hold for three and you might repeat this a couple of times, you might do three breaths and call that a break.

Um What this does is it significantly lowers your heart rate and it improves your ability to concentrate. So that brings us to next steps.

Um Be sure to tune back in on Wednesday, September 2nd for a specific session dedicated to test day tips and tricks. Be sure to check out osmosis.org for even more study resources as you prepare for your exams.

And two resources II wanna just quickly highlight for you are this course. Um It's a webinar of a five part webinar called How To Ace Med School in USM le and I also wanna highlight another course on osmosis University called How To Learn In Medical School.

This first course is a webinar hosted by our director of Curriculum who has a significant background in teaching and she actually goes through in five different sessions, actually breaking down usm oe questions and preparing you for step one.

This is a really, really fantastic resource that I would encourage you. Um looking over for, especially as you work on those practice questions.

The second course is about cognitive learning theory. And our doctor Sean Tackett, who's our osmosis research director and a Johns Hopkins physician really goes into how to learn while you're in medical school And this isn't applicable for um other pro health profession schools as well.

It's really about learning theory. And here's an example of the curriculum there that you would be able to access.

So please be sure to tune back in um before we recognize that these resources are there for you, especially on osmosis.org.

Um And I wish you the very, very best of luck while you prepare for your exams. Um These are a couple of my references and I will um look through here and take some questions, let's see here.

So we have one reco we have one question about how to um how to spend your um your breaks during the pomato technique. Um What breaks kind of help you feel energized?

I strongly recommend that box breathing. Um I think that you would be surprised the effects that that can have on just kind of calming you down and resetting your mind.

Other things that you can do is take a nice stretch, go for a little walk outside get outside, get a little bit of Vitamin D if you can.

Um, that kind of thing is to help you feel energized and get right back at it. The key is to really make sure you're taking those breaks.

Um, and really set, set a timer for yourself, set five minutes and make sure you take the full five minutes. And then another question that I had was about, um, how to give yourself a longer breaks or give yourself rewards during those breaks.

Um Go for it, if that means that you get a piece of chocolate during your long re reward um for that 25 to 35 minute break, then definitely go for that.

Um One question was asked about, can test anxiety develop into more serious cases of anxiety. And I think that there is definitely an association.

Um And partly because it's, it is itself a form of anxiety. Um We're actually gonna talk a lot more about the mental health um aspect of chest anxiety on our second webinar.

So if that was your question, I highly encourage you to tune back in. Um I wanna be mindful of everyone's time.

So I don't think that we're gonna be able to get to everyone's questions today, but we will be sure to take a look through all of your questions um and be sure to answer them either on social media um or um within our next webinar as we're preparing the material for that.

Um So I highly highly encourage you to tune back in on September 2nd. Um And I really, really appreciate you all joining.

Thank you so much.