How I Escaped the Anxiety Loop Prepping for My Biggest Exam
From anxiety and self-doubt to a sense of purpose while studying for a doctor’s most consequential exam
Last year, I was studying for the infamous exam that every medical student in the US has to take before officially becoming a doctor, the United States Medical Licensing Examination (USMLE).
International medical graduates, or IMGs (Medical students that are trained outside the US), like myself, have to write the same exam if they wish to practice in the US.
There are a total of 3 Steps (3 HUGE EXAMS!!!) to the USMLE. The one I was preparing for was Step 2, arguably the most crucial one — the score of which greatly influences the chance of matching into a residency program (training program that most medical graduates go through) of one’s choice.
It is brutal, even for the most brilliant minds.
The actual exam lasts 9 hours with up to 320 multiple choice questions. Each question describes a clinical scenario in which an imaginary patient’s symptoms, medical history, physical exams, blood test results, and sometimes images of an X-ray or CT scan are provided. You will be asked to choose the correct diagnosis, best treatment option, or a reasonable work-up plan, from five, sometimes seven or eight choices that all seem plausible.
You have to do all the following:
- Read and analyze the information
- Pull out every bit of relevant medical knowledge in your brain
- Consider all the possibilities
- And try to rule out choices that are designed to confuse you
In 90 seconds.
For a mental process that normally takes at least 10–15 minutes in a real clinical setting, this is an absurdly small amount of time.
Preparing for such an exam is stressful, to say the least, especially on days when you don’t feel like studying or when your performance on practice tests smashes your dwindling confidence. There is constant anxiety and self-doubt.
Like some people would do, I went on Reddit, seeking useful tips for exam prep, and hoping to read positive posts to ease my anxiety.
Apparently, Reddit is not a good place to seek comfort. It’s flooded with “freak-out” posts with negative emotions on top of each other.
That’s not what I was looking for.
On a particular day, I performed extremely awful on my practice questions. The score report indicated that I was far from ready. My anxiety level, therefore, reached an all-time high at that point.
My brain, luckily, still had the ability to find ways to get myself out of the anxiety loop. It was like, ‘Why not appreciate the fact that the questions I got wrong today helped me realize my weaknesses as a doctor?’
The knowledge gap that I found and hopefully filled from today’s mistakes might go on to save a patient’s life in the future.
That thought changed my perspective on the exam preparation.
Instead of searching for more tips and tricks on Reddit, I decided to write a post on the platform with the hope that somebody would find it comforting and helpful to get through their stressful study sessions.
I’d like to share the post here with some minor tweaks.
Trust me. You are getting better everyday.
We can all agree that studying for the USMLE is stressful. Who doesn’t? As an IMG that has a dream of matching into a competitive specialty in the US, I can’t help but doubting myself every time I look at my UWorld (an exam prep question bank) correct percentage hovering around 55%-60%. One good thing about me is that for some reason, my brain is very good at getting myself out of an anxiety loop. I just wanted to share a thought that I came up with recently and hopefully someone finds it helpful.
So, after I got a 30% from a UWorld question block that I did yesterday, I realized one thing: I am not good enough to be a doctor to practice in any specialty, not yet. I mean, 30% is atrocious, by any standard. It’s not far from completely picking answers with eyes closed (20% given a 5-choice question).
Then, the other part of my brain said to me that from this point forward, I’m only going to become a better doctor. I AM getting better, every single day.
Imagine the 35-year-old man with an atypical chest pain in a UWorld question stem is standing right in front of you. What would you do? It’s not just a practice question anymore. It’s a real thing that most of us will face some point in our career.
As we study the explanations and try to find the answer to that question, we get better. And very likely, we become more capable of saving that “imaginary” patient.
I know it sounds crazy to think that you would save a patient’s life by solving a practice question. But why not?
Since most of us on this journey are making our best efforts to get the highest score possible, you will study hard no matter what.
What I realized is that appreciating every little progress that you are making makes the process more “real” and “relevant”. And making things more relevant (ex. linking a practice question to a real patient who needs your medical expertise) might help with your knowledge retention too.
I really felt refreshing with this thought and found the remaining study session today much more enjoyable.
A few weeks later, I sat for the exam. My score turned out to be decent. Not great, but good enough for me.
More important than the score was the sense of purpose and accomplishment that I felt during every study session when I intentionally tried to
- Appreciate every tiny progress and improvement that I made in each study session.
- Make every part of the exam prep relevant to the career/dream that I was pursuing.
Though I’ve since completed all the USMLE exams, I am no longer planning on residency training in the US. Instead, I am currently working as a surgical resident in Taiwan. Nonetheless, because of the time spent on tackling this USMLE monster, I can understand the pain and grind everyone on this journey has to face and overcome.
And I hope the 2 takeaways above could make your next study session slightly more enjoyable.
