Fear of Board Exam Failure

Fear can make us behave in counterproductive ways, including how we respond to an upcoming medical board exam. We have set ways of responding to fear – fight, flight or freeze. Classically, fear is defined as an emotion triggered by imminent danger, as we would experience if we saw an aggressive person running toward us or if we heard breaking glass in our house as we were lying in bed. Anxiety is defined as an emotion triggered by non-imminent dangers or by potential rather than actual ones. Our behavioral responses to anxiety have similarities to fear behaviors. Rather than fight or flight, we can engage in planning to minimize risk (a proactive type of fight behavior) or we can engage in avoidance (a type of flight behavior).

So, any physician facing their board exam can engage in these two categories of behavior – either preparing for their exam or putting off preparing for their exam. Of course, an additional common approach is to spend a lot of time in worry rumination. I do not want to go into a detailed discussion of worry in this post, except to make one strong statement: worry is the enemy of effective preparation – that’s the bad news – because the more a person worries, the more they feel demoralized, and emotionally and physically exhausted. Now, the good news is that, conversely, preparation is the enemy of worry because the more a person engages in such effective action the more worry becomes irrelevant. Worry just seems to not enter the mind when one is doing the required task at hand.

So, the first lesson I wish to share with you today is: spend your time preparing in a way that makes sense to you. This means watching or listening to board-relevant lectures or answering board-reflective multiple-choice questions. Whenever you feel pangs of anxiety and worry, just start studying. You will notice an immediate and dramatic decrease in them.

Now, let me move to a new point: because the behavioral strategy of avoidance prior to a board exam can become so engrained and hard to overcome, I have a way of reframing success and failure in a way that diminishes avoidance and all those worry ruminations.

Rather than focusing on the chance of failing my upcoming board exam, I focus on my ability to prepare for it. Whether I pass or fail my exam is fundamentally out of my control. I can still study and fail, or I cannot study and pass. But what I have complete control over is whether I do the work of preparation. In that I can guarantee my success.

So, my second lesson is to define success as doing the hard work of studying for your board exam so that when you look in the mirror the morning before your exam you can say to yourself, “Whether I pass or fail, I did everything I could to be prepared for it. Even if I happen to fail my exam, I will do so with a clear conscience. I will pick myself up and just start preparing for the next one.”
Let me end here so I don’t keep you from your studies.

Thanks, and take care. All the best on your exam.

Jack Krasuski, MD

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