Sleep and Board Exams

I’m about to tell you something so obvious about sleep and board exams that you may want to throw something at me. Despite the apparent obviousness, many exam candidates still will make the mistake I’m about to describe and do so for entirely understandable reasons. Let me explain.

On the day (or several days) prior to your board exam, your anxiety level likely will increase. You may realize you are not as prepared as you would like to be and regret not devoting more time to preparing. If this sounds familiar, join the very large club of nearly all other physicians having these same thoughts and feelings at this point before their exams.

So, to minimize this increasing tension on the days before the exam, a sensible approach is to dive into watching exam-related videos, reading books, and going over practice tests. Can this ever be a bad idea? The answer is yes, if this course of action leaves you tired and drained. If you consider the circumstances of your exam you realize it is an extremely taxing experience. It drains you physically, mentally, and emotionally. Just imagine needing to maintain focus while completing hundreds of multiple-choice questions over several hours. In addition, you’re not likely to be in an emotionally neutral state of mind. The anxiety over possible exam failure and the discomfort of feeling uncertain over the correct answers to the majority of the exam questions, adds to feeling drained. At the end of the exam (and hopefully not before) you will probably feel like a zombie, devoid of physical, mental and emotional energy.

In other words, the day of your exam you will feel like crap. This is common, expected, and ok. I’m not raising this likely scenario to increase your anxiety but rather to help you anticipate it and inoculate you against its deleterious effects. Again, join the club. Nearly every exam-taker will feel like this to a lesser or greater degree.

So, given that you can predict the likelihood of experiencing feeling tired and draining on exam day, how should you prepare yourself? The answer is simple: set the conditions to increase your likelihood of getting enough rest and sleep on the days before your exam and especially on the night before.

At this point you may be considering whether or not you should use a hypnotic agent on the night before your exam. My answer is: yes, consider it and, if you’re comfortable, use one. BUT DO NOT USE A HYPNOTIC FOR THE FIRST TIME THE DAY BEFORE YOUR EXAM! You have to become familiar with the nature of the sleep-aid’s effects, its duration, and its next day after-effects, if any.

And note this additional point: if you take a sleep-aid for the first time the night before the exam, I can predict you will feel anticipatory anxiety about possibly sleeping through your alarm. This will lead to an even more challenging night’s sleep. So, again, become familiar with your hypnotic much ahead of time, including with your ability to wake up when your alarm goes off in the morning.

And here is my last prediction and inoculation against it: you may have a bad night’s sleep no matter what you do or don’t do. You cannot guarantee how well you will sleep before the exam because sleep is one of those functions you cannot will into being. Rather, what you can do is to set the conditions for increasing the likelihood of a positive outcome. So, do this: arrange the situation to improve your chances of sleeping well, including by not studying late into the night before the exam and considering the use of a well-tried and tested sleep aid. And, if you still don’t sleep well, it won’t kill you.

And whether or not you do sleep well, there are some things you can do to conserve your energy during the exam itself:

• Anticipate and accept that you will not feel certain about which is the right answer (or answers) on MOST board exam questions. You may feel relatively sure but not 100% sure. And this is a common reaction and it is ok.
• Anticipate and accept that you will get many board exam questions wrong. This is common and it is ok. On board exams, the cutoff for the percentage of right answers needed to pass is usually in the upper 60%. That leaves a lot of questions you can (and inevitably will) get wrong.
• Hydrate well and plan on using the restroom. Yes, some candidates delay or avoid using the toilet during their exam because of the time it may use up in the optional break time. This is unwise. Taking a few minutes away from the exam is much better than making yourself dehydrated or trying to concentrate with a full bladder.
• Since I’m writing you with (at the very least) several weeks left before your exam, use my message to prepare for your exam now, so you can avoid a surge of scrambling in your preparations later.
• When you have done your job of preparing for the exam, just go in there and do your best. Most exam candidates will pass. The doctors who won’t – well it’s not great but it’s not the end of the world either. I like to remind myself, whether I pass or fail, no one will love me any more nor any less.

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