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Examinations are essential to any academic course to assess students enrolled in it and they are even more important in medical education, considering that students have to deal with patients in the future. Even though exams are despised by many, they are here to stay and with it comes the anxiety surrounding it. Some amount of stress and anxiety before an important evaluation is constructive as it makes you more alert and aware to face the presented problems. But excess of it can trigger many harmful physiological and mental responses which can compromise your performance- this is called “Test Anxiety”.

There is a difference between Generalized Anxiety Disorder and Test anxiety as the latter is a localized situational condition and is triggered specifically by any type of examination- it is a form of performance anxiety when a person has an obligation or pressure to perform good. Research indicates that between 25 - 40 percent of students world wide experience test anxiety and is higher (almost 50 percent) among medical students in India, according to some other studies.

Test Anxiety is generally not considered as a type of mental health issue and is often disregarded as an exaggeration of a normal physiological reaction. It is important to understand that Test Anxiety goes beyond normal physiological and mental response of the body, to a point where it hampers the ability of a person to even attempt the exam- in fact people with extreme cases can drop out of school to avoid assessments altogether. And it is not always because of lack of studies; a well-read student can also experience test anxiety which can make her/him go blank and further accentuate her/his fears. There have been many surveys on this issue and it has been well studied, but institutes still fail to consider this while planning examinations. There are certain factors that contribute to test anxiety and there also exists a gender bias to the condition. In many studies it has been observed that female medical students have a greater emotional effect due to exams as compared to their male counterparts. Another major factor is accommodation- students living in hostels or away from their family experience greater levels of anxiety than the ones living with their family. Parental pressure to score higher or forcing unrealistic expectation can be an additional cause of test anxiety.

Constantly changing paper patterns, uncertainty about the exam schedule, intimidating and rude examiners, insufficient time and even claustrophobic exam locations can make students nervous for completing the paper. Other than this, change in the language of study, previous failures, lack of preparation, and physical heath - all contribute to the underlying problem. Personality-wise, people who are perfectionists or have unrealistic expectations for themselves, have low self-esteem or negative self-talk, etc. are more prone suffer from test anxiety.

Symptoms of text anxiety have mild to severe effects, people experience many of these symptoms together during the exam. Depending on the severity; students with mild symptoms are able to perform fairly well; others are almost paralyzed by fear and can even experience panic attacks before or during the exams. Anxiety and Depression Association of America has categorised these symptoms under the headings- physical, emotional and behavioural.

Physical Symptoms

  • Sweating

  • Shaking

  • Rapid heartbeat

  • Dry mouth

  • Fainting

  • Nausea

Emotional Symptoms

  • Depression

  • Low self-esteem

  • Anger

  • Hopelessness

  • Distress

  • Feelings of inadequacy

Behavioural Symptoms

  • Fidgeting

  • Avoidance of testing situations

  • Forgetfulness

  • Self-doubt

  • Negative self-talk

There are several things that you can do to manage, reduce or deal with Test Anxiety:

Exam Awareness: Knowing your exam format, syllabus, marking scheme, important topics, allotted time and other details can help you plan an appropriate approach and make you more confident. If you are unclear about these things, discuss them with your professors or seniors. Try attempting mock tests to make yourself comfortable before an important examination.

Prepare well: Once you know what you are dealing with, you can plan you studies well before time according to your pace and study regularly. Ill-preparedness is one of the major contributors to anxiety during exams. Your confidence and self-esteem will rise when you have prepared well for an exam.

Rid the negativity: Refrain from negative or apocalyptic thoughts about the test and the result that will follow. Do not underestimate yourself or get stuck on past failures. Instead, assert yourself by thinking about your hard work and all the time you've put in. Remember, you get what you work for!

Physical well-being: Like mental state affects your physical state, the opposite is also true. A well maintained physical body can also give rise to a calm and stable mental state.

o Get at least 7 to 9 hours of uninterrupted sleep. Sleep helps in the formation of memory, prevents you from getting exhausted and keeps you fresh. A good sleep is essential prior to an exam to improve your performance.

  • A healthy meal before the exam will keep you alert and awake throughout the exam.

  • Exercise releases natural stress relieving hormones which keep you relaxed & at ease.

  • Meditation or breathing exercises can greatly improve your control on anxiety.

Writing the exam: On the day of the examination try doing these things, they might help you!

  • Arrive early to the exam, this will help you avoid unnecessary anxiety due to the last minute rush.

  • Engage your brain in revision or positive thoughts rather than negative ones.

  • Read the instructions and contents of the paper carefully to avoid confusion and avoidable mistakes.

  • Do not compare yourself to other students, go at your own pace. Focus on yourself.

  • Use time management to avoid haste at the end. Try dividing your allotted time according to the questions and the marks they hold.

  • If you feel overwhelmed at any point; sit back, take a few deep breaths to regain composure before you continue.

Finally if you feel things aren’t improving, try seeking professional help. Therapy can provide a more subjective and personalized approach to help you deal with your anxiety.