How Do You Calm Pre-exam Nerves?

Kendra Campbell -- Yesterday, I took an oral clinical skills exam, which will allow me to progress past the basic sciences and delve into the clinical world. It was an absolutely nerve-wracking experience. The exam is split up into four rooms. Two rooms involve completing a clinical task, one room involves examining someone with a particular complaint, and one room has a simulated cardiac patient that you must examine and diagnose. I’ve been practicing my skills for months now. I felt pretty prepared going in, but it seems like my brain went out the window when the exam came.

To add fuel to the fire, I was the very last person to go in my group. That means I had to wait for several hours while everyone else completed his or her examinations. I sat in a room, trying to not chew what’s left of my fingernails off, while they called people one by one into the rooms. Talk about stressful!

In my first room I was asked to do a complete examination of a patient’s pupillary reflexes. I had to remember to test both the light and accommodation reflexes. Simple enough, right? Well, I think I did okay. Then the examiners started asking me all kinds of secondary questions like what is an Argyll Robertson pupil, and what pathology would you see in someone who has multiple sclerosis. Luckily, I knew all the answers, and I think I passed that exam.

The second room was the cardiac simulator patient. By this point I should have been getting less nervous, but for some reason I was getting even more nervous! We only have six minutes to complete the exam, and I spent almost a minute trying to find the mannequin’s radial pulse, only for the examiners to finally tell me that his radial pulse wasn’t working! I then proceeded to auscultate the heart. Under any other circumstances, I could have identified the problem as a systolic murmur, but I was so nervous that I blurted out “diastolic murmur!” I realized right away that I was wrong because they started asking me what the problem could be if it was a systolic murmur. Luckily I was able to come up with some causes. Then it was on to the next room!

I entered the room and was asked to perform a pelvic exam on a patient complaining of right lower quadrant pain. I’ve practiced doing a pelvic exam many times, but I suddenly panicked anyway! I explained the procedure, and positioned the patient in the lithotomy position. Then, I switched to the model to do the actual exam. Usually, we don’t use lubrication on the models, but the examiner asked me to anyway. After inspection, I inserted my fingers to begin the exam. Well, since I was the very last person that day to perform the exam, there was already tons of lubrication inside. I could barely feel what anything was! In addition to that, the model was somehow distorted (I still don’t know what it was), and I thought for a moment that there was a foreign body inside! I proceeded to do my best to describe what felt like an octopus (no, I definitely did not say what I thought it was) and finished the exam.

The very last room was a gentleman with the complaint of angina. Although I forgot a few things along the way, I think the exam went pretty well. However, the man had significant bradycardia, and it was somewhat difficult to describe the sounds. But I think I got the secondary questions correct, so I hope that made up for my small mistakes.

After I walked out of that room, I felt like a huge weight had been lifted off my shoulders! My heart rate began to slow down, and I could finally take a huge breath in and out. I still have seven more exams to go in the next three weeks, but luckily they are all multiple choice written exams, which are much easier for me to handle.

Over the next few hours, I went over everything I did and said during the exams in my head. I realized what I forgot to do, and I knew the answers to questions that I hadn’t been able to answer at the time. Why couldn’t I remember all that stuff during the actual exam?! It was probably because I was so horrified during the entire experience. I don’t get pre-exam anxiety when it comes to written exams, but for some reason, I turn into a bumbling idiot before oral clinical practical exams. Do any of you out there seem to have a similar problem? Maybe you’ve figured out a way to calm your nerves before an oral exam? I’d love to hear any suggestions you may have!