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My Weekly Anxiety Attack

JeffJeff Wonoprabowo -- I remember when I was in first grade, my teacher would split the class into teams and we would play trivia tic-tac-toe. Whichever team was able to answer the question correctly had the chance to place an X or an O on the board. At one point I answered so many questions in a row that she instituted a new rule: Jeffrey can't answer every question.

Somewhere along the way, I have no idea when, I stopped wanting to answer questions -- even when I knew the right answer. Thinking back to my college days, I don't think I ever raised my hand to answer a question or offer an opinion. I only did so when called upon. Maybe I didn't want to sound dumb saying the wrong answer, I don't know. All I know is that I've gone from an excited first-grader basking in the spotlight of answering questions to someone who would rather just sit quietly and let the spotlight fall on others. Now that I'm older and wiser, I know the value of being "cool." And it can be quite stressful being put on the spot, with the wrong answer, or no answer at all, rolling off your tongue.

In medical school, about once a week, we have a pathology session that involves team-based learning. During these sessions, the class is divided into groups of five (these groups work together throughout the whole year and various different classes as well). Each lab session is intended to help reinforce the material we covered in lecture during the previous week. And this is where I am guaranteed my weekly episodes of anxiety and stress.

At the beginning of the lab session the groups are all given a laptop and we take a group quiz on the computer. Once that is submitted, we receive a worksheet with about 12 clinical vignettes. We must determine the disease for each one and answer questions about each particular case. (These questions will ask for things like the mechanism, clinical presentation, comparisons with similar diseases.)

After about 40 minutes, our course instructor picks up a microphone and announces that our time is up. His assistant walks over to a group and hands the microphone to a person of her choice. At this point, Nervous Student (NS) has the eyes of the entire lab (almost 100 pairs) on NS, and NS has no choice but to take the microphone and announce his/her name and group number. And the encounter might go something like this:

Professor (P): "What does this patient have?"

NS (answering with a shaky voice): "Carcinoma-in-situ"

P: "And what condition most likely preceded this lesion?"

NS (drawing a blank): "Um..."

P: "Consult with your group."

After conferring with the group, NS replies: "HPV infection leading to dysplasia."

P: "Good, and will the biopsy reveal malignant cells penetrating the underlying basement membrane?"

NS: "Uh.. I don't think so."

P: "Of course not."

NS (sounding very confidant): "Oh, right. Of course not!"

Cue class laughter.

The encounter might seem quite benign. No harm, right? But every time I go to lab I am anxious and apprehensive hoping that the microphone is not pointed in my direction when it is my group's turn. And I get the feeling that I'm not the only one who feels this way.

Maybe it's good for me and will prepare me for the pimping that will come during third and fourth years. Then again, with all the stress and anxiety, maybe it's bad for me.

Oh, who am I kidding? Medical school is a big ball of stress and anxiety, and that much more can't be that bad... Right?

November 14, 2008 in Jeff Wonoprabowo | Permalink

Comments

Next time, grab that microphone! Defeating your anxiety means facing up to it. I solomnly swear that you are not the only person feeling this way. And you are definitely not the only one who is not sure of the anwswer. I graduated 2 years ago, and I still get things wrong. The greatest skill you will ever develop in medicine is the ability to tolerate looking silly. It makes learning a lot easier!

Posted by: Jessica C | Nov 15, 2008 2:10:26 PM

Thanks for being so honest about you anxieties. This is a skill you can't learn for your medical books. Only a few doctors I have met are brave enough to commit their weakness. So go on!!

Corine (medical student, The Netherlands)

Posted by: Corine | Nov 15, 2008 2:47:47 PM

So I really don't know how are things in the US or even in your med school (I'm from Venezuela), but right now I'm doing my clinical rotations (IM at the moment) and every day is an anxiety session guaranteed. Everybody asks you anything about anything, and you just HAVE to know the answer. If you don't, your told to look it up, but being so close to actually have the patients' lives in my hands, I feel really bad when I don't know something I should. So my advice is that you take the chance to conquer your fears in a controlled environment while you still have the time and study A LOT!

Thanks for your post! It makes me feel like I'm not the only one ^^

Posted by: Daloha Rodriguez | Nov 17, 2008 1:33:41 PM

I'm sooo glad i'm not alone!!!!! Here I'm in first year med school and besides feeling like I'm the only one that hides from the professor when he calls on people, I thought I was the only one sweating bricks!! I'm relived to know that I'm not the only one that this situation is just a process in which us future doctors have to over come.

Posted by: Judy | Nov 18, 2008 2:49:45 PM

you can always try beta blockers.. they're great for public speaking

Posted by: scott | Nov 18, 2008 3:30:41 PM

... or you can try Inderal or Xanax! Thanks for your story.

Posted by: molly | Nov 18, 2008 3:59:37 PM

It sounds like you need to see a psychiatrist. Fix this problem as early as possible.

Posted by: | Nov 18, 2008 5:20:53 PM

Molly is obviously not a med student.

Posted by: | Nov 18, 2008 6:18:07 PM

This story couldn't of come at a better time. I just got back from the Dr.like about 2 hrs. ago I was told I have anxiety and stress. I am in the nursing program and like you we have clinical and skill check offs,nursing diagnosis, testing everyday, and teachers who are less than sympathetic.I usually can handle the stress but lately I get dizzy and a confused, foggy feeling. So thanks for letting us know we are not alone in this.

Posted by: Debbie | Nov 18, 2008 7:52:11 PM

It is med school. Be thankful that the anxiety attacks are ONLY once a week. As a first year, I try to keep it to once a day...although I am not so sure I will survive if I keep that up.

Posted by: Adam | Nov 18, 2008 8:40:58 PM

I'm not sure why the person above suggested that you see a psychiatrist. It's perfectly natural to feel the anxiety you're feeling. I find that it's like jumping into a cold swimming pool every time I do something like you describe: once I start swimming, I feel better, and the more often I do it, the better I'm able to handle it.

The laughter is totally benign. People are sympathizing with you, not scrutinizing you.

Posted by: Greg | Nov 18, 2008 8:59:30 PM

I can totally empathize and sympathize with your anxiety. As a 3rd year Nursing student, I have experienced many days of frustration and many hours of studying and at times, still not being able to produce all of the correct answers...that is why we are in school, is it not? If we knew all of the answers we wouldn't need the class. So, knowing that you are not dumb and you are in learning mode, it is okay to be incorrect to get the correct answer. We actually learn things better, after we have gotten the answer wrong...We learn 1st why it is wrong, then the rationale to why the other is correct...So, even though we feel that we may be embarrassed that we gave the incorrect answer, others have done the same thing and have felt embarrassed inside. But they too can feel your pain, as we all do...so, bottom line, the more you get wrong, the more you are learning and becoming more prepared! Keep Learning!!

Posted by: Michelle M | Nov 19, 2008 12:28:15 AM

Thank you for sharing.

Posted by: Melody | Nov 19, 2008 5:34:14 AM

Jeff- it's not you.

It's not your fault and there is nothing wrong with you. Don't rely on beta blockers and certainly avoid Xanax or any other benzodiazepine!

The medical system, as you are beginning to see, is filled with bullies and know-it-alls. Unfortunately, when you begin your third and fourth year clinical rotations, you'll find that these particular groups of people seem to blossom into their full potential. You are smart and resourceful though, and you'll find a way to deal with them.

Here's a big secret that only the most honest of physicians will admit: The more you know, the more you know that YOU JUST DON'T KNOW.

So when you run across an arrogant pathology resident who makes remarks that imply you are an idiot for questioning your own knowledge, remember that it's his/her problem, not yours.

You're doing great - - your honesty and vulnerability will help shape you into a fantastic physician.

Ann, MD

Posted by: Ann | Nov 19, 2008 6:45:02 AM

I too am a nursing student and feel a lot of anxiety and stress when put in the spotlight. I believe our instructors dream up ways to pull us out of our comfort zones....oh , soon this will be a faded memory. Right?! Good Luck!

Posted by: Traci | Nov 19, 2008 6:45:22 AM

I agree with Ann, MD. It's perfectly natural to feel anxious under such scrutiny, especially if the instructor insists on picking on people at random. Your reaction suggests that you care about your subject and are honest enough to know your limitations which will make you an approachable and safe physician. Looking at the scenario you've given above, there is no positive feedback or encouragement from the instructor. My training as a medical herbalist in the UK was much more encouraging. When wrong answers were given the tutor would talk us through the processes to the right answer, making sure that we all understood before moving on. Clearly, if one student doesn't know the answer (and let's face it - there aren't always clear cut answers in healthcare!) then it's quite likely that others don't know either.

It might help to talk to fellow students about their experience of this weekly session and perhaps you could talk to the instructor privately (or pass an anonymous note) to see if a more collaborative approach helps.

No-one knows everything - not even the instructor!

Posted by: Paula Foster | Nov 19, 2008 10:06:13 AM

Oh yes, grab the microphone!
In fact, you are not preparing for the third or fourth year, but to be a PHYSICIAN!
To be a good physician is not only a question of your knowledge, but mostly your self-confidence you can treat your patients! (if you don´t desire to stay in lab or so..)
Don´t concentrate so much on your anxiety, but rather find the way how to cover you feel nervous. It is the condition which ever worse patients trust!
Imagine you are in a surgery, alone, nobody else listen to you just a nurse and young woman scared of cancer...

It´s great you´ve written the article - brave and honest. The first step to deal with your anxiety!
Look straightly on your fears and fight!
I believe you, just go on!

Posted by: Alzbeta | Nov 19, 2008 10:40:31 AM

Thanks for the encouragement, everyone.. and for the psychiatric counseling too.. LOL.

I just wanted to clarify that none of us think that this professor is mean, inappropriately picking on people or being a bully.

He is one of the most liked teachers in the medical school and has won the teacher of the year award a number of times (voted by students).

But I can see how it may have sounded like being picked on, so I just wanted to say that.


Posted by: Jeff Wonoprabowo | Nov 19, 2008 12:03:11 PM

Each day was challenge in second year medical school. Patho tutorial today or be it Pharmac tutorial tomorrow. Every day was a challenge for your nerves and I remember being scared every single day. You are not alone. But I guess they help you realize that medicine is not that simple as any other profession and that one must keep reading every day! If it were not these nerve recking tutorials we would not care reading well before the exams we on our head!

Posted by: Leena | Nov 19, 2008 12:17:45 PM

Just wait till clerkship when your weekly anxiety attacks become a multi-daily event...but it gets better. I'm in my 11th week of clerkship and, those first couple weeks getting put on the spot at least 5-6 times a day, and getting 4 out of every 5 answers wrong, can make you dread waking up every day. But you learn to savour the right answers and forget about all the times you're wrong. When the time comes when you get an answer right that neither you nor the preceptor expected you to get right (trust me it will happen!) and he/she says "Excellent" or "Well done", you hold on to that feeling for the rest of the week!

Posted by: Zo | Nov 19, 2008 12:24:08 PM

Its a sign of REAL strength to be able to admit youre weaknesses for yourself and also a sign of good judgement...

Posted by: | Nov 19, 2008 12:34:13 PM

I feel your pain Jeff. I too have the same problem and Im a nursing student. It's good to know that Im not alone because they are times that I don't retain all the information learned in class and I do get anxious when the spotlight is on me. Learning from your mistakes just makes you a better person. I have been stressed since I started my nursing program and I've never thought that school can be this stressful. We all are in the same boat so have more confidence in yourself! Good luck in med school! =)

Posted by: kit | Nov 19, 2008 12:36:39 PM

Don't worry you are not alone on this boat... It is pretty common for second year students to react with anxiety, it's basically something which everybody has experienced in some extent. Now the problem is that if you answer alright as it seems to me, than just ignore that feeling inside you that tells you not to answer and it will go away eventually. On the other hand, if you observe that you aren't coping with the material, than it's a completelly different problem. In that case you need to "Shift waits": The feeling of anxiety comes as a compensation from your subconcious, which basically is telling you: "You are not prepared, you can't make it..." and that anxiety is what comes of it.
You should shift your anxiety in off the class hours,where you need to learn more, study more and basically "suffer" more. Yes, is just like old school "the more you sweet here the less you bleed out there". Anyway, success!

Posted by: George | Nov 19, 2008 2:56:29 PM

From my experience, despite the anxiety I was feeling, I was able to learn so much during sessions like these...especially if the professor keeps the questions coming...they squeeze our brains til they're dry but we come out of the class with a bit more knowledge.
Remember mild anxiety is always good, we end up becoming more analytical and better at problem solving...just as long as you keep it mild of course..hahaha
Good luck and God Bless!!
wait til pre-board review or wait til after the boards while waiting for the results....that is real anxiety...hahaha

Posted by: | Nov 19, 2008 5:36:11 PM

Hi smart fellows!! Thought this topic is kinda interesting so I pop in to have a look. I'm not a medical student but studying other medical fields. Well, it's pretty normal to feel anxious. Anxiety is good to a point it boosts performance but bad in a way if anxiety is over some point. I can totally understand Jeff's feelings. I myself had some kinda anxiety disorders and chronic insomnia during my study life. I tried everything but nothing works (sleep hygiene, benzos-yuck, I hate benzos!!). I had a few sessions of psychological counselling and accupuncture and it did help me...But I think for your case you don't need to do any of these. Trust me, everyone has gone through some level of nervousness!! I myself was like a nervous freak everytime during presentation or tutorials or oral exams. Thank god I don't need to go through them now. Now come to think of it I just felt it's kinda funny why I need to be so nervous when it's totally unnecessary. Oh well, I think the lecturers want us to be well equipped before the sessions to make sure we know our stuffs well. We're health care professionals & you have an important role because many lives lie in your hands when you become future doctors!!!

Posted by: J | Nov 19, 2008 5:54:37 PM

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