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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

if u think that the stress will be gone once u become a doctor then ur wrong...even residents and those who are subspecializing are still being pimped... and the right attitude is if u get it wrong, yeah LOOK IT UP... read on it... and u will learn...and u will really feel glad when u will be able to use it to help ur patients... not just to be able to answer the question
beta blockers might help... that is if u dont have any contraindications....

Posted by: ninett_umpa | Nov 19, 2008 6:04:16 PM

Of course you're not alone. I'm in fourth year medicine school now, and every day i must face high levels of anxiety and stress, but i believe it's part of our formation. Definetely do not go with any kind of drug, but you may try with simple relaxions techniques (like breath deeply, or if you are in presentations, try to look in people's forehead and not the eyes).
Personally, people say that i don't look nervous on presentations, but i'm always a bit scared. I guess it gives you the necessary adrenaline, right?

Posted by: Holy | Nov 19, 2008 6:39:36 PM

It is natural to be nervous... next time give the answer, we never forget our mistakes (no matter how hard we try), so you will also learn the answer...that is why making mistakes its so good. Make them now that you are not caring for patients and you will make a lot less when that time comes.

I loved making mistakes at lectures or study sessions when I was a student and still love making mistakes...as long as a patient is not involved, and regretfully some times you won't be able to avoid making a mistake while working with patients, that is also part of the learning process.

I am going to say something I hated to hear when I was in med school "Relax", it seems impossible but eventually you will see that a relaxed physician is a happy one and for some strange reason I feel that when I am happy I am also "in tune" with the right answers, so be cool and good luck.

Posted by: Fernando | Nov 19, 2008 8:39:16 PM

I have exactly the same problem..Until about 2 yrs back I was an extremely outgoing person, confident....But am a bundle of nerves now...
How can I overcome my anxieties???
some1 plz help...

Posted by: Gunjika | Nov 19, 2008 11:03:42 PM

wow...your condition just the same as mine but in my pathology class, we are not divided into group so we have to depend on our own knowledge. the profesor will just point to any student she likes n dang! the best part is, she does not only ask patholgy question, but sometimes anatomy too..T__T

Posted by: fara | Nov 19, 2008 11:12:29 PM

trust me you are not alone on this one...i've gone through 5 years of med school having the same anxiety attacks. as part of our final year curriculum we are supposed to present seminars (more like CMEs) to our entire class and one professor who is more often than not waiting for u to goof up!or be ignorant about a point so he can grill you..but looking back it is for our own good. once you start clinical rotations,the same Q & A session starts in the wards over every bed and one ends up feeling even dumber since the patient is listening and forming a judegement about you. but hey it's part of learning medicine...at no point can u say u have learnt enough...there's an infinite universe of knowledge and it is not possible to know everything. if it was only about cramming and spilling te right answers, we might as well have parrots doing medicine!
so take heart and stay away from the benzodiazepenes!

Posted by: Ritu | Nov 20, 2008 1:38:25 AM

you think you're nervous, try studying in Nigeria. A wrong answer can keep you in med school for the next 4 years. Despite our flaws as a Nation, Haven't you noticed that Nigerian Doctors seem to have better clinical skills.

Posted by: | Nov 20, 2008 1:49:02 AM

am doing my internship right now and anxiety is still as bad as it was in med school. what can we do but hang on!

Posted by: josie | Nov 20, 2008 2:04:01 AM

answer all the questions...
its NOT important you choose the wrong answer.
making mistakes is the first step for progress.

Posted by: Sahand | Nov 20, 2008 4:01:21 AM

its normal to feel anxious. try to get out from your comfort zone, do something diff. its ok to make mistakes, its ok to be yell at. thats how we learn. it doesn't matter if you r med student, law student etc.

Posted by: ll | Nov 20, 2008 4:21:59 AM

Hi, I'm a fifth year medical student in Jordan and believe me I go through the same anxiety everyday. Whether the Dr. is intending to be a bully or not i end each day with an unbearable tension headache and my clothes soaked in sweat...on one occassion the consultant started shouting at me in the clinic infront of all the patients, my friends and residents for no particular reason, other than to make a scene...but i feel like its helping me build up character (I hope anyway)....so glad to hear I'm not alone ;)

Posted by: Danah | Nov 20, 2008 5:17:25 AM

i think it's even more stressful during the question and answer session during bedside teaching... the doctor is just half a meter away, staring through your eyes, asking about surgical landmarks, pathology, differential diagnosis, treatment, and all sorts of question that randomly come up to their mind.

but it's fun.

Posted by: | Nov 20, 2008 6:42:47 AM

If I were you I would be grabbing for that microphone. Learning in any medical profession is a process of correcting your failures. I can guarantee that you will never forget the answers to any of the questions that your professor asks you.. even if you don't know the answer right away. It sounds like you have a good attitude. Be more confident and don't beat yourself up when you don't know something. Like one of the posts said earlier.. the more you know the more you realize what you don't know. Best of luck to you.

Posted by: John | Nov 20, 2008 7:35:15 AM

I had similar experince as well. I remembered during an orthopedic class, when the lecturer was asking questions, and the microphone was being passed around. I felt like petrified, even I know the answer, I just can't speak. But that experience motivated me to study before a class. It does help. =)

Posted by: Kai Foo | Nov 20, 2008 9:35:16 AM

I just had a REALLY bad one today. had to present a case for department rounds. unfortunately i still half asleep the day after a 40-hour call plus OT and i had to present a case that a colleague summarized. not knowing the case very well, i knew i was going to get shot and i did eventually, but not before stuttering and choking on my words and flipping through frantically the notes which my colleague just blatantly copied from bits of radiological investigations without much logical flow. it was a horrible experience.

Posted by: neo | Nov 20, 2008 12:10:23 PM

I had always felt that kind of anxiety of thinking you know the right answer but at the same time afraid of being wrong and scrutinized. Now in my final year I look back and laugh, and wish I had asked more to residents, professors, etc, instead of pretending I was ok with everything. So don´t be ashamed, we are students so we are expected not to know, ask as much as you can. I just met a resident that went to Yale and he was very straightforward and honest enough to accept he does not know everything but is willing to read about it. I think that´s the point right?

Posted by: pau | Nov 20, 2008 1:29:17 PM

It's such a relief to know that i'm not the only one feeling like a nervous wreck. there are some classes that i really study for and i simply get 4 out of 5 answers wrong...and i really feel miserable coz in my group i'm slightly more hardworking (but i don't think so i'm that smart) than the rest of my classmates, thus the teachers always put extra pressure on me to perform well during the exams, class works bla bla bla...i mean if others in my group can't answer, they look at me and honestly,this freaks the hell out of me...coz i'm just a normal student and no matter how much i wish i could answer well, there are many times that i fail..and i fail miserably. however,learning from these mistakes help me retain my knowledge better and most of the time i find that i'm more prepared for the next round regarding the same topic. now that i'm in my 5th year, i'm really getting anxious as to my capabilities to become a doctor. Guess doctors are humans after all :)

Posted by: anna | Nov 20, 2008 3:32:21 PM

When I used to have my rotations in the Cardiology floor, the clincal preceptor would constantly pick on me for answers in front of others.
If there was a patient who needed their catheter flushed, she'd call me.
If I a patient needed advance wound care management, she'd call me.
Not a day past where i felt at ease, nor did i get much compliments letting me know i did a good job. In fact, her voice was very flat so i didnt know when she was joking. But this brutle struggle made me more resilient, independent and eventually confident in my knowledge. I have become a stronger nursing student. She also inspired me to go to medical school.

Take home message:
-continually stepping into your fears can only help u. Eventually, you will concur them. The students that thrive on attention and showing their knowledge will succeed the most. Thats part of med school.

Posted by: Sunny Kwatra | Nov 20, 2008 5:07:57 PM

I COMPLETELY understand how you feel!! The stress and anxiety I have experienced even with bedside teaching has gotten so bad at stages that i've considered leaving medicine, but i'm slowly learning that you have to focus on what you do know and embrace what you don't....we are doctors in training after all and can't be expected to know everything, this is just the way we have to learn! It will feel so much more worth it for the worrying in the end when we finally reach our goal! Great article....

Posted by: Jean | Nov 21, 2008 3:36:03 AM

OMG!!!and I thought I was the only 1!!!really relieved 2 see ur post jeff...I face pimping almost every hour of the day being in my IM rotation and in final year with just 2 more months to end my medical school...and especially studying in India and being with the doctors who are at the epitome of knowledge it gets us all so worked up when questions are directed right at us...but it's amazing how the answer comes to us so quickly when the questions aren't to us!!!I get blanked out when asked and I guess facing it is the only solution!!!thanks a lot...makes me feel I've got company!

Posted by: simily | Nov 21, 2008 10:18:18 AM

It's comforting 2 know that it's not only my problem . Although-to say the truth- after several embarrassing answers I've slowed down some of this enthusiasm and stopped giving such answers.....

Posted by: Aya | Nov 21, 2008 11:52:14 AM

I am a senior, and have recently finished my int med rotation. We were 4 students to a group, each student assigned to an intern, and we had one professor as a supervisor. Every morning, after doing our labs on patients, clinical exams, vitals, etc, our prof would come down and we'd go through the wards and present our patients. I had to present my intern's patients plus be completely and utterly informed on the patients that belonged to the other interns and their students. On average, this was a total of 12-18 patients. I personally would have 4-7. Whenever the prof would ask another student something about his/her patient and they couldn't answer, I'd try as often as I could to be the next one in the line of fire. Reason? our prof would ask in order, each student, regarding the case, even if it wasn't his/her case. As he would go down the line, the questions became more and more nit-picky. That gave me so much anxiety!! I mean, it's hard enough to present, but then to know the craziest details...yes it keeps you on your toes, but at the same time, it makes you dread the moment when it's your turn. Just the fact that I'd be "scheming" in a way in order to get "easier" questions (which was not always the case)took its toll on me, on a daily basis. I felt like I had a final every day. I've learned a very valuable lesson and got why our prof did this:At least, when I'm a resident next year, presenting will be easy, or at least I got the anxiety out of my system!! That's life, that's med school. But hey, we asked for it, didn't we? :-)

Posted by: Charlotte | Nov 21, 2008 12:21:57 PM

wow! thanks for this. This is exactly how I'm feeling in medical school too. Back in school, I'm always answering and I get so much fun out of participating. Now, I'm dying to participate, but I don't feel I belong here (yet) and there's always the fear of answering incorrectly (especially when the rest of the class are all medical students and not just your typical school friends). Now I feel much better that I'm not the only one feeling like this. ><

Posted by: workaholic888 | Nov 21, 2008 6:47:56 PM

If you are interested in learning to speak well, on the spot, and learning helpful techniques to accomplish this in a non threatening environment try visiting a local Toastmasters club (in your spare time!)

Posted by: Diane | Nov 21, 2008 7:11:18 PM

I agree! med school is full of those feelings. U really can't be confident about something unless you know everything. Inspite that you know everything, sometimes you have second thoughts too! hahaha whatever. I hope I could survive med school...

Posted by: louvelle | Nov 21, 2008 8:29:55 PM

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