Articles and Case Studies

Effective Study and Surviving Exam Stress

04 Nov 2014

No matter how many exams you have sat before, it is likely you will experience an increase in stress and anxiety at exam time. Education Developer, Gemma Brudenell, outlines strategies for effective study and managing exam stress.

A career in medicine involves regular assessment. Lifelong learning is highly valued in medical culture and practise with ongoing learning and professional development a requirement for doctors.^1,2 Awareness of learning styles and strategies allows you to use your strengths and manage limitations to enhance learning. This is important not only to do well in exams, but also in becoming a successful doctor.

Learning styles and strategies

Learning styles describe “how” you learn – how you take in, process and retain information. By recognising your preferred style, and using appropriate study techniques, you will optimise your studying and improve learning. Learning styles can be classified into four dimensions: active or reflective, sensing or intuitive, visual or verbal, and sequential or global. Your preference towards a learning style in each dimension listed below may be strong, moderate or mild, and in some situations, both styles may apply.³

The Way You Connect with Information
The Way You Make Information Meaningful
	Active	Reflective
Characteristics	Retain information by doing something active with it, e.g. discussing, applying, or explaining to others^3-5 Like group work⁴	Prefer thinking about an idea quietly at first^3,4 Like to work alone^3,5
Strategies	Group study^3-5 Explain topics to others⁴ Create mock exams and work out how you will answer the questions⁴ Enhance your memory by doing something practical with the information⁶	Periodically stop to review the information^3,4 Write summaries in your own words⁴ Consider possible applications to what you have learnt⁴ Ask yourself questions as you study and investigate the answers⁶
	Sensing	Intuitive
Characteristics	Prefer facts^3-5 Like detail^4,5 Retain information by connecting it to the “real world”³	Prefer principles and theories⁵ Enjoy discovering relationships^3,4 Like using abstractions^3,4 and formulae⁴ Dislike repetition^3,5
Strategies	Find out how what is learnt applies in “real world” practice^4,6 Focus on the detailed aspects of a concept.⁶ Break large chunks of information into smaller parts⁶	Consider theories and link them to facts⁴ When taking notes, record facts so you will have something specific to study⁶ Practice explaining your reasoning in a way that others understand⁶
The Sensory Input You Prefer
	Visual	Verbal
Characteristics	Remember best what you see, e.g. demonstration, activities, graphs^3-6	Prefer learning through words, e.g. spoken, heard, or read^4-6
Strategies	Concept maps⁴ Colour coded notes⁴ Use visual representation of material such as concept maps,⁴ diagrams,^4,5 flow charts^4,5 Create mental images of the information⁶	Study in groups and explain information to each other^4-6 Write summaries of what you have learnt in your own words^4-6 Translate visual information such as graphs and diagrams into words⁶ Use mnemonic devices such as rhyme and acronyms⁶
Your Pattern of Learning
	Sequential	Global
Characteristics	Gain understanding in linear steps^3-5 Prefer to follow logical stepwise paths when learning⁴	Integrate new information without seeing connections and then suddenly “get it”^3-5
Strategies	Put information such as notes in logical order^4,6 When studying, create an outline of the material, connecting this to the learning objectives, and then filling in the details⁶	Skim over information to get an overview, looking at the “big picture” first^4,5 Study topics in large blocks of time rather than spending a little time on all subjects^4,5 Establish the relevance of the information and relate it to personal experience⁵

Exam Stress

It can be difficult to balance training and educational commitments with a heavy workload.⁴ This can be even more challenging during exam time. It is tempting to spend all your time studying, but this can lead to burnout and various physical and mental health problems.⁵ The following stress management strategies are not an exhaustive list, and you should include some of your own healthy strategies to manage stress during exam time.

Managing stress in the lead up to exams:

Discuss concerns with a mentor⁴
Exercise^4-6
Plan a holiday or time off⁴
Spend time with family and friends^4,5
Get sufficient sleep^5-7
Maintain a healthy diet^5,6

Managing stress during the exam:

Arrive at the exam in good time⁷
Take a few slow deep breaths before starting and whenever you feel your breath quickening throughout the exam^6,7
Make a time management plan that includes revision time⁷
Begin with the questions you feel confident about⁷
Don’t panic if you cannot answer a question immediately, come back to it later⁷
Be positive, use positive self-talk, e.g. “I have studied, I am prepared”⁶

Assessments are often stressful, but using study strategies based on your personal learning style can lessen this stress and increase your learning. Remember that effective learning is important for medical professionalism, not just passing exams.

References
1. Agnew A, O'Kane C. Addressing the Hiatus of Learning Incentives for Prevocational Doctors: Continuing Medical Education Points For Interns. Med J Aust. 2011;194(7):349–52. Available at: mja.com.au/journal/2011/194/7/addressing-hiatus-learning-incentives-prevocational-doctors-continuing-medical.
2. Medical Board of Australia. Obligations on Medical Practitioners. AHPRA; [updated 19 July 2011; cited 3 October 2012]; Available at: medicalboard.gov.au/Registration/Obligations-on-Medical-Practitioners.aspx.

3. Seiler D. Age and Learning Style in the Adult Learner. The Journal of Human Resource and Adult Learning. 2011;7(2):133–8. Available at: hraljournal.com/Page/15%20David%20Seiler.pdf.
4. Australian Medical Association. AMA Survey Report on Junior Doctor Health and Wellbeing. 2008. Available at: ama.com.au/node/4217.
5. beyondblue. A Script For Healthy Living and Wellbeing. In: Perry W, Hillis J, Shun M, editors. Keeping Your Grass Greener: The Wellbeing Guide for Medical Students: Australian Medical Students' Association; 2011. p. 12–3. Available at: media.amsa.org.au/publications/keeping_your_grass_greener_2011.pdf.
6. University Counselling Service. Tip Sheet for Exam Anxiety. Australia: The University of Newcastle; 2010. Available at: newcastle.edu.au/Resources/Teaching%20and%20Learning/UNISS/Student%20Resources/examanxiety.pdf.
7. The Learning Centre. Surviving Exams. The University of New South Wales. [updated 17 August 2012; cited 5 October 2012]. Available at: lc.unsw.edu.au/onlib/survive.html.

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