I’m sure there’s a whole bunch of you studying for those infernal clinical exams, or know someone who is. I do not look fondly on those days (few do, occasionally you get a misty-eyed consulting waxing lyrical about how they loved carrying their briefcase away), partly because they were, well, horrible and partly because I have classroom anxiety. There. I said it. In public (of sorts). I don’t know when it started and it was a very very long time before I realised it was a problem, but sometime between high school and med school, I became extremely afraid of classroom environments. It probably got worse in medical school – there’s nothing quite like being an arts grad in postgrad medicine, busting your arse comprehending a chapter in your physiology textbook, fronting up to class the next day armed and proud with your newfound knowledge…and then getting absolutely owned by your cocky PhD wielding colleague who just happened to do their doctorate on that very subject. And variations on that theme. Daily and weekly, for a good two years. Being the dumbest person in the room for a protracted length of time broke something in my brain and I didn’t realise it for a long time.
It started with avoiding lectures. Especially the ones where the lecturer was known to pick on people. The thought of being picked on, of not knowing the answer, of everyone discovering that I didn’t belong there, that I was in some way illegitimate was just too much. Then suddenly when I began to study, learning new information became anxiety inducing. I fell into this strange hopelessness that whatever I learned would never be enough, someone was always going to know more, be better, be more worthwhile, which in turn would reinforce that I was nothing. So I began to avoid studying too. Then my fears would be reinforced when I did front up to a class, and be berated for not doing the pre-reading, when all my other conscientious colleagues would dutifully know the answers. The berating then deepened the anxiety and the avoidant behaviour got worse. Eventually even when I did study, it got to the point in classroom situations that my memory became impaired by the anxiety of it all, and even if I had learned the right answer, it was gone. Either it never went in from study anxiety, or it couldn’t come out due to classroom anxiety!
Occasionally I would have bursts of ultra-effectiveness, learn something really well, show up to class and know the answer…and then feel like an impostor because I’d learned it the night before and didn’t do it consistently. Sometimes in your own mind there is no winning.
Clinical exam practice was particularly painful. You have to show up, or you fail. So I did. I still remember being shouted at “DON’T FREEZE UP! YOU CAN’T FREEZE UP ON THE DAY!!” in front of everyone. And while I showed up, I was still so impaired from the fear of it all. I couldn’t pre-read because when I did, all I could think about was how I was never going to know enough or be good enough, or be like that awesome colleague who just studied consistently and practiced and did everything right. I cried every day from that anxiety, and I was very very lucky that I had colleagues who stopped me in corridors and hugged me, or made me laugh to distract me. Your colleagues are your everything in times like these.
These days I still freeze up. I still hide in the back of the classroom hoping I wont get picked on. In medicine people love being the one that knows the most, they love it when someone gets something wrong because we all love to show off our knowledge, it’s like a reflex. But I still show up and don’t avoid, and sometimes the class is on a topic I know something about and even stick my hand up to answer. It seems like such a small thing doesn’t it? I take a lot of notes that I never seem to read, mainly to focus and calm down. I look at my higher functioning colleagues, the consistent ones and these days I’m in awe. I’d love to be that person asking the intelligent questions. Maybe one day I will!
I look back over med school and my early career and wish I didn’t have this anxiety. How amazing I would have been if I wasn’t so worried about everyone finding out. Of letting go and allowing myself to be seen as stupid. Of just letting go in general. I’d get better marks, get along with consultants better – ah c’est la vie! And the problem with anxiety is that it’s your normal – you don’t know you have it. Your brain protects by coming up with perfectly reasonable excuses not to study, not to attend class, your ability to justify it is simply amazing, and you’re generally affronted if someone suggests anxiety to you because you’re so unaware of it. Excuses are your reptilian brain’s way of protecting itself and it’s so hard to break free of them. As the exam looms, try to notice it. You don’t have to ‘fix’ it, just notice. Through the practice of noticing, you find a new voice that takes you by the hand and leads you around the excuse, it allows you to put the anxiety into words with your colleagues, it allows you to start becoming that amazing persistent person. And if you notice that it’s a really big problem – find a psychologist! It’s a really really really fixable problem and any performance coaching psychologist or educational psychologist will work with you and tailor a program to take it down from destructive anxiety to the best functional kind. My very best friends have this amazing ability to take their fear and turn it into relentless study. I’ve slowly developed the skill over time, and I’m very glad to be able to write this post because admitting it means it’s finally conquered.
Yesterday was Crazy Socks 4 Docs Day and this post was written in support of physician mental health. We all suffer in this job and we are all in it together – I hope by admitting one of the things that has crippled me, that my readers can find a little solace.