On sober Eugene (or embracing the minimum effective dose and test anxiety)

Three days before my first medical school exam, I spiraled into a whirlwind of doubt and anxiety while leaving a movie theater. “You are bad at this, why are you studying material that you don’t care about? You know this is only the first test, right? If you are losing your cool now, how can you survive the next year, let alone residency?” The negative self-talk grew in volume and in strength: seeing a movie, a simple study break, turned into a near melt-down as the credits rolled and test anxiety sunk in around me.

Even before the first lecture of medical school, I knew I had to shake off the student cobwebs. A four year gap between finishing undergrad and starting medical school had left me with a lot of self-doubt about my capabilities compared to my peers. Some of them entered into seven-year programs and should technically be seniors in college, but instead are charging through higher education and into their careers.

Coming from the world of coaching, CrossFit and high school rowing, I could talk to a standardized patient with no prior planning and keep most of my cool. Ask me to memorize the molecular cascade of intracellular transcription signaling? My eyes will glaze over while I sweat only out of my armpits.

So, a few weeks before the first exam, I decided to conduct an experiment on myself.

Within medicine, and some physical training philosophies, the idea of Minimum Effective Dose (MED) guides a wily physician. Consider a strong and potent chemotherapy– yes, it destroys cancerous tissues, but also ravages the patient’s body and spirit, so giving them all the chemo that you have in stock is out of the question. You also need to give them a strong enough dose to rid the patient of the cancer, or else any surviving malignant cells will be resistant to further treatments with that specific chemo. Thus, you need to find the MED: the dosage at which you are effective for the treatment, but not any more.

There are a number of possible outcomes regarding the first exam, with my effort and study time as the primary input variables. Let’s say that I put in the maximum amount of preparation possible for the exam– I sequester myself in my apartment, force myself to constantly review flashcards, and am overall not very happy but know that I did everything in my power to do well on the first test. Not taking into consideration the efficiency of study, meaning that certain study styles could have a greater return on time and effort invested, let’s go a bit further and assume that my maximal effort is rewarded with a stellar grade.

High test scores = awesome, but what did this sequence of events tell me? If I devote all of my time to studying, then I will get great grades. Well, what if I devote 90% of my time to studying, will that yield good grades? Or still great? At what turning point does additional effort yield negligible results, considering that my time is valuable.

Yes, I can do the studious hermit routine to prepare for an exam; I can probably do it for two exams, but can I maintain that effort throughout the entire first year? Will I burn out due to a lack of social, emotional, and spiritual stimulation in my life?

My experiment attempts to determine the MED for my study preparation. In order to find this sweet spot, I need data points. To obtain these valuable data points, which will guide my future studies, I need to take exams with varying levels of preparation.

Under the (possibly arrogant) assumption that if I were to maximally study, then I would do maximally well on the exam, I decided that I could move onto other study amounts. Under the (likely correct) assumption that if I were to minimally study (ie not at all), then I would do minimally well on the exam, I decided not to play with fire as I didn’t really want to fail my first test of medical school.

Too hot and too cold; with the MED, I need to find the amount that is just right.

Keeping to this experimental plan is trickier than it sounds. Sober Eugene, with no real worries way ahead of the exam, can say and create whatever plans he wants. Stressed Eugene has to deal with those plans and actually execute them despite the loud voices telling him to abandon ship. Stressed Eugene has to trust that Sober Eugene made an informed and intelligent decision on his behalf– Sober Eugene tends to believe in Stressed Eugene more than Stressed Eugene does.

This relationship expresses itself not only in exam experiments, but also at mile 21 of the Boston Marathon, the morning before an amateur MMA bout, and on the first day of medical school. Sober Eugene tends to create a lot of madness for Stressed Eugene, and also a lot of growth.

So, I found a very medium option. I decided to study a little bit. Nothing too crazy– I’d go to all the lectures, review some materials on the long days but not beat myself up if I felt too tired, and study a solid four or five hours on the weekends and enjoy myself for the remainder of the day. The first exam landed on a Wednesday and on Sunday I felt pretty good.

Then, a Monday review session happened. As others answered the questions effortlessly, the doubts began to creep into my mind, “Is this really a good idea? Everyone else seems to be preparing a whole lot, maybe this experiment is a bad idea. I can’t be taking med school so lightly!” And I slowly and definitively began to transition from Sober Eugene to Stressed Eugene. I spent most of Tuesday studying, trying some group study to no avail, just feeling inadequate and that my knowledge-level couldn’t compare to my peers. As a study break, I went to a nearby movie theater and ate some dinner.

I try to control my diet for mental performance reasons– I have found that the cleaner I eat, the cleaner I think. The physical manifestations of a high-fat and whole-food meal plan are secondary to the cognitive benefits. I ate a burger and fries in this stressed out state and this triggered the introductory downward mental spiral. I wanted to curl into a ball and ignore the rest of the day– didn’t want to take the exam either. The movie wasn’t very funny, either.

When I got home, I used my last bit of willpower to sit and breathe. I began my mindfulness practice, which revolves around breathing exercises, and felt control materialize in my hands. With each breath, the weight seemed to lift a little, and by the end of the ten minutes, I felt brand new. I remembered my trust in Sober Eugene, studied a bit more before going to bed, and took the exam in the morning.

And the results of the exam? A solid pass. Nothing fancy, no high honors. I passed my first medical school exam and I didn’t beat myself up too much to get it. Now, I can adjust my studying strategies from this baseline to find that groovy MED and I can believe that Sober Eugene knows what he’s talking about. It’s going to be a long couple years, but Stressed Eugene is all buckled-up, has his helmet and mouth guard properly fitting and in place, and may or may not have on a diaper underneath all those layers.

7 thoughts on “On sober Eugene (or embracing the minimum effective dose and test anxiety)

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