What to do the night before your fellowship exams
It is important to understand that while you may focus on the night before the exam, or exam-day preparation, the overall exam experience is multi-faceted. There are three equally important supplementary “phases” surrounding the exam itself: the learning phase, the preparation phase, and the post-result phase (Raffety et al., 1997). So, while the focus is on the day before exams, it is vital to view that day not in isolation, but as part of a larger system and process of preparing, performing, and learning.
Pre-exam nerves and anxiety
There are five main types of exam-specific coping strategies:
- Positive Thinking
Coping with pre-exam anxiety is situation-specific and depends on two key personality traits: worry and emotional arousal (Kondo, 2007). Worry involves the thoughts and concerns about the consequences of potential results (e.g. failing); emotionality is the perception of autonomic reactions that are evoked by the situation (i.e. preparing for and performing the exam) (Stöber, 2004). The way that these traits manifest will be different for each person, and – importantly – different in each situation.
Take-home message: focus on what you can control
Understand yourself, where your strengths are, and where your preparation could potentially be derailed. When you are clear about this, you can then set about creating routines, systems and methods that support you achieving a mindset and disposition that gives you the best chance of success on exam day.
An example of why it is so important to know what works for you, and what you need to achieve on exam day, is taking a daytime nap – while there are physiological benefits, they “work” for some people and not for others. They may be effective in certain phases of your life and not in others (Vgontzas et al., 2007). Another example is caffeine – sensitivity to caffeine varies greatly across the population.
Take-home message: You need to find what works for you, in your context.
Exam-day considerations – the logistics are very important
Have as many of the logistics sorted the day and night before the exam. This includes things like your diet, such as meals for the day before, morning of, and snacks for during the exam. Make sure you are across the regulations for the day (including food and water allowances): RACGP CCE FAQs.
Make it as simple for yourself on exam day as you can – the less decisions you need to make on the day will help you keep your mind as clear as possible and keep your stress levels lower than if you were to spend the hours prior to the exam trying to find something to eat, pick out the clothes you will wear, find out your car doesn’t have enough petrol, or you don’t know where to park.
On exam day, if you want to, do a top-line review of your notes, then put them away. Don’t try to cram in any last-minute information – this could actually increase your stress and anxiety which may have the opposite effect on your performance than you want.
It is crucial to think through the actual exam-day experience – do you need to socialise before the exam to feel energised, or would you prefer some alone time to prepare on your own? You need to consider how you will navigate this in the time preceding the exam. Some registrars recall feeling distracted because of an unwanted conversation prior to entering an exam hall, or seeing someone they didn’t want to. Think of ways you can mitigate this, if this might be a concern for you – would you prefer to be at home on your own prior to the exam? Or do you need the distraction of family and friends in the morning prior to your afternoon exam? What do you need to do to stay calm and relaxed (e.g. go walking, listening to music, meditating, socialising)?
Take-home message: Don’t do anything new or untried in the week leading up to the exam. This includes sleep, nutrition, exercise, study techniques – keep things as predictable and as basic as possible. The NSW Institute of Sport outlines practical tips of how to prepare, both mentally and physically, for exam performance, covering nutrition, hydration, sleep and planning. Read their article here.
Planning for the second day of the exam
You may also want to consider what material you want to review (if any) after your first day of the CCE that will help you move on from thoughts about the exam just completed, to re-focus on the upcoming exam. Are there specific notes or a case study that you can have ready to read over lunch, or a colleague that you can arrange to call on Friday night to debrief and refocus, ready for the weekend? Would exercising or a certain meal help you to get into a healthy headspace?
Students who slept 6-10 hours at some point within 24 hours before the exam obtained significantly higher exam scores than did students who slept less than 6 hours (Fakhari et al., 2016).
While a good night’s sleep the night before your exam(s) is vital, this won’t happen in isolation – healthy sleeping routines and habits need to be embedded in the days and weeks leading up to the exam. A study of residents and medical students found that poor quality and lack of sleep leads to subjective feelings of increased fatigue and decreased motivation (Browne et al., 1994). Lack of enough and uninterrupted sleep will not only impact your potential exam performance, it is also likely to decrease your motivation to study in the lead up. Wake as early as you need to spend as much time as you require getting organised and into the right head space for the exam. Give yourself an extra half an hour if you need. If you can, arrange someone to babysit the kids, or a spouse, partner, parents or someone else to take on your parental and home duties for the Friday and weekend of the exam. Have children that wake up during the night? Organise to sleep elsewhere (a different bedroom or even house!) and organise someone else to be on call during the night in case there is a late-night wake up. The research is clear on the impact that sleep will have on performance, so set yourself up for the best chance of an uninterrupted sleep.
Let those close to you know that you have the exam coming up this weekend – their well wishes will help instil positivity and a sense of optimism, underpinned by support and community. It will also help you re-focus after the exam, if you have plans booked in, whether that be immediately after the exam (e.g. going for a meal or a drink with colleagues who also sat the exam), or arranging a catch-up for later that day, once you have wound down from the exam experience. Having something else to do will lessen the “all or nothing” feeling once the final exam is finished – having other plans will help you maintain perspective and shift your focus away from the exam.
Good luck and all the best from the GPEx + ModMed team!
Browne, B. J. et al. (1994). Influence of sleep deprivation on learning among surgical house staff and medical students. Surgery, 115(5), 604-610. https://pubmed.ncbi.nlm.nih.gov/8178259/
Fakhari, A. (2016). Sleep duration the night before an exam and its relationship to students’ exam scores. British Journal of Medicine & Medical Research, 15(8), 1-6. link
Kondo, D. S. (2007). Strategies for coping with test anxiety. Anxiety, Stress & Coping, 10(2), 203-215. https://doi.org/10.1080/10615809708249301
Raffety, B. D., Smith, R. E. & Ptacek, J. T. (1997). Facilitating and debilitating trait anxiety, situational anxiety, and coping with an anticipated stressor: A process analysis. Journal of Personality and Social Psychology, 72(4), 892-906. https://doi.org/10.1037/0022-35188.8.131.522
Stöber, J. (2004). Dimension of pre-test anxiety: relations to ways of coping with pre-exam anxiety and uncertainty. Anxiety, Stress & Coping, 17(3), 213-226. https://doi.org/10.1080/10615800412331292615
Vgontzas, A. N. et al., (2007). Daytime napping after a night of sleep loss decreases sleepiness, improves performance, and causes beneficial changes in cortisol and interleukin-6 secretion. American Journal of Physiology, 292(1), 253-261. https://journals.physiology.org/doi/full/10.1152/ajpendo.00651.2005