Advice on MCAT Breakdowns, Depression, and Stress

Posted by Weike Wang on 1/27/16 10:00 AM

Roy_Lichtenstein_Drowning_Girl.jpgRoy Lichtenstein, "Drowning Girl" (1963)

The MCAT is a brutal test.  Having taken it and tutored numerous MCAT students (as well GMAT and GRE students), I can say with absolute certainty that I seen more students break down over the MCAT than they have with any other test.  Every one of my MCAT students has, at some point, teared up over this test and cursed it to hell.

Why is the MCAT so hard?

Because whereas other graduate exams rely heavily on common sense and logic (two things that we humans have gotten very good at developing over time), the MCAT relies on knowing content and knowing content and then APPLYING content.   The MCAT relies on you having paid attention in science class from first grade through college and then thinking creatively about science.  You cannot go in and ‘wing’ the MCAT like some people profess to doing with the LSAT or the GRE or even the GMAT.  The MCAT is one of the few tests where extensive studying does help and is absolutely necessary!

However, the cause of all the mental stress surrounding the MCAT stems from the thing I hear so frequently from students:

I studied so hard (and they do, all of my students have been tremendously hard working) why still can’t I get this?

More than any other test, the MCAT challenges students not just through the material but also through the intensive self-questioning that follows.  For many students, this test is integral to their self-worth. If they can’t do well on the MCAT, then they will never get into med school, then they will never become doctors, and they will have wasted all this time dreaming and hoping and dreaming and hoping.

Thing about the MCAT is that it is not just hard, but that it varies with the student.  Many students believe that if they study their butts off, they will ace the test and that, unfortunately, is not always true.  An analogy for this is, if I train really hard, I will one day be as fast as Usain Bolt...obviously, this is silly, I am a terrible runner no matter how much I train.  But like innate physical strength, mental capacity works similarly.  Not all students are built the same.  Every brain is different and what is hard for other people may not be hard for you and what is not hard for other people may be a huge challenge for you.

A Downhill Mental Spiral

I have seen so many students work incredibly hard, harder than I did when I took the test, and still not do well.   The inevitable next conclusion that these students reach is: if I’m working hard and I’m not improving, then it must be me, I must be incompetent somehow, not as smart as I thought I was. I must be inadequate.

Once you get to the word inadequate, it is all downhill from there.

(As an aside, this is also what doing a science PhD feels like.  The cycle of hard work and no rewards and then the inevitable ‘I must be the problem here, me, I must be the dumb one, how did I get so dumb, when did I get so dumb, and was I just too dumb to realize it?’)

Generally, the first thing I do when students start to cry about the MCAT (and it happens more often than you think) is to tell them about my PhD experience.  How many pockets of darkness there were.  How many times I thought about quitting.  I know what it feels like to hit a wall that you didn’t think existed until now but then suddenly that stupid wall is all you can think about. After we commiserate, which usually involves me shutting whatever book we’re studying from and going to the nearest bakery, I want to be realistic with my students and honest.

Facing the truth

I tell them: this is not the last test you will take.  Unfortunately, you are signing up for med school.  You are signing up for 4 more years of tests and then all through your residency and career, you will be tested in high-pressure situations by other doctors and patients and the families of those patients.  Then every five years you will have to retake your boards…and pass them.

I don’t want to scare my students but I want them to understand, truly understand, what they are getting into after this exam.  If they don’t find a way to control their anxiety now, they will have trouble in med school and beyond.

Strategies for Dealing with Breakdowns

The first time a breakdown happens, I start the student on the first line of defense.  These are not necessarily quick fixes, but they are studying strategies that can help control anxiety.  Think of this as secondary prevention.  The injury to your mental psyche has already happened, the goal now is to mitigate it.  

So try this:

Think back to anytime you have done sports.  

Generally every student has done some kind of sport competitively. You have probably heard of the phrase ‘getting into the zone’.  You have probably gotten into the zone a number of times.  How did you do that?  How were you able to focus for a large amount of time without distraction?

Preparing for the MCAT is exactly like training for a race.  You have to have the same kind of dedication and drive and endurance.   If you don’t focus when you practice, you will not be able to focus when you race.  Granted, I have heard that many people race differently than they practice, but keep in mind that is not the NORM.  The norm is to perform well in practice and then to perform even better during a race.

Ask yourself: how much are you actually studying?

Are you checking your email every 30 minutes?  Are you texting nonstop?  Are you chatting?  All these small distractions can build into huge studying impediments such that something that should have taken 1 hour to learn took you 2 or more and so you feel like your learning rate is much worse than it actually is.

Ask yourself: how good are you at studying?  

Unlike school tests, the MCAT has NO partial credit.  The computer that is correcting you cannot differentiate between the student who knew the concept but simply made an error last minute and the student who didn’t know the concept and guessed.  When you check your homework answers, are you giving yourself the benefit of the doubt?  Are you saying, well, if I knew this, I would have gotten it right?  Are you giving yourself a half right half wrong check?  Are you categorizing your mistakes into two bins -- honest mistake versus careless mistakes?

If you answered a partial yes to any of the above, you need to rethink how you are studying.  You have to tell yourself that wrong means wrong and be harsh with yourself (because the computer is always harsher).

Many of my students tell me that if they could cut out all their careless mistakes, they would get the score that they wanted.  But that is not possible.  You can certainly decrease the number of careless mistakes, but they will never disappear completely.  You are taking a daylong test that has over a hundred multiple-choice questions.  Human error will happen.  The best way to deal with careless errors is to be realistic with them.  Tell yourself, you will not make more than 5 on this section, and allow yourself to err but in a controlled way.  If you tell yourself that you will make no careless errors on this section, you are bound to make one just on the sheer strength of giving yourself such an ultimatum.

Once you have been honest with yourself with all of the above questions, try studying in a new place, away from your everyday distractions.  

Being somewhere different can change your mental state.  It can make something that has become routine and mundane, exciting again.  For me, it is not a new place but a new piece of stationary.  I am a sucker for funky and cool stationery.  I love colorful pens.  Always take your practice tests in a new place.  You will be taking your real test in a public facility and not in the comfort of your own home so when you take practice tests, you should feel equally uncomfortable.

Find a way to make yourself accountable for what you have accomplished.  

This could be a log or a list or simply talking to a friend about your day’s work.  During the start of some sessions, I will sometimes have students give me a list of everything that they have learned since the last session.  When students do this, they immediately feel a sense of fulfillment that all their time and energy did not just disappear, but has been transformed into new knowledge.

Exercise. Find a hobby.  

I don’t care if it is running or Pilates or sewing or putting together a positivity board (all things my students have done), factor in time for an outside activity and way for YOUR BODY to stay active.

Reframe how you approach studying and learning. Remind yourself what you’re gaining by studying for the MCAT

Okay, story time.

I swam competitively for 10 years but had a very hard time getting into the zone.  I could not ignore my own fatigue—God, my lungs hurt; God, my feet hurt, God, are you listening? Are you there?  Do something about all this pain.

But some of my teammates, the ones who really defined the athleticism of the team, could practice for three hours in the morning and three hours in the afternoon without complaint.  They were all business and yet every time they finished a set, they were smiling.  I don’t believe that their muscles hurt any less than mine, in fact, they probably hurt more, but how were those girls able to focus so much better than I was?

A big reason is that they simply wanted it more.  They wanted to become great swimmers, perhaps not professional Olympic swimmers, but great swimmers.  They wanted that skill much more than I did.

I saw swimming as a fun thing to do, but nothing more.  I did not want to become a super skilled swimmer.  I was okay being an okay swimmer, which of course, meant that I would push myself enough to become an okay swimmer but not enough to be the best. While everyone else pushed themselves to be the best, I complained a lot to God.

But what I did care a lot about, and still do, is learning.  I value education and the ability to understand the world not just as it is, but why it is.  Why do satellites orbit the Earth?  Why is the periodic table shaped the way it is?  Why is there fluid in our ears?

I still have more questions that I can answer, but I have answered a lot of my own questions through self-study, though finding the right kind of books and reading them.

So do not think of MCAT studying as a chore, but as a chance to learn new things.  The MCAT, while more demanding than any other graduate school test, teaches you much more about the world.  And as a doctor, shouldn’t you have an endless curiosity for how things work?  You should.  The body works the way it does because of natural laws that are in all the sciences.  

Now back to that frequently asked question.

If I studied so hard, why can’t I get this?

With a proper study plan, the proper materials, and a great tutor, I guarantee that you will improve.  I guarantee that your score will be better than what you would have gotten without any of those three things.  But I cannot guarantee that you will get the score of your dreams.   Here is where the mental stress sets in again.  For some students, the score of their dreams is just always a bit out of reach.  

Even for the best MCAT takers, getting their dream score entails that:

  1. All the stars align.   
  2. And no matter what happens, you are thinking clearly the day of, because remember, to the MCAT, test day is the ONLY day that matters.

I have had brilliant students arrive on test day not in their element and/or having run into a lot of bad luck.  I have had students who scored 95th percentile on every single practice test but then bombed the real thing because a fire alarm went off or the test taker next to them started crying or the computer froze.  Sometimes things just don’t go your way and you have to be able to accept that as well, and just go with the flow.  

Where’s the anxiety coming from?

If a student starts to have multiple breakdowns and when secondary prevention tips from before have been applied but the student still feels that he/she is falling to pieces, there is always, always a deeper reason for this anxiety.   So here I turn to some primary prevention questions.  Instead of trying to mitigate the anxiety, I am now trying to find the cause of it.  My hope is that the student will become more self-aware and that awareness will turn into acceptance and the beginning of a long-term healing process.

So two questions to ask yourself:

Why do you need that dream score?

Many students come to me with a score in mind without having looked up any med school stats.  Sometimes the students are surprised to find that the average scores their target schools take are much lower than the score they have in mind, and also, the average standard deviations are much wider.

For the old test, I know that Harvard Medical School accepted an average score of 36 but the standard deviation was huge, with more than 5 points on either direction.  That means that a 30 was not unheard of.  Nor was a 40.  But when I was taking the MCAT, I told myself 40 or bust because all of my peers wanted that score, and so naturally, I wanted it as well.  But had I just looked up the stats, I would have been much more relaxed going into the exam, and maybe I would have even done better.

Some of the answers that I hear are

  1. All my friends tell me that I need to get this score or else I’m screwed
  2. My significant other got this score and went to a top med school and I want to be just as good as him/her
  3. To prove that I can or I will have no chance of becoming a good doctor  

These are all great reasons but none of them have anything to do with getting into med school.  Your goal, as a taker of this cruel test, is to get into a med school and become a great doctor.  Who cares what your friends, peers, significant others, personal ego wants.  Your goal is to become a great doctor.  I know for a fact that a great MCAT score is not a predictor of how great you will be as a doctor.  A lot of my friends who did not do as well as they had hoped on the MCAT went on to become some of the most compassionate, sincere and loving of their work doctors I have ever met.  And a lot of my friends who scored very well on their MCAT went on to become doctors who did not like clinical work or patients for that matter.

The score is not a judgment of you.  So cut yourself some slack and allow yourself not a dream score but a dream range.  This is also what I request of my students.  I request a range of scores that they can be happy with rather than an all or nothing score.

Why do you want to go to med school?

I didn’t end up going to med school.  I took the test, went through the application process, went to all my interviews and then at the very last minute, realized that it wasn’t for me.  Had I gone to med school, I would have been doing it for the wrong reasons.  I was doing it for the stability and most of all for the prestige, but not for the reason that the best doctors do it—to help the patient.

This goes back to the swimming analogy.  Those who were able to be the top swimmers on my team wanted to swim more than anything else.  As a result, they were able to sacrifice more of their time and energy into that one pursuit whereas I could not.  Those who become the best doctors don’t do it by acing one test.  They do it through determination, dedication and the countless sacrifices that they have undoubtedly made on their journey.  The tests they ace constantly at not always the ones on paper, but the ones with their patients.

If you are going to med school for all the right reasons, then yes, getting a good MCAT score is important but it is not a make all, break all.  Take the test seriously, but also don’t kill yourself by striving for perfection.  Everything in moderation is a great truism for any kind of diet, that of food and also that of the mind.  Care enough but not so much that you end up hurting your chances to show your true potential.

I have encouraged students to make posters and bulletin boards that list out all the reasons they want to go to med school.  ‘Because I can’ is not a good reason.  Nor is ‘Because other people have’.  Nor is ‘I have wanted to all my life’.  Ask yourself, why have you wanted it all your life then?

The MCAT is the start of a transformative but long process.  As such, you have to be doing this for yourself and no one else.  Once you make your list of reasons, I encourage you read through that list anytime you feel test anxiety.  This test is nothing compared to what you want and will accomplish in the future.  Treat this test as a learning experience, as a way to fill in any gaps in your previous knowledge, and then use this test as a springboard for all that you have left to learn.

Once the student and I have gone through the latter two question thoroughly, I ask one more thing of them.  I ask that they acknowledge their own weaknesses and strengths.  This is a difficult one.  It is like Truman Burbank reaching the end of his world.  No one wants to know about the ceiling. But if you are ever going to rise above it, you have to know what you’re dealing with, and knowing that you are not great biochem or physics or electrochem is a good place to start.

Now, I am sure you’re thinking, so i’ve read all this and I STILL don’t feel any better.  I’m weak at everything, I suck, where do I start to fix this suckiness?

Getting a tutor

If you are on the fence about getting a tutor, let me un-fence you.  Go get a tutor!  The top reason I recommend tutors is that a good tutor will have a plan for you such that all you need to worry about is to do the studying, and the other stressors (when should I take it, when will I be ready, what kind of practice tests should I be taking), those will be in the tutor’s ball park.  The tutor is there as your coach and if you about some of the best coaches you’ve had, they did not try to stress you out with every minute detail of the plan but knew the plan so well that they could put you at ease.  

If you are a student who stresses easily, a tutor is there to say, hold up, I got this, you worry about A, B and C and let me worry about D through Z.   

Also not only will the tutor have a plan, he/she will be able to go through the MCAT anxiety protocol with you however many times you need it.  This protocol may involve talking about the big picture, or even the small picture, or even doing breathing exercises with you.

Friends and family who are not taking this test and/or never will usually do not understand the stress that you are going through and so can only give you stock answers (it is just a test, don’t worry, there, there), whereas a tutor will not only listen, but help you fix your score.  

The great thing about having a tutor is that he or she is also very invested in your success and your happiness.  He or she will care so much about you.  I have been on the phone with my students for hours, not even on the clock but on my own time, just talking them through a stressful studying day, a terrible practice exam, a day when everything seems to have leapt out of the brain and gone on vacation.  Sometimes, just having someone who really understands what you’re going through and is going through it with you, is the cure.

To be honest, whenever I have an MCAT student, it is like I am going through that experience again.  When the student is stressed, so am I and I put all of my energy into finding ways to alleviate that stress.  I have literally sat with a student through a pedicure and talked her through it.   Afterwards, she and I both felt much better.  And then the rest of her studying went better.  Her next practice test was the highest she had ever gotten.

If I had to boil all this down for you into an elevator pitch, as they say in the writing world, the best way to deal with stress, especially MCAT stress, is to practice telling yourself at the end of a long day: okay brain, that's enough, you did good.  

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Tags: test anxiety, MCAT