Test anxiety is common among medical students, especially with the high-stakes USMLE. While some anxiety can drive performance, too much can spiral into paralyzing “what-ifs.” Here’s how to turn anxiety into an ally and perform at your best on exam day:

1. Recognize the role of anxiety. Accept that a certain level of anxiety can be a motivating force. It keeps you alert, focused, and prepared to tackle the task ahead. Embrace it as a part of the journey, not an obstacle. Anxiety is an inevitable part of the test-taking experience, but you can plan for it by developing coping strategies in advance.

2. Embrace mindfulness. Mindfulness is a practical skill, not just a concept. It involves staying present and acknowledging thoughts without getting emotionally overwhelmed by them. Deep breathing and focused attention can calm the nervous system and clear your mind for optimal performance.

3. Sweat it out. Aerobic exercise is one of the best options to manage anxiety. Regular aerobic exercise decreases stress hormones and increases endorphins, facilitating improvements in mood and brain function. Beyond exercise’s mental health benefits, it can improve your test-day performance. We often specifically build exercise into our students’ study schedules!

4. Systematic approach to questions. When anxiety strikes and you feel “frozen,” having a step-by-step method for approaching questions can help. This might include reading the last sentence of the question stem first, eliminating incorrect answers systematically, and trusting your educated instincts.

5. Acknowledge your efforts. Give yourself credit for the hard work and preparation you’ve put in. Remember that you’ve overcome challenges before, and you’re equipped to tackle this one, too.

6. Utilize mindfulness tools. You can never have too much mindfulness! Incorporate apps like Headspace for guided mindfulness exercises—they even have a guided meditation specifically for test-taking anxiety! You can also explore literature such as Eckhart Tolle’s’ The Power of Now to deepen your understanding and practice of mindfulness.

7. Practice makes permanent. Regularly practice your anxiety management and question-approach strategies while doing practice tests under test-like conditions (including the time of day!). The more familiar they become, the more automatic your response to anxiety will be during exams.

With these strategies, you can convert the energy from your anxiety into a focused drive toward success. Remember, the path through medical school is as much about mastering your mind as it is about mastering the material. You won’t just be preparing for a single test; you’ll be preparing for a successful career in medicine.

Brett Doliner is a cardiovascular disease fellow. Alyssa Ehrlich is a psychiatrist.