Every physician preparing for specialty boards knows the feeling: it is late, you are tired, and instead of studying, you are sitting with a low hum of dread about everything you do not know yet. Worry is almost universal among physicians preparing for high-stakes exams. The question is not whether you will experience it — you will. The question is whether you will let it run the show.
The good news is that worry, handled correctly, does not have to work against you. Understanding how it operates is the first step to taking back control.
Good Worry vs. Bad Worry
Oakland University professor Barbara Oakley teaches “Learning How to Learn,” widely regarded as the most popular online course in the world — a massive open online course that enrolled more than 1 million students from over 200 countries in its first year alone. From that vantage point, she has watched millions of learners worldwide awaken their potential to learn and grow.
Oakley makes an important distinction: instead of interpreting stress as fear of failure, she reframes it as the opportunity to do your best, grow, and achieve. This is what she calls “good worry” — the type that drives motivation and focus — as opposed to “bad worry,” which only paralyzes action.
Jack Krasuski, MD, a psychiatrist and author of “How Not to Lose Your Mind When Preparing for Your Boards,” puts it even more directly: “Worry is the enemy of study, and study is the enemy of worry. Studying more leads to a greater sense of mastery of the material and confidence in being prepared for the exam. Thus, when the thoughts that lead to worry are starved of attention, they begin to lose their malign power over a person. Conversely, worrying more leads to less study or less effective study.”
It can be difficult to stop worrying because ruminating on a problem — keeping the danger visible — can feel safer than letting it go unexamined. The problem is that continuing to ruminate does not reduce the danger; it reduces the behavior that would actually minimize it. Overcoming worry requires discipline.
As soon as you catch yourself worrying, do the one thing that is its enemy: start studying.
A Word Worth Holding On To
Before getting to the specific strategies, take a moment with this:
You will never be as prepared as you want to be. You will never know everything there is to know. You will always get some exam questions wrong. And that is all okay.
Study in a way and to a degree that when you enter the exam, you can hold your head high, knowing you are a disciplined and conscientious medical learner. The rest is out of your hands. Say a prayer. Focus on the exam question in front of you. Answer it to the best of your ability. Take a breath. Move to the next one. Repeat. All will be well.
10 Strategies for Managing Worry During Board Preparation
Here are 10 strategies that can help.
1. Acknowledge Your Worry
Do not try to suppress worry. Instead, acknowledge it as a natural response to a stressful situation. Recognizing your emotions helps you gain perspective and, ultimately, control over them.
2. Focus on Present Action
Worry often involves fixating on negative future scenarios. When you feel overwhelmed, redirect your attention to the present task: the chapter in front of you, the practice question on your screen, or the break you have scheduled. One thing at a time.
3. Develop a Study Plan
A structured study plan with achievable goals provides a sense of control and reduces uncertainty. Focus on what you can control — your preparation — rather than the uncertainty of the exam itself.
4. Practice Self-Care
Prioritize activities that promote relaxation and reduce stress: exercise, meditation, time in nature, and connection with people you care about. Taking care of yourself mentally and physically improves your overall resilience and your capacity to study effectively.
5. Challenge Negative Thoughts
When thoughts about failing or not being good enough surface, challenge their validity. Ask yourself whether these thoughts are realistic or helpful. Replace them with honest affirmations about your effort and your ability.
6. Limit Unhealthy Coping Mechanisms
Avoid relying on excessive caffeine, alcohol, or procrastination as stress relief. These may offer temporary comfort but worsen anxiety over time and undermine your preparation.
7. Seek Support
Talk to peers, mentors, or family members about what you are experiencing. Sharing your worries can reduce the sense of isolation and provide valuable perspective. If anxiety is significantly affecting your preparation or well-being, consider seeking support from a therapist or coach who specializes in exam anxiety.
8. Focus on Progress, Not Perfection
Everyone makes mistakes. It is okay not to know everything. Celebrate your progress, however small, and avoid measuring yourself against others. The only comparison that matters is where you are today versus where you were last month.
9. Practice Mindfulness
Mindfulness techniques help you become more aware of your thoughts and feelings without being consumed by them. This allows you to observe worry without getting caught up in it, reducing its hold on your mental state. Even a few minutes of mindfulness practice each day can shift the pattern.
10. Visualize Success
Spend a few moments imagining yourself in the exam room, calm and focused, working through each question with confidence. Visualization does not replace preparation, but it does build confidence and reduce the anticipatory anxiety that can make the exam feel more threatening than it is.
Worry Is Part of the Process
Managing worry during board preparation is not a one-time fix. It is an ongoing practice that runs in parallel with your studying. Some days will be harder than others, and some strategies will work better for you than others. Be patient with yourself as you figure out what helps.
What does not change is this: the most productive thing you can do when worry shows up is to turn back to the work. Study, and the worry loses its power. Rest when you need to, take care of yourself, and trust that the preparation you are putting in is building something real. One question at a time, you are getting there.
Board preparation does not just test your medical knowledge. It tests your ability to function under sustained pressure while maintaining a full clinical schedule, personal responsibilities, and some version of a normal life. The stress is real, and it compounds over months. But it is manageable — and how well you manage it will directly affect both your performance and your quality of life between now and exam day.
Here are six strategies that work.
1. Recognize That Stress Is Normal
Stress is an inevitable part of high-stakes preparation. The goal is not to eliminate it. It is to manage it well enough that it does not derail your studying or your health.
Start by becoming aware of your specific stress triggers. If you feel stressed when you are tired, prioritize sleep and build breaks into your day. If you feel overwhelmed when your to-do list is out of control, focus on setting realistic daily goals rather than staring at the entire list.
Recognizing the pattern is the first step to interrupting it. As LeBron James, who has spoken openly about using meditation and mindfulness to manage the pressure of elite performance, has noted, he does not put a lot of pressure on himself — if he plays his game, he trusts it will take care of itself.
The same principle applies to board preparation. Do the work, manage what is in front of you, and trust the process.
2. Get Organized
One of the most effective ways to reduce stress during board preparation is to build a study schedule and stick to it. A clear plan takes the guesswork out of every study session and eliminates the low-grade anxiety of not knowing whether you are covering the right material.
Set daily, weekly, and monthly goals, then break them into manageable steps. If you tend to procrastinate, smaller daily targets — one to two hours of focused study on a specific topic — are more sustainable than ambitious blocks you will avoid.
Build in breaks as well. Board preparation is a cognitive marathon, not a sprint. Pacing yourself is not a shortcut; it is how you make it to exam day with your mental energy intact.
3. Stay Focused
To-do lists and timers are simple tools that make a real difference. Working against a clock keeps you on task and prevents sessions from dragging.
One time management method worth trying is the Pomodoro Technique, a structured approach that breaks study time into focused 25-minute sessions followed by five-minute breaks. After four cycles, take a longer break of 15 to 30 minutes. This approach can increase productivity and reduce the tendency to multitask. Every time you switch tasks, you work harder to produce less.
The ideal state to aim for is one of heightened focus and full immersion in the material, what psychologist Mihaly Csikszentmihalyi calls “flow.” When you’re in that state, studying feels less like a grind and more like active engagement, and retention follows.
4. Be Positive
It is easy to fixate on everything you have not covered yet or how far away the exam feels. Staying positive is not about pretending those pressures do not exist. It is about not letting them dominate your mental state.
Remind yourself why you are doing this. Think about your patients, your career, and what passing will mean for both. Visualize the outcome you are working toward — and the relief you will feel when it is over.
Simone Biles, the most decorated gymnast in history, has spoken about learning to manage the weight of enormous pressure and expectation. She has described her approach as learning to carry those expectations lightly, the way a turtle carries its shell — present but not crushing.
The expectations you carry into board preparation are real. So is your ability to carry them without letting them overwhelm you.
5. Take Care of Yourself
Physical self-care is not optional during board preparation. It is part of the strategy.
Eat well. Consistent, nutritious meals help stabilize your mood, improve focus, and maintain the energy levels you need to study effectively. Relying on caffeine and processed food through several months of board preparation will catch up with you.
Exercise. Regular physical activity releases endorphins that improve mood and reduce stress. It also improves sleep quality, which has a direct impact on memory consolidation and cognitive performance. Even 30 minutes a few times per week makes a measurable difference.
Meditate. Practicing mindfulness, even briefly, can lower anxiety and help you stay focused on the present moment rather than spiraling into worry about the exam. Apps such as Headspace or Calm make it accessible even during five-minute sessions between study blocks.
Michael Phelps, the most decorated Olympian of all time, has described his own approach to preparation this way: the more prepared he is, the more in control he feels: less nervous, less stressed, and more focused.
Physical and mental preparation reinforce each other. Neglecting one undermines the other.
6. Seek Support
You do not have to do this alone. Talking to a trusted friend, a partner, a colleague who has been through the process, or a therapist can provide real relief. Venting to someone who understands the demands of medicine — or simply the stress of high-stakes exams — helps more than most people expect.
Beyond emotional support, having structured outlets for stress matters. Whether it is exercise, music, cooking, or time outdoors, activities that help you genuinely decompress are not luxuries during board preparation. They are maintenance.
Naomi Osaka, the four-time Grand Slam champion who has been one of the most prominent advocates for athlete mental health, put it directly when speaking to younger athletes:
Asking for help and building in recovery time are signs of someone who understands what it takes to perform at a high level over a long stretch of time — not signs of weakness.
A Final Word
Board preparation is demanding, but it is finite. The physicians who get through it most successfully are the ones who treat stress management as part of their preparation, not as something separate from it.
If you are finding it difficult to build a plan that accounts for both your studying and your well-being — or if you have tried preparing on your own and are not seeing the progress you need — working with a board preparation coach can make a meaningful difference. A good coach does more than help you cover the material; they help you build the systems, habits, and mindset to carry you all the way through exam day.
Whatever your next step, the strategies above are a place to start. The goal is not a perfect study season. It is a passing score, and you are more likely to get there when you take care of yourself along the way.
Positive self-affirmations can be a powerful tool for improving your self-esteem, motivation, and overall well-being.
If you want to boost your confidence and achieve your goals (even pass your boards), try incorporating positive self-affirmations into your daily routine. Being positive will help you stay on course.
Keep these positive statements handy, and read them whenever you need a boost!
Some study every day, even just a little, is a significant step forward.
I only have to work on it a little bit today.
I can start to study even though I don’t feel as ready as I’d like.
Only 25 more minutes … Only 25 more minutes …
Even if it’s hard, I’ll figure it out; I always do.
I can learn from my mistakes.
I will take it one step at a time.
I will focus on this task now and not worry about what will come later.
I bet many people don’t understand this either.
I am confident that I will learn the material because I have scheduled several content review cycles.
The work I need to do is a simple and enjoyable task.
I feel calm and accomplished when I complete each small task.
Of course I can get this done.
I am making progress every day.
Others struggled while working too.
I am building good lifelong habits of learning.
I know I can; I know I will!
I deserve to take time off to rest.
I am learning how to learn more efficiently and effectively.
I am using new strategies to learn and enjoy the process.
I can do this.
Others think I can do it, and I can.
I am a very strong and determined person.
I am persistent and capable.
I’m open to comments that improve my ability to learn and retain information.
I am smart enough to pass my boards.
I will reward myself for small bits of progress.
I can be comfortable with confusion, knowing it leads to answers.
Switching to another topic will not get the challenging topic completed.
If you feel a bit burned out today, start with something easier. The easier stuff needs to get done, too, so you are still moving toward the finish line.
Don’t let the inner critic disrupt your thinking.
Any work is better than no work.
Keep it simple!
The study you do today will make it easier to do questions tomorrow.
Take a moment to reflect: “I have completed 30 MCQs in 30 minutes by staying focused.”
By studying every day, it makes it easier to study the next day.
Keep focused; you can do it.
You can successfully pass your boards!
You can make this work.
It is important to follow through, and it will be worth the time invested.
Enjoy the process.
New learning strategies will help you understand and remember the information better.
Remember, this is not your life’s work, just the keys to the club.
It’s not the end of the world if you miss something.
You’re building on existing knowledge. Everyone adds incrementally to what they learned before. You are expanding and reshaping your knowledge base.
Doing anything towards your goal is helpful.
Slow and steady gets you to the finish line just fine!
Look forward and live in the moment.
Just do it!
Trust.
With effort, time, and patience, your learning issues will be understood.
Reflective writing to recap what I’ve learned helps deepen my understanding.
Creating visual images of what I’ve learned helps me remember the content.
Testing myself by doing MCQs to discover what I know may surprise me.
It’s ok if you don’t understand something right now — remain curious to figure it out.
There’s no such thing as perfect scores all the time.
Just keep plugging.
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Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
The medical profession is one of the most demanding and stressful occupations. Dealing with long hours, constant stress, and the pressure to be perfect can take its toll.
Plus, preparing for specialty boards adds another critical dimension. But it’s possible to conquer the feeling of being overwhelmed and stressed with the board preparation journey. Here’s how:
1) Realize that stress is normal. Stress is an inevitable part of life. If you manage stress well, your overall daily life experience will be more positive, and your health will benefit.
“I like to stress on the things I did right, because there are certain things that I like to look at from a positive standpoint that are just positive reinforcement.”— Tiger Woods
Be aware of your stress triggers and try to avoid them if possible. If you know you get stressed out when you are tired, try to get enough sleep and take breaks during the day. If you get stressed when you are overwhelmed with work, try to set realistic goals for yourself and take some time to relax.
2) Get organized. When studying for the boards or any other high-stakes exam, one of the best things you can do is make a study schedule and stick to it. Be sure to factor in time for breaks, review, and practice questions!
Set daily/weekly/monthly goals for yourself and break them down into manageable steps. This will help you stay on track and avoid getting overwhelmed.
Maintaining a regular study plan can take time and effort, especially if you tend to procrastinate. One way to combat this is to set smaller goals, such as studying for one to two hours daily and covering several topics weekly.
Finally, make sure to take breaks and allow yourself time to relax. Board prep is a cognitive marathon, not a sprint, so you must pace yourself.
3) Stay focused. One of the easiest ways to remain focused is to create to-do lists and use a timer. Working against the clock helps keep you on target and keep you energized. Try using the Pomodoro Technique–it can set you up for success by helping to manage your time and your workload. Set your timer for 25 minutes, and focus on a single task until the timer rings. Then, enjoy a five-minute break and start another session. After four pomodoros, reward yourself by taking a longer 15-30 minute break.
The Pomodoro Technique can increase your productivity and decrease your tendency to multitask or switch-task. Each time you switch-task, you are working harder to produce less. The ideal scenario is to find pleasure and lasting satisfaction in what we do by creating a state of heightened focus and immersion, which Mihaly Csikszentmihalyi refers to as “flow”.
4) Be positive. It’s easy to get caught up in the negative but try to focus on the positive. Think about why you became a physician in the first place, and remember that you’re making a difference in the lives of your patients. A positive attitude will help you stay focused and motivated.
It’s normal to feel overwhelmed during board prep, but trying to stay positive is essential. Remember that you’re doing this for yourself and your future career. Visualize yourself acing the exam and imagine the relief you’ll feel when it’s over.
5) Take care of yourself. Remember to take care of yourself physically, mentally, and emotionally during this process. Eat healthy foods, exercise, and make time for activities that make you happy. This will help you to maintain your energy levels and stay focused.
Eating healthy foods can help manage your stress, improve your mood, and give you the energy to focus on studying.
Exercise releases endorphins, which can help to improve your mood and reduce stress. Additionally, exercise can help improve your sleep, which is essential for managing stress.
Practicing meditation can also help manage stress. This involves focusing on your breath and letting go of all other thoughts. It can be a difficult practice to master, but it can be beneficial.
6) Seek support. Finally, it is okay to ask for help if you feel overwhelmed. Talk to a friend, family member, or therapist. They can provide support and help you develop a plan to manage your stress.
Venting to someone who understands the stresses of being a physician can be incredibly beneficial. It can help to vent about a challenging case or a long day.
In addition to having a sound support system, it is important to have outlets for stress relief. This can be anything from working out to listening to music. Finding activities that help to relax and de-stress is crucial for maintaining a healthy balance.
While being a physician is stressful, it is also gratifying. Following these tips, you can learn how to handle stress healthily and make the board prep journey manageable.
_______________
Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
Like hundreds of other physicians, you may still feel the weight of failure from not passing previous board exams. This feeling can deflate your ego, make you question your ability to achieve this milestone, and suck the energy and motivation out of your board preparation. Today’s piece offers solutions to this issue.
One of my previous physician-clients suffered unease and anxiety whenever she remembered seeing the word “FAILURE” on her board report. Her therapist shared a novel idea with her–to post sheets of paper on her walls (in several places in her home) with the word “PASSED” to reduce the negative impact of seeing the word “failure.”
This strategy echoes the research in marriage and work relationships that show significantly more positive forms of communication are needed to counteract criticism or negative feedback. Interestingly, research has uncovered a numerical relationship—the Gottman ratio of 5:1 (positivity-to-negativity)—that supports this notion. This is worth remembering and applying in our daily lives.
Carol Dweck, a psychologist-researcher at Stanford University, offers another idea—change the word “FAILURE” to a powerful phrase, “NOT YET.” This change in our thinking gives us hope and a chance for growth. She argues that our mindset can determine the course of much of our lives.
For people with fixed mindsets, perfection is essential. However, individuals with a growth mindset believe they can change, and that success is about stretching themselves, learning, and improving. Effort is a positive–it helps you get smarter and increases your abilities.
WATCH Carol Dweck’s Ted Talk here (~10 minutes). Dr. Dweck’s research on a growth mindset among young learners reveals fascinating insights that can be applied to adult medical learners like yourself.
Research confirms that our mindset significantly impacts our learning and memory. A growth mindset is not about effort, although effort plays an important role. Rather, it is about what individuals believe about their ability to learn. By changing our perspective (or mindset), we can turn past failures into opportunities to learn and grow.
When we face a setback such as failing boards, we need to replace our neurological hardware with “new” thinking–focusing on the present moment, not returning to the failure, which is emotion-laden.
The setback exists in our mind. We keep the hurt alive by continuing to think about it. We need to let it go, because what we think about continues to grow.
Ask yourself, “What is the emotion that I am feeling?” Take six deep breaths. Breathe out through your mouth. This process deactivates the stressful part of the brain and brings you back to the present moment.
In truth, if you shift your mind, you will shift your life–the choice is yours.
________________
Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
You may be one of the thousands who recently received their board results. If you were unsuccessful, you’re probably wondering how to regroup and move ahead. If you find yourself in this situation, you are not alone! Each year, thousands of physicians–across all medical specialties–fail their boards.
Failing to pass specialty boards is disappointing, demeaning, and personally and professionally devastating. For many, it means vacations aborted, less time spent with family and friends, and thousands of dollars spent on board review resources. But, the biggest frustration is the realization that you remain an “outsider” of your medical specialty community.
Board Prep Options to Consider
Most physicians regroup by attending a review course and/or subscribing to additional online question banks. Unfortunately, research shows that review courses offer little help because of their breakneck speed of delivery, and using additional question banks may not make a significant difference.
However, another option is available–coaching. If you played sports in school, you understand that the coach’s role is to provide technical support and training to the athletes and motivate the team.
Academic coaches function similarly to athletic coaches. They can (1) provide tips and techniques to help make your learning more meaningful and memorable, (2) suggest resources to make your learning more effective and efficient, and (3) monitor your progress and offer methods for improvement.
Seven Steps to Help You Regroup
Before you decide what your next step will be, here are seven ideas to consider:
Take a mini-break. Press Pause. Don’t beat yourself up! Avoid freaking out–you’re not a failure! Give yourself time to unplug. Workout at the gym. Catch up on one or two critical tasks that may have been put aside while you were studying. Clear your head. Get a fresh perspective on your goal. Give yourself a few days or a week or two to gain perspective.
Review your board results in detail. Identify the topics where you scored less than the median of passing candidates. If you failed your boards previously, compare your results across content domains. Then, review the exam blueprint, and take special note of topics that represent 5 percent or more of the exam. Focus your board preparation on these BIG topics–even if you passed them. Study the highest yield topics (i.e., those most frequently tested on your exam), earlier rather than later. Don’t spend a lot of time on topics representing less than 5 percent of the exam–they can take a long time to master.
Create a timeline for re-taking your boards and create a study schedule. Ideally, you will want to begin studying at least one year prior to your boards. Work backwards from the date of the exam. Divide the number of topics that you need to review by the number of months that you have before the exam. Consider what time is best for you to study and how much time you can devote to studying–be realistic. Schedule your study time on your digital devices using an alert as a reminder. Include in your timeline some free time or gym time as well as vacation time. It’s critical that you devote two to four weeks to full-time study just prior to the exam–make arrangements for this at the outset. If you are unable to devote full-time to board prep, consider working part-time for awhile. Find a method for keeping you accountable to your study schedule–set deadlines and create rewards.
Take another look at your board resources. What helped you the most? the least? Did you use multiple online question banks and rotate between them periodically? Did the online questions match the level of difficulty of your board questions? Did you use one primary review book to clarify and reinforce your learning? Don’t try to use too many books–stick to one primary review book and know it well. Did you review the material enough times? If you are re-taking your boards, you should aim to review your primary study resources at least four to five times in a high quality way.
Reflect on your study methods. Did you use a multi-modal approach in your studying to reinforce material in several ways? Actively engage with the content (e.g., complete multiple-choice questions, watch key videos, write notes and review them periodically, highlight notes, create flash cards or mind maps, listen to audio recordings (even your own recordings of learning points) during commutes, generate questions, revisit information regularly, recite from memory what you learned, compare patient cases with the material you are studying). Depending on the amount of time you have, add at least three to four timed Practice Tests of 300-350 practice questions to monitor your progress. Get in the habit of timing yourself–do at least five timed questions each day to maintain your momentum once your scores have reached your goal. To retain material, devote time to studying and recalling what you have learned.
Sharpen your test-taking skills. Approach each question in a consistent manner. Read questions carefully, determine what the question is asking. Rephrase the question in your own words and ask yourself what you already know about it. Review the answers carefully, and again, question yourself as to what you know about each response. If you are planning on doing questions only, plan on completing 2500 practice questions prior to the exam. This assumes that for each question you do not know well or get incorrect, that you go back and review the answer, explanation and review material to ensure that you understand the topic. Revisit information you have studied > 6 hours after you review it and ideally after a good night’s sleep (again, at least 6 hours).
Create an effective learning environment. Where you study is just as important as the study methods you use. Remove clutter. Organize your board prep resources in one place, preferably a bookcase. Find a good desk (or table) and a comfortable (preferably ergonomic) chair. Use a desk lamp to ensure adequate lighting. Personalize your study space by adding posters, signs, and/or photos that motivate you. Create a learning space that simulates the testing environment. If you are easily distracted by TV or have small children at home, consider using a study cubicle or a private study room at a local library. For convenience, consider using a briefcase on wheels to hold your essential board prep material (laptop, primary review book, pens, highlighters, 3-ring notebook with tabs for each content area) to take with you to work or the library.
Board Failure Can Have a Silver Lining
Interestingly, failing medical boards will not materially hurt your career. Sometimes, there is a silver lining to failing an exam. As Dr. Jack Krasuski, a psychiatrist, says, “the silver lining is that you are more than passing or failing an exam. Physicians are all high-performers. Most have no history of failure, and when they fail a board exam, it can undermine their self concept.” Watch his video “What To Do If You Fail Your Board Exam.”
If you’re like most physicians preparing for boards, you’re short on time and need to be as efficient and effective as possible. You’ll want Dr. Carr’s free study guide. Inside, you’ll find 71 insightful tips to help you pass your boards successfully. You’ll receive ideas and strategies to make your study time more enjoyable and better focused. ____________________
Linda L. Carr, Ph.D., Founder/Principal at Coaching for Medical Specialty Boards, is a medical educator and learning specialist who coaches physicians preparing for specialty boards through virtual, one-on-one coaching. Visit www.DrLindaCarr.org to learn more about her program and download her FREE Study Guide.
