DIP Episode 400 - Get Your Head In The Game: The Psychological Aspects of Doing Well on Test Day
Topic
Test anxiety; Cognitive behavioral strategies for high-stakes testing; Performance optimization; Test standardization protocols.
Key Takeaway
Optimal performance on high-stakes exams requires rigorous, standardized preparation combined with advanced psychological techniques, including simulation, maintaining emotional neutrality, and adopting a mindset that the outcome does not define one's self-worth.
Episode Notes
Source / episode info
- Episode: 400
- Title: Divine Intervention Episode 400 – Get Your Head In The Game: The Psychological Aspects of Doing Well on Test Day
- Published: 2022-07-05
- Source: Episode page
One-liner
Episode 400 provides comprehensive strategies for managing test anxiety and optimizing performance on USMLE exams by emphasizing standardized preparation, simulating high-stakes environments, maintaining emotional neutrality, and adopting a non-dependent mindset.
High-yield summary
- Simulation is Key: Practice testing under conditions that closely mimic the actual exam environment (e.g., time limits, location, duration) to reduce novel stress responses on test day.
- Standardization Protocol: Develop and adhere to a fixed process for every question type (e.g., how much time to spend on a difficult question; reading strategy). Do not change this protocol due to the "test day" novelty.
- Emotional Neutrality: Maintain a calm, humble, and quiet mindset ("even mindedness"). Avoid emotional decision-making, as anxiety leads to poor judgment and micromanagement.
- Negative Influence Avoidance: Isolate oneself from peers who exhibit panic or fatalism before the exam; negative peer pressure severely impairs focus and confidence.
- Self-Affirmation & Visualization: Actively counter negative self-talk by using positive affirmations (e.g., "I can do this") and visualizing successful performance to build psychological resilience.
Learning objectives
- Articulate the difference between confidence (based on preparation) and pride (overconfidence).
- Implement standardized cognitive strategies to manage test day variability and anxiety.
- Identify sources of negative peer pressure and develop coping mechanisms for high-stakes environments.
- Apply visualization techniques and positive self-affirmation to enhance mental resilience during testing.
- Understand that optimal performance requires maintaining emotional neutrality and consistency across all practice phases.
Board exam buzzwords
| Condition | Key Finding | Association | Board Exam Tip |
| Test Anxiety | Symptoms of panic, inability to recall information (blanking out). | High stakes; lack of standardized process. | Practice in simulated environments (mock exams) to desensitize the anxiety response. |
| Standardization Protocol | Consistent approach to every question/task. | Reduces cognitive load and emotional variability. | Develop a fixed "checklist" for test day actions (e.g., time allocation, reading method). |
| Negative Peer Pressure | Panic, fatalism, pessimism among peers. | Emotional contagion; social environment. | Isolate oneself from negative groups before and during testing to maintain focus. |
| Self-Affirmation | Positive self-talk ("I can do this"). | Cognitive restructuring; positive psychology. | Actively replace negative internal dialogue with empowering, factual statements. |
Rapid review table
| Topic | Key Point | Context | Exam Relevance |
| Preparation | Must be thorough and consistent in method. | Avoid "false faith" or minimal effort belief. | Emphasizes that how you study (process) is as important as how long you study (time). |
| Simulation | Mimic the entire test day experience. | Practice location, timing, breaks, and duration (e.g., 8-hour exam simulation). | Reduces novelty stress; ensures physical and mental readiness for the actual environment. |
| Mindset | Treat the exam as a non-defining event. | Adopt a "life does not depend on this" mentality. | Prevents undue pressure from causing performance collapse (the "weight of expectation"). |
| Standardization | Use fixed, repeatable protocols for all tasks. | Avoid changing strategies because it is "test day." | Ensures that success relies on process execution rather than emotional state or luck. |
Board-speak -> diagnosis
| Board-speak / Vignette phrase | Diagnosis / Concept | Why it fits |
| The student who performs poorly despite high practice scores, often citing feeling overwhelmed on test day. | Performance Anxiety/Test Day Choking | Indicates a failure to generalize learned skills from low-stakes practice to high-stakes reality; requires simulation training. |
| A resident who spends excessive time re-reading questions and cross-checking answers during the exam. | Micromanagement / Lack of Standardization | Overthinking disrupts flow and leads to cognitive fatigue, violating the principle of simple, consistent process execution. |
| The student who believes minimal effort combined with positive thinking will guarantee success on a complex board exam. | False Faith/Underestimation of Workload | Demonstrates a failure to recognize the correlation between study input (effort) and academic output (score). |
| A physician who becomes highly agitated or negative when discussing test outcomes with peers in the waiting area. | Negative Peer Pressure / Emotional Contagion | The emotional state of the environment can negatively influence one's own cognitive resources, requiring self-isolation from panic. |
| Failure to maintain a consistent approach (e.g., changing time allocation per question) between practice exams and the actual test day. | Process Inconsistency / Lack of Standardization | Suggests that performance is dependent on routine; deviating from established protocols introduces unnecessary variables and stress. |
Differential diagnosis / distinguishing features
Confidence vs. Pride
| Key Features | Distinguishing Findings | Next Step |
| Calm assurance; belief in preparation and ability to adapt. | Grounded in facts/practice; maintains humility. | Maintain a balanced perspective: acknowledge strengths but remain open to learning. |
| Overconfidence; arrogance; tendency to underestimate challenges. | Often loud, boastful, or dismissive of difficulty. | Practice self-reflection and maintain an "even minded" approach. |
Management pearls
- Simulation: Conduct full-length practice exams in a controlled environment that mirrors the actual testing center (timing, seating, breaks).
- Process Checklist: Create a written checklist detailing your optimal strategy for common test scenarios (e.g., "If down to two answers, I will eliminate based on mechanism X").
- Emotional Detachment: Practice viewing the exam as merely another day or task; do not assign existential weight to the outcome.
- Positive Reframing: When negative thoughts arise ("I'm going to fail"), immediately counter them with a positive, factual affirmation ("I have prepared for this specific topic").
Don't miss
Integration & clinical reasoning
- Cognitive Psychology: These principles align with Cognitive Behavioral Therapy (CBT), which teaches patients to identify and restructure negative thought patterns that lead to maladaptive behaviors (like test anxiety).
- High Performance Psychology: Elite athletes use standardized routines, visualization, and emotional control techniques—the same principles applicable to high-stakes medical testing.
- Resilience Building: The goal is not merely passing the exam, but building psychological resilience that allows one to perform optimally under any stressful condition (e.g., emergency medicine).
Concept connections / cross-references
- For detailed information on biostatistics and epidemiology reasoning: Divine Intervention Podcast [ Episode 401 ] (Hypothetical future episode number for continuity).
- For general study planning and resource management: Divine Intervention Podcast [ Episode 37 ].
High-yield association table
| Condition | Association | Mechanism | Clinical Significance |
| Test Anxiety | Cognitive Overload / Panic Attack | Excessive focus on potential negative outcomes (catastrophizing) depletes working memory. | Requires structured, low-stakes practice to build automaticity and reduce emotional dependency on the outcome. |
| Standardization Protocol | Routine/Checklist Mindset | Reduces decision fatigue by automating cognitive steps; allows for focused execution. | Essential in high-stress fields like surgery or emergency medicine where protocols must be followed flawlessly. |
| Negative Peer Pressure | Emotional Contagion | Exposure to panic and fatalism triggers the sympathetic nervous system, impairing rational thought. | Maintaining emotional distance is critical for preserving focus and cognitive resources during testing. |
| Visualization | Mental Rehearsal | Pre-programming successful outcomes in the mind strengthens neural pathways associated with performance. | Helps build confidence by making success feel familiar before it happens. |
Key terms glossary
| Term | Definition | Context | Example |
| Standardization | Adhering to a fixed, repeatable process or protocol. | Test-taking strategy; clinical workflow. | Always allocating 1 minute per question regardless of difficulty, rather than spending variable time. |
| Self-Affirmation | The act of consciously stating positive beliefs about oneself. | Mental health/Psychology. | Instead of thinking "I might fail," affirming: "I have prepared thoroughly and I will do my best." |
| Micromanagement (Testing) | Overly detailed, cautious focus on every small variable during the exam. | Test-taking error; cognitive bias. | Reading a question three times or checking answers against previous questions, which wastes time and energy. |
| Emotional Contagion | The tendency to absorb the emotions of those around you. | Peer interaction/Study groups. | Being surrounded by panicking peers can induce panic in oneself, regardless of one's own preparation level. |
Study optimization
| Topic | Study Approach | Priority | Resources |
| Test Anxiety Management | Cognitive Behavioral Techniques (CBT); Simulation; Visualization. | High - Must be practiced alongside content review. | Mock exams, mindfulness exercises, positive journaling/affirmations. |
| Process Standardization | Create and adhere to a fixed "test-day checklist" for all exam types. | Medium-High - Focus on how you approach the question, not just the answer. | Reviewing past successful test-takers' strategies; creating personal flowcharts. |
| Mindset & Resilience | Practice emotional detachment and accepting uncertainty. | High - Must be integrated into all study phases. | Reading literature on high performance (e.g., sports psychology); discussing principles with peers/mentors. |
Question pattern recognition
- Pattern: Student performs well in practice exams but fails the real test day. -> What it points to: Performance anxiety or lack of standardization. Why it matters: Requires intensive, full-length simulation under strict conditions.
- Pattern: Difficulty maintaining focus when faced with a complex question (e.g., biostatistics). -> Associated Condition/Error: Micromanagement and emotional overthinking. Next Step: Implement a time-boxing rule: spend X seconds maximum on any single question before flagging it for later review.
- Pattern: Feeling overwhelmed or panicked in the testing center environment. -> Diagnosis & Next Step: Recognize this as negative peer pressure/emotional contagion. The next step is to physically and mentally distance oneself from panicking peers.
Test yourself
Common mistakes to avoid
Common traps
Original transcript with highlights
Original transcript with highlights
Okay, welcome. My name is Divine. This is episode 400 of the Divine Intervention Podcasts. And into this podcast we will be discussing a topic that I call Get Your Head in the Game. Get Your Head in the Game. In this podcast I will be discussing the psychological aspects of doing well on Tuesday. And I'm grateful to God, you know, that we've got into episode 400. It's been a long journey so far, but I'm grateful for the journey that we've traveled so far on the journey ahead. And thank you to those that have been listening to this podcast. I'm really grateful. I hope you find this podcast to be helpful. And I hope that you find it to be something that blesses your life. So with that said, let's just get right into it. So the thing is, you see many people, the, you know, you get into a med school. And I guess maybe this podcast is going to apply to people that are taking the MCAT. You get into a med school. You go through your first years of med school. And then you're taking your USMLE exams. You've gone through your dedicated period. You've done all your studying. You've done all your preparing for your test. And then you get to game day. You get to game day. And that game day ends up being a very important day. Because you see some people, I read this all the time on the internet. They've done all this prep. They've crushed all their practice exams. And then on test day, they just completely fall apart.
Or you see people that they're doing really well, but just on exam day is almost like something just flips in their brains and they just underperform. Or you see people, they keep postponing their test days because they're just afraid to take the exams. They just have so much anxiety associated with the process. And I can understand why people will feel that way. Because these exams are very high-stakes They have very profound consequences and repercussions if you don't do well on them. But I feel like many times people focus so heavily on the prep and they don't focus so much on game day. Don't get me wrong. Your prep is probably the most important thing you need to take care of. But you also need to be psychologically prepared for game day. And if you hear me say game day during this podcast, then you're testing. So that that doesn't end up being a factor that hampers your success. Your mind needs to be in the right place. You need to get your head in the game. You can prepare for a game, but when you get to those big moments, how do you succeed and prosper in those big moments? Because there are many people, they are very good at preparing for a big moment. When the big moment comes, they completely cover in fear. They completely fall apart. They choke literally in those big moments. And I mean, you know, you're not a, we're not talking about basketball here, but many of us can probably relate to this where you see a person. There are such good players.
You know that they have the potential. You know they have the talent. You know they have the wisdom. You know they have the resources. You know they have the skill. But then when a big game moment comes, when the time comes where like the most important time where they need to absolutely just do well, they just choke. They just severely underperform. And you're like, wow, this person was like a bull, like a lion during the regular season, like a bull, like a lion in all these other situations. But now they're like sheep in this really big important scenario of their lives. So you know for those that watch basketball, again, you can probably relate to that. So I'm just trying to bring in those analogies, just to get you to understand what I really want to talk about today. So how do you do well in the big game situation of USMELY exam? The first thing you need to do is you need to prepare. You need to prepare. Again, I'm not going to be spending more time on psychological concepts today. Well, you need to be prepared. Some people have what is called a false faith, you know. But really it's not faith. It's just been delusional. They believe that somehow they can put in minimal effort, put in minimal work. And just, you know, by faith, they will crush their exams. And that is just not the way things work. Again, whatever you sow, that is literally what you're going to reap. If you don't put in the work, then you should not expect to be successful.
That is just the way life works. If you don't put in the work, you see some people, they're very delusional. They just have this great faith in their hearts. And again, it's not faith. They just deceiving themselves. They think that, oh, you know, I know, but fingers crossed, you know, everything will work out well on test, the fingers crossed, fingers crossed. They've not done the right kind of prep. They're absolutely just feeling their practice exams. And then they're like fingers crossed, they will test the stuff that I know. And then they get there on the exam day, they get completely crushed. Their scores are nothing to write home about. And then they wonder that the world is wicked. The world is no wicked. You're just being unrealistic. You need to absolutely, absolutely prepare, not just prepare, but you need to prepare in the right way. The fact that you're spending 10 hours a day studying does not mean that you're getting anything out of your study day. The fact that you're studying something for 10 hours doesn't mean that that thing is going to help your life. That's why I tell people some of the problems you see, again, speaking from my experience as a tutor and a teacher. Some of the problems you see that people face as instructors, I mean, as students, is they just do the wrong kind of prep. You see them, they've been studying for a year for one of these exams for two years, for months.
And you notice that while they are passing practice exams, you notice that there is just something about their process that is just shooting them in the foot. So make sure you prepare. Now, what is the second principle you need to keep in mind to get your head in the game? You need to simulate game day. That's the truth. You need to simulate game day. I'm telling you this, some of the people that have grids in certain sports, in certain professions. And you notice that while they are in these big, massive, the whole crowd is watching you, the spotlight is turned on you situation. And you see them just handling calmly and absolutely crush it. These people, they have practiced those scenarios. Secretly, they have practiced those scenarios. Like, them seeing those scenarios in real time is not the first time they've seen those kinds of scenarios. So they are very comfortable handling those kinds of things. How does this apply to a USMLE situation? Well, think about it. Say, for example, you're taking step two. Step two is an eight hour exam. And it has an hour of break time, if you don't do the orientation. You shouldn't let your step two day be the first day you're seeing those kinds of circumstances. You shouldn't. You need to have a few practice situations where you are as close to what will constitute your USMLE exams as it's possible. I'll give you an example from when I took the MCAT. I took the MCAT back in the day.
This was probably in, I don't know, like 2000 and 13 or something like that. So this was like nine years ago at this point. This is a long time ago. And I remember back then, the test that was, you know, the predictive practice test was AMC 11. I remember that back then. So my exam was on a Saturday. And the Saturday before, like the Friday, you know, so the Saturday before, so this is a week to my exam. The Friday before then, I started preparing like my exam was tomorrow, like I literally, I think again, the details are very easy for me. But I think I may have packed some items that I knew I would need on Tuesday. I did everything like, oh, divine, you need to have all these things prepared and ready for Tuesday. I did that. And then the Saturday itself, which was again one week to my actual test, I woke up right around when I would have wanted to wake up to take my exam. I drove to the Prometrics Center. I literally walked in. I saw the place. I saw the doors. I saw everything. I saw the parking spots. And then I literally drove back home and took AMC 11. If I'm remembering correctly, my exact score on my test was exactly like it was on AMC 11. But literally, I took to the fine detail. Where am I going that day? Where do I want to park? What kind of food do I want to eat during my exam? Everything. I tried to mirror that test as closely as possible. And when the test came, it did not seem like such a struggle. It did not seem like such stress.
It did not seem like such an effort because I had just exposed myself to that situation so many times. So again, have gained these simulations. It's just like think about it. Like certain disciplines that see high stakes situations, right? Like emergency medicine physicians, for example, these people do a lot of same labs. Same labs are popular for that reason. Because they train you in those high stress situations so that you feel comfortable with them. Like take, for example, Libreon James. Labyrinth has been in situations where he has had to make game winning shots. His team is down so many points. This is a game seven situation. He has been in those situations so many times that when those situations crop up in the present for him, he's able to handle them because it's almost like just over a long career. He has had so many of those kinds of simulations. So have game day simulations. Now, what is the third psychological thing you need to keep in mind with regards to your with regards to your testing? Don't hang out with people that are panicking. I'm telling you this. Do not hang out with people that are panicking. What does this mean? If you know that you're in a study group and there are people in that study group that are just panic that are very fatalistic that are very pessimistic days before your test, don't hang out with them. Study on your own.
When you get to the testing center, don't hang out because I'm telling you when you go, I mean, I've taken all these exams. You go to a testing center. You see people's hands shaking. You see them shaking their heads. You see them crying and all those things. Do not hang around those people. Personally, I do not like hanging around those people. I like, just go sting your car. When is your time for your exam? You step in and take your exam. Because again, those people are examples of negative peer pressure. There are two kinds of peer pressure. There is negative peer pressure and there is positive peer pressure. Negative peer pressure is when you are around people that spoil you to do the wrong thing. Positive peer pressure is when you're around people that spoil you to do the right thing. So if you see a bunch of people panicking at the pre-metric center, don't hang around them. Don't hang around them. Don't hang around them. Don't walk with them. Don't stay with them. Stay away from them. Because you don't want the outcomes of a person that is panicking. So stay away from people that are panicking. Another component of staying away from people that are panicking is staying away from social media. Stay away from these forums. Like, I'll give you for example right there, all these threads, like mission reddit or whatever. Where you just see people finding fears, finding fears, finding fears, finding fears, finding them. I'm telling you, just avoid those things.
Those things are not beneficial to your process in terms of study. Again, obviously, reddit is amazing. You get a lot of valuable information there. SDN is amazing. You get a lot of valuable information there. But those panic inducing threads don't hang around them. Where you see a person saying it was the worst, I guess like 80% of the exam, right? Again, chances are that's a lie, right? Because you see people, people are very good at making things out to be much worse than they actually are. Don't hang around people that are panicking. Now, what's the fourth principle you need to keep in mind? The fourth principle you need to keep in mind is don't make changes just because it's test day. I'm telling you this, again, as a person that has coached tons and tons of medical students, I've fought many different test against strategies class. I've worked with many people on a one. One of the things that absolutely crushes people on testing is they make changes to their testing process because it is testing. That is literally the wrong thing to do. That is literally the wrong thing to do. You see people, they've been taking the exams a certain way, they finish their blocks in a certain time frame. They don't spend so much time on questions on the first pass and everything. They throw all those things completely out the window once they get on testing. And then they wonder, why was I getting 250's on my practice tests? And then I'm getting 230's on my real exam.
That's what happened. You changed. The mindset, the behaviors, the practices that got used a certain score or certain series of scores on your practice exams should not be changed on test day. Literally, let your test day be like a regular study day for you. You need to literally capture that mindset as you're walking into the exam. That you're not going to be changing things all over the place. You see so many people, they is almost like the study process is like a series of experiments. They know the conditions that work. They know the controls that work. They know the variables that work. And then on test day, they start changing multiple variables. If you change all those variables, you will get different outcomes. Again, don't change things because it is testing. Okay. Don't change things because it is testing. Now, principle number four is almost like a good segue from principle number three. Don't micromanage your testing. Do not micromanage your testing. What do I need by that? You see people on test day, they become extremely cautious. They become extremely careful. They start paying attention to every single little thing. No, that is not the way to handle test day. Some of the things that I miss in the spot cast me sound bizarre to you. But I'm telling you this, these things are logical. And these things, I have seen them play out in the lives of many different people. The thing is on test day, you should take your exam.
I'm not saying you should throw all caution to the wind. No, that's not what I'm saying. I'm just saying don't micromanage. Focus on your testing process. Be simple about your testing process. Don't start taking all these extreme safeguards because it is test day. What do I need by that? I think maybe a good amount. Again, some of these concepts I'm discussing today and analogy will help the most. For example, there's this show that myself and my wife will watch. It's called the Amazing Race. And we watched the season finale yesterday. And you see the final leg of the race. There was this team that we were watching and this team did just started doing a lot of things that were really out of character for them. All the stuff that they had done that had helped them win every leg successfully. Or at least, you know, not be eliminated. It's almost like they just threw all those things out the window. They started micromanaging everything. Let's do this. Let's do this. Let's do this. Let's do this. Let's do this. They started introducing taking all these safeguards, taking all these precautions on test day. Test day for them was the final leg of the race. And guess what? They lost. It was some of those little decisions they took. All those little variables they introduced on test day that ended up messing them up. But the other people that were just calm took you, you know, took the last leg with a free mind. You know, they didn't go in with any preconceived notions.
They just like, you know what? This process we have executed so far has worked well for us. Let's just keep executing this process. They ended up winning. The thing is this team that ended up losing that was micromanaging their final leg. They have all these advantages that the team that ended up winning did not have. Well, the team that ended up winning did not micromanage their day. You see people, they're like, woo, I'm taking my USML exam. Oh, every question I'm going to leave really three times. But during your study process, you read your question once, think big, big, big, big, big answer, and move on. We're like, oh, let me read this. Let me read this question three times. Let me read the last sentence. Let me check out all the answers. Let me cross out all these other answers. Let me do this. Let me do that. Let me do this. Let me do that. I'm telling you this, you're literally choking up your mind. When you choke up your mind like that, then you can not think and think straight. Again, I know some of you listening to this. You can hear me right now. You're going to be like, wow, yes, I've gone through this problem before. Don't micromanage your day. Be simple and straightforward in the way you approach your testing. Now, what is principle number five? Principle number five is be humble and quiet in spirit. Be humble and quiet in spirit. What do I mean by this? Don't let your mind be proud.
Even if you've been crushing it with your practice tests, going with confidence, but there is a big difference between confidence and pride. A person that is confident has prepped, but they still keep a level head, even if they know that they will likely do very well. A person that is proud, you know, they've done their prep, they know they will do well and then they start, how do I put this? They start counting their chickens before it has hatched. If you understand the term counting on chickens before it has hatched, it's almost like celebrating, celebrating, even if you've not finished the journey. You see, these people, they are so focused on the celebration and they completely take their minds off the journey. They are so focused on the celebration and then they don't focus on what they're supposed to do in that moment. They don't realize that you need to finish the journey first before you start celebrating. So what do I mean by that? So just be humble. Be humble and quiet in spirit. Just be calm, be quiet. Don't be loud. Don't be loud. Be quiet. Like, let me give you a good analogy. A good analogy for a person that has this kind of mentality is a person like Kauai Leonard. I'm not a supporter of the LA Clippers, but I really love Kauai Leonard as a player. I really love Tim Duncan as a player. These were people that exemplify these qualities. These were people that knew that they were good. They knew that they were gifted.
They knew that they're probably better than everyone else that they are going to be playing against. But they were still humble, calm, quiet in spirit. The thing is when you have that humility in your mind, when you have that calmness in your mind, when you have that quietness in your mind, it's almost like the world slows down for you and you can begin to think constructively in stressful situations. Take, for example, I remember when I was doing my intern year, I was doing a nice ear rotation. I actually did multiple nice ear rotations, probably like two of those. And there are high-stakes situations that are praying the ICU, the other is those state patients that I did. You need to do CPR, you need to do certain new things that for a person that is just vaguely from medical school, you've probably never done before. In many of those situations, I try to tell myself, divine, be calm, divine, be calm. And many times I'll pray my heart, God help me. Divine, be calm, be quiet, be humble in your heart. You know, I'm telling you on begin days, those are not days you want to be so talkative, just be quiet. I'm telling you like quietness builds a certain kind of psychological strength that sometimes is really hard to explain. Be quiet. Let your mind go silent. When your mind goes silent, you can begin to perceive things in your environment.
You can begin to see like, oh, if your mind is quiet and you are not like all emotional, all rumbled, all jumbled, all over the place, you can see traps that have been lead for you in questions. You can avoid those things that people fall into that gets them to pick the wrong answers, right? Be humble and quiet. Like sometimes I think there was a nurse that commented, this was again, the my first year after I graduated from medical when I was in residency, and the nurse commented that, wow, you're really calm. And I think we're just resuscitated a patient going to cardiac arrest or something like that, right? Just really calm. Be even minded. Be even killed. I'm telling you, even mindedness is very helpful for doing well in stressful situations. And you just notice that, wow, this thing that looks so arcane, looks so stressful, looks so terrible, you just notice that you do that thing and you do it with excellence. You do that thing and you do it with excellence. Now, what is principle number seven? I think I've talked about six principles so far. That next principle is self-affirmation. Self-affirmation. Self-affirmation. Again, some people are very fatalistic. They're very pessimistic. They just tell themselves that their failures or this exam is going to be the death of themselves. I'm not, you know, I'm not even going to clean it for myself. Oh, this exam is going, this exam is the worst. Oh, definitely going to fill this thing.
Definitely going to, no, no, no, I'm going to, just see all these evil statements about themselves. They show these terrible things about themselves. And then they wonder why they get certain outcomes. Let me tell you this. As a month thinks in his heart, so he is, the way you think about yourself is the way your life will end up turning out. That's one thing I strongly believe in. The way you speak of yourself. What do you say to yourself? What do you think in your heart? I'm telling you, this is why it's almost like, again, like a corollary of principle number three, don't hang with people that are panicking. What are you letting coming? What are you allowing into your heart? Your heart has gates. Don't let negative thoughts come in. Don't let negative words from other people come in. And don't let yourself think or speak negative of your own self. Like for example, for me, when I'm taking exams, and this is something I recommend to people sometimes, I have literally some Bible verses in my mind that I run through that. Oh, you know, I don't have the spirit of fear, but I have the spirit of love, of part of a sound mind. Like I have a sound mind as I'm taking this exam. I'm not fearful as I'm taking this exam. Or I can do all things through Christ, the strength, things, me. I tell myself that you know what? This exam, I can do everything on this exam well. I can do it well, and I can do it right, and I can succeed in it.
So even if that's not what you use, but find some positive statements, find some positive statements, find things to self affirm yourself. Don't see things about, it's just mind boggling how people talk themselves down. I'm telling you this, if you lose a battle in your mind, you like if you lose the battle in your mind of doing well on your USM exams, you probably lose that battle on your real test day. You need to affirm yourself. You need to speak positive to yourself. You need to think positive about yourself. It just gives you psychological advantage that a person that is thinking negatively of themselves does not have. Now, what is principle number eight? Principle number eight is to take the exam with the mindset that your life does not depend on this exam. I'll say that again, you heard me correctly. Have the mindset that your life does not depend on this exam. What do I mean by that? The thing is, the reality is that this exam can determine various, these USMD exams, they have the ability to determine very significant portions of your future. But don't focus on that. Have like almost like don't care mentality as you're taking these tests. I'm not saying don't care, but don't give so much importance mentally to these exams, especially on test day, especially on test day. Because if you feel like, wow, my life depends on this. Then you begin to shake.
It's almost like you're putting pressure on yourself that you have to carry in addition to the pressure of just taking the exam itself. So if for example, you know, I know probably almost no one listening to this podcast has seen me take a test. When I'm taking high-stakes tests, I have like a very carefree, let me not say careless, but carefree attitude, carefree attitude. Like I just don't have this worried mentality like, wow, this exam is going to, this isn't, no, no, no, no, no, no, again, many of these things I'm saying as principals, they kind of relate to each other. But I take these exams very calmly. Like when I take my USMD exams, you see me like wearing shorts, wearing a simple shirt. I'm not like, you know, is my, am I nervous? Yeah, I very likely am. But I'm just kind of taking the exam as well. This is just another day. I'm not putting so much weight on that day that I don't need to put myself under. Right? So I'm just encouraging you like, have that mindset. Even if the exam is an important exam, we'll take that exam like your life does not depend on it. Now what's the next principle? I believe this is principle. So I not talked about preparing, simulating game day, not hanging out with people that are panicking, not changing just because it's test day, making all these changes. Principal number five was not micromanaging your day. Six was being humble and quiet in spirit.
Seven was self-affirmation, eight was your mindset like your life does not depend on it. So this is where Principal number nine, I'm going to get into the end of this. Right? Principal number nine is be very standardized, be very, very standardized, be very, very standardized, almost be like a robot on your exam. Be on emotional, be on emotional, be on emotional, be on emotional, be on emotional. I'm repeating this over and over again. This is something that kills many medical students on these exams, emotions, emotions, emotions, be very standardized, be very standardized. What do I mean by being standardized? Being standardized is almost like having a checklist mindset as you do certain things. Whenever you have a checklist mindset to certain things, you will likely do very well in those things. You'll be able to replicate similar performance. In fact, over time, you get better and better and better at that activity. Let me give you an example. As a person like during my third year of medical school, during my medicine rotation, in fact, to be honest with you, this is as, this is almost like something I did with pretty much every rotation as a medical student as a resident, whatever. I always have this mindset that when I'm on a rotation, the first few days, it may literally take me just two, three days to accomplish this, but I literally start making checklists of the common things that I have to do. What do I mean by that? Like, oh, for pre-rounding, this is okay.
I kind of observe like a few residents that I feel like, well, these people seem to be doing a pretty good job. I observe what they do. I make a checklist of that. I see this. I look in the medical record. I see, wow, this person's notes are really good. Their presentations are really good. What did they do? I make a checklist from it. I make checklist, checklist, checklist. So it's almost like before the big game scenario, the big game situation, I've already told myself, this is exactly what I'm going to do. This is exactly what I'm going to behave. This is exactly how I'm going to act in these situations. By having all these decisions made ahead of time and then pinching myself literally, telling myself divine, this is what you must do if the situation arises. It takes away a lot of stress, a lot of fear, and a lot of anxiety from the testing process. That is the truth, right? That's literally one thing I recommend with people, especially when I'm teaching them test-ticking strategies. I tell them, these situations, you're going to see x, y, z on your exam. This is what you're supposed to do in this situation. Like literally, before you take your exam, you should have like an algorithm in your mind, oh, this is how much time I'm going to spend on each question on my first pass throughout the exam. This is what I'm going to do when I face a bio-statistic question. This is what I'm going to do when I meet a question where I have no clue what's going on.
This is what I'm going to do when I'm down to two answers and I don't know which one to pick. This is what I'm going to do when I hit a series of 10 questions that really shakes me to my foundation. The thing is, you don't want to be making these decisions for the first time on exam day. No, you want to have made these decisions. You literally want to know what you want to do before you get to do those things, right? So be very standardized. I'm telling you this, like residents that you see as struggling is many times a lack of standardization. A lack of standardization. Be standardized. Almost be like a robot like, okay, in this situation, like for you want to tell me that these really, some of these really successful basketball players, they don't recognize, oh, five minutes to the end of the game. This is exactly what I'm going to do. Or in a situation where my team is down 10 points, but we are not scoring and this defense is thrown in front of us. This is what I'm going to do. That is what is called like game management, game management. The US Emily exams are like a game. You need to be able to manage those games. You need to be able to make these in-game adjustments so that you can do well on your exam, right? So that's why I tell people be very, very, very standardized. Be on emotional. I'm telling you, when you bring emotions into a process, you make very bad decisions.
I mean, like there's a little part of the Bible that says that the heart is deceitful and desperately wicked. Who can know it? I'm telling you this. The heart is very deceitful. Emotions are very deceitful. When you take decisions from an emotional perspective, you're going to make awful, awful, awful decisions. That's why it's important ahead of time. Tell yourself, what are the common standard pitfalls or common standard scenarios I will see on my test? Okay. And then start writing down decisions for each of those scenarios. Ooh, if I'm down to two answers, this is exactly what I'm going to do. If I notice that I've spent a minute on this question and I don't know what's going on, this is what I'm going to do. And those decisions write those things down. Don't just imagine them. You hit literally, write them down. Write that vision, make it plain so that you know how to run with it in the future. Literally write those decisions down. If you write those decisions down, when the time comes to make the right decisions, you will make the right decisions. Although you also have to discipline yourself to make those right decisions. Well, write those things down. So that when those scenarios happen, it's almost like they're pressing different modes on the robots that is yourself. You're like, oh, okay, I'm down to two answers. I don't know what to do. He I'm down to two answers. I don't know which one to pick.
Okay, what decision have I made ahead of time that I will practice in these moments? Follow that decision. I'm over. Right? So the thing is, don't take your exam based on how you feel. Take your exam based on the decisions that you have made ahead of time. I'm telling you this, I'm telling you this, I'm telling you this, it sounds like wow, the vine is saying a lot of hokey stuff today. But I promise you these things are very critical to your success. They are very, very critical to your success. Right? Now another thing that also helps the next principle of kind of lost count at this point. I'm not going to keep going back, but I'll probably try to summarize at the end. Visualize your success. Run it in your mind. Literally, run it in your mind. Run it in your mind. Run through it. Visualize yourself getting a good score. Visualize yourself getting the score you want. As you're driving to the test center, visualize yourself like wow, just answering these questions and just absolutely knocking them out of the park. Again, as you're thinking your heart, so you will be. One of the greatest books that made a massive, massive difference on my life was a book I got when I was very young. It was a mentor of mine. Give it to me back in the day in Nigeria as a loner. The name of the book I believe is as a man think it by James Allen. It's a very small book. You can probably read it in like two hours, but that book touched my life massively.
Your thoughts can really control the outcomes of your life. And then the final thing I want to say here is be bold, but don't be cocky. Be bold, but do not be cocky. Be bold. Be bold. Again, they are going to be scary situations in life. If someone tells you that you will never face a scary situation in your life, that person is lying to you. Even I face scary situations every now and then. But in those scary situations, you need to learn to be bold. You need to learn to be bold, but don't be cocky. Be bold. Have confidence in yourself that you know what I can do this then. I can do this. I can succeed at this. I can crush this. I can make this a accomplishment, but don't be cocky. A person that is cocky again is very loud. You see them, they already talking about how I'm so good at this. You can tell like the thing is in your heart, you can tell when you're being cocky. That's the truth. So just be calm. Be bold, but don't be cocky. So again, just to summarize everything I've talked about today, prepare. Simulay game day. Don't hang with people that are panicking. Don't make all these crazy changes on you just because it's testing. Don't micromanage your test day. Be humble and quiet in spirit. Self affirmation. Take the exam with a mindset that your life does not depend on it. This standardized. Be almost robot-like. Make these decisions ahead of time. Be on emotional. Be bold. But don't be cocky. And also visualizing your mind. Run your success through in your mind.
Run that simulation of success in your mind and all will be well with you. And for those that are taking these USMLA exams anytime soon, I do have an MBA me test taking strategies class that you'd find to be very helpful. It's a class where again, we really address many of these exam scenarios that people face and teach you what to do to get the right answers in those situations. And then I'm going to be having one this Friday from 5 to 7, 30 PM Pacific Standard Time. And then I have a review class that is starting next week is going to be Monday Tuesday Thursday Friday and Saturday. So we're not going to be having a Wednesday. It's going to be from 5 to 9 PM Pacific Standard Time. It's a 20 hour course. It's for step two, step three and for complex level two or three. And we cover internal medicine, OB-GYN, PED, psych, surgery, biostatistics, ethics, multi-systems, processes and disorders, communications, healthcare systems, professionalism. We cover all those things by clinicals, vignettes and scenarios. I don't just give stock lectures. I actually do a lot of scenarios. I will say like maybe like 98% of the course are scenarios. And there's time that we are not Kate to taking and answering people's questions. So it's not just me I'm going to be talking at you. No, I'm going to be answering your questions. And I go at a pace that should give you an off time. And I repeat myself so many times that should give you an off time to take very good very quality notes.
And then I also have a biostatistics. In fact, call this move on epidemiologic bootcamp. It's going to be taking place on the 21st of this month from 4 to 8 PM Pacific Standard Time. All these courses over Zoom. What is a course that I suspect you're going to find to be profoundly helpful is going to be on Zoom. And we will really address a lot of epidemiology and biostatistics concepts. Not just formulas because most of the MBA exam questions these days, they don't depend on you plugging and jogging. They depend on you like actually conceptually being able to reason through these questions. So we're going to discuss how to reason through biostatistics questions for your exams. You're going to get a very strong solid conceptual basis. And again, it's not going to be lectures. It's going to be by using examples. I'll show you how to think. If you want to become a good biostatistical or epidemiological thinker, that's the course you want to attend as well. We're going to a lot of depth on biostatistics and epidemiology. And you know, also don't want to want to learn on a limited basis. And you know, I help with ERAS applications, rec letters, personal statements, supplemental applications, mock interviews. I do all those things. I've worked with lots of people that are residents. Some of them I even now attend things out in practice. So again, if you interested in any of those things, feel free to reach out to me.
I do have these podcasts on the major podcast platforms, Apple podcasts, Google podcasts and Spotify. At least the most region in 150 episodes. If you want everything from episode one to episode 400, just go to divineinterventionpodcasts.com. If you actually have a Word Press account and you sign up, you'll get an immunosification whenever I make a new podcast. And the thing I definitely want to say is, you know, some people are like, divine, how do I know what podcasts to listen to? Again, I will strongly encourage you. Go on the website, click on exam topics list. If you click on exam topics list, it will take you to a spreadsheet, a Google spreadsheet that shows you all the USMLA exams. And then I literally break things down by topic like, oh, for step two, step three, internal medicine, these are the suggested things you should listen to. Surgery, these are the suggested things you should listen to and stuff like that. And then I also have a new website called divineinterventionlifelessens.com. I post like two podcasts every week. They're about 10 minutes long. And most of them reflect like a life lesson, like a common problem that people face. And I use a biblical perspective to discuss how to counter those problems. And I also have a podcast with that is on Apple podcasts. It's called the divine intervention life lessons podcast. I believe we have about 96 episodes of those right now. So thank you for listening to me. I really hope you found the spot cast to be helpful.
Again, for those taking the exam and really not just for taking you as many exams, but if you're like in a big game situation, you're like in a situation where you're like, wow, I need to perform and perform well on this thing. Listen to the spot cast. Apply these principles. I'm telling you this. They have worked for me. They have worked for many other people. I've worked with. So again, put these principles into practice. And I trust that everything will be well with you. Have a wonderful rest of your day. God bless you. See you next time. Thank you.
Practice questions — USMLE style
Question 1 — Behavioral Science
A resident physician, who has successfully completed multiple complex procedures during his training, is preparing for a high-stakes surgical rotation. He realizes that he tends to become overly cautious and begins introducing numerous "safeguards" into his routine—such as triple-checking every instrument count or requiring excessive sign-offs—which deviates significantly from the established departmental protocol. His attending physician advises him that while diligence is appreciated, these changes are counterproductive. Which principle of high-stakes performance management should the resident adopt to optimize his performance and reduce unnecessary stress?
- A) Implementing a highly individualized set of protocols based on perceived risk factors.
- B) Modifying standard operating procedures (SO Ps) when the environment feels particularly stressful.
- C) Adhering strictly to established, proven departmental checklists and algorithms regardless of emotional state.
- D) Delegating all critical decision-making processes to senior staff members during peak stress periods.
Answer: C. The core principle discussed is standardization—acting like a "robot" or following an algorithm. While caution is good, changing the process (modifying SO Ps) because the situation feels stressful leads to poor outcomes. Adhering strictly to established protocols (checklists/algorithms) removes emotional variables and allows for consistent, replicable performance, which is crucial in high-stakes medical settings.
Question 2 — Stress Physiology
A student preparing for a major board examination notes that while he has mastered the content and scored highly on practice exams, his anxiety levels are escalating dramatically as the test date approaches. He finds himself spending excessive time reading every question multiple times and overanalyzing minor details in the answer choices, leading to mental fatigue and decreased efficiency during mock testing. This pattern of behavior suggests a failure to manage which aspect of high-stakes performance?
- A) Cognitive load management due to insufficient foundational knowledge.
- B) The ability to differentiate between confidence and excessive pride.
- C) Emotional detachment from the outcome, allowing focus on the process rather than the result.
- D) Adequate physical preparation for prolonged periods of intense mental exertion.
Answer: C. The transcript emphasizes that high-stakes testing requires emotional detachment—the mindset that "your life does not depend on this exam." Overanalyzing every detail and becoming overly cautious (micromanaging) indicates that the student is placing too much psychological weight or importance on the outcome, leading to performance impairment.
Question 3 — Team Dynamics
During a simulation for managing septic shock in the Emergency Department, a team member becomes visibly distressed after receiving negative feedback from another resident about his initial assessment. He begins voicing fatalistic and pessimistic statements ("This patient is hopeless; we're doomed") to the group, causing palpable anxiety among the other participants. According to principles of optimal performance in collaborative medical settings, how should the remaining team members best respond?
- A) Engage with the distressed member by validating his feelings to maintain emotional rapport.
- B) Immediately redirect the conversation and focus on objective data points and established protocols.
- C) Ignore the negative comments, assuming they are merely transient emotional outbursts.
- D) Challenge the resident's pessimism by citing historical success rates for similar cases.
Answer: B. The podcast strongly advises avoiding people who are panicking or exhibiting negative peer pressure. In a clinical setting, this translates to maintaining focus on objective data and established protocols (the "process"). Engaging with panic validates the emotion rather than addressing the medical problem; therefore, redirecting attention back to actionable, objective steps is the most effective intervention.
Question 4 — Performance Optimization
A surgical team leader is preparing for a complex, multi-stage operation that requires flawless execution under extreme time pressure. To ensure optimal performance, she decides to implement a detailed pre-operative checklist and runs through every single step of the procedure—from initial incision to final dressing change—multiple times with her team during non-critical training sessions. This preparatory strategy best exemplifies which principle for maximizing performance in complex medical scenarios?
- A) Self-affirmation, boosting morale before the critical event.
- B) Cognitive restructuring, changing negative thought patterns into positive ones.
- C) Simulation and standardization, ensuring procedural fluency under simulated stress.
- D) Humility, acknowledging that external variables may compromise the plan.
Answer: C. The concept of "simulating game day" is central to optimizing performance. By running through every step repeatedly (standardization), the team gains procedural fluency and comfort in a high-stress environment. This practice minimizes cognitive load and allows them to execute complex tasks automatically when the real, high-stakes situation arises.
Quick fire review
What is the most critical psychological aspect of test-taking, beyond just studying?
Being psychologically prepared for "game day."
If a student relies only on faith and minimal effort without proper study, what fallacy are they exhibiting?
False faith or delusion; success requires corresponding work.
What is the key principle regarding peer interaction before an exam?
Avoid people who are panicking or pessimistic (negative peer pressure).
How should a student approach test day to avoid performance decline?
By maintaining a standardized, robotic process and not making changes from their usual study routine.
What is the difference between confidence and pride in preparation?
Confidence is grounded and maintains a level head; Pride involves premature celebration or overconfidence.
What does "simulating game day" involve for an exam like Step 2?
Practicing the full duration, including breaks and logistics (e.g., orientation), to mirror real-world conditions.
Principle 1: What is the first step in preparing for a high-stakes exam?
Thorough preparation; understand that effort must match expected success ("whatever you sow, that is literally what you're going to reap").
Principle 2: What psychological technique should be used to prepare for test day?
Simulate game day by practicing the full environment and logistics (e.g., timing, location) as closely as possible.
Principle 3: What type of peer influence must a student actively avoid before testing?
Negative peer pressure from panicking or pessimistic individuals; stay away from negative social media threads.
Principle 4: Why is it dangerous to change your study/testing process on test day?
Changing variables (e.g., reading questions multiple times) disrupts the established, successful pattern and leads to poor outcomes.
What does "being standardized" mean in exam preparation?
Developing a fixed, checklist-like algorithm for common scenarios (e.g., what to do when down to two answers) so that decisions are automatic and emotionless.
Principle 5: How should one approach the exam mindset regarding life outcomes?
Adopt a "life does not depend on this exam" mentality; reduce mental pressure by detaching from the outcome's perceived weight.
Quick recall / Anki-style questions
Principle 1: What is the first step in preparing for a high-stakes exam?
Thorough preparation; understand that effort must match expected success ("whatever you sow, that is literally what you're going to reap").
Principle 2: What psychological technique should be used to prepare for test day?
Simulate game day by practicing the full environment and logistics (e.g., timing, location) as closely as possible.
Principle 3: What type of peer influence must a student actively avoid before testing?
Negative peer pressure from panicking or pessimistic individuals; stay away from negative social media threads.
Principle 4: Why is it dangerous to change your study/testing process on test day?
Changing variables (e.g., reading questions multiple times) disrupts the established, successful pattern and leads to poor outcomes.
What does "being standardized" mean in exam preparation?
Developing a fixed, checklist-like algorithm for common scenarios (e.g., what to do when down to two answers) so that decisions are automatic and emotionless.
Principle 5: How should one approach the exam mindset regarding life outcomes?
Adopt a "life does not depend on this exam" mentality; reduce mental pressure by detaching from the outcome's perceived weight.