Managing Exam Stress
A quick-reference guide for Resident Medical Officers (RMOs)
Sitting exams while carrying a full clinical load — ward rounds, on-call, night shifts and decisions that matter — is a genuinely difficult combination. If study feels harder than it should right now, that’s not a sign you’re doing it wrong; it’s probably a sign of how much you’re already carrying. Some of the pitfalls and patterns that are easy to fall into are examined below. They’re common responses to sustained pressure, not a lack of ability. Each is paired with a counter-strategy written for the realities of ward life, shifts and exam prep.
| HABIT / PITFALL | TOOL / TECHNIQUE |
|---|---|
| All-or-nothing / black-and-white thinking |
Challenge and reframe Notice “all or nothing” language after a rough shift or a poor practice paper (“I'll never pass this”) and reframe it: “That's one topic to target, not a verdict on the whole exam.” Or “Shifts are going to be up and down and there are things out of my control.” |
| Perfectionist thinking |
Value failure as learning Rewriting the same notes for the third time or feeling you must know every guideline cold before attempting a practice paper, is perfectionism — not preparation. Treat a wrong practice answer as the fastest way to find a gap. |
| Not taking breaks |
Build breaks in deliberately Studying through an entire day after a night shift with no break, then crashing, is a pattern some may be familiar with. Consider using the Pomodoro technique (25–50 min focus, 5–10 min break) and schedule rest before you study, not after you collapse. |
| Studying huge unstructured blocks, no active tools |
Study actively, not passively Re-reading information the night before an exam or spending hours continuously re-reading rarely sticks. Swap it for flashcards between patients, spaced and structured repetition, practice questions, or talking a topic through with a colleague over a break. (Bowler, 2021) |
| Forgetting the foundations — sleep, food, movement, routine |
Protect the foundations first Skipping meals on a busy on-call shift, or cutting sleep to cram before an early exam, undermines the memory and focus you're trying to build. Sleep, food, movement and routine are the base layer everything else depends on. |
| Lack of planning |
Manage a busy life deliberately When balancing exam preparation with a full clinical workload, trying to cover everything at once can be overwhelming. As these exams can assess a broad range of topics, focus on a realistic, structured study plan that prioritises consistency and addresses your learning needs. A sustainable plan you can maintain is often more effective than an ambitious one that doesn't fit your schedule. |
| Procrastination |
Habit stacking, changing environment or structure of the task. Anchor study to something already in your day (“after I hand over, I review 10 flashcards before I leave”) or stacking 20-30 minutes movement with revising or listening to a lecture (Clear, 2018). You may also be neurodivergent and find that certain strategies work better for you when managing procrastination. Use the techniques that suit your own needs, such as adjusting your environment, changing how you structure tasks, or finding a system that helps you stay focused. |
| Burnout |
Short wellbeing resets + self-care Feeling numb on the ward, or dreading a shift you'd normally enjoy, are early burnout signs — not just tiredness. Short resets (a breathing break, spending time in nature, doing something enjoyable daily) between study blocks help you consolidate, and protect real self-care time (Borges, 2019). Taking a leave break can support a wellbeing reset. |
Reframing all-or-nothing thoughts
| INSTEAD OF… | TRY… |
|---|---|
| “If I don't know this topic, I'll fail the whole exam.” | “That's one gap out of many topics. I can prioritise it, not panic about it.” |
| “I should be studying every free minute between patients and after every shift.” | “Rested, focused hours beat exhausted, scattered ones. My roster needs me sharp too.” |
| “I got that practice question wrong. I'm not cut out for this.” | “Mistakes on practice questions are how I avoid them in the exam, and on the ward.” |
Daily foundations checklist
☐ 7–9 hours of sleep, protected — even the night before an exam or after a run of night shifts
☐ Three regular meals even on your shift days, not skipped or replaced with coffee
☐ At least 20–30 minutes of meaningful movement.
☐ A rough daily plan with priorities set the night before, built around your roster
☐ One scheduled break every 25–50 minutes of study — treat it like a fixed commitment
☐ One moment of real contact with another person — a call, a message, a debrief with a colleague
A 60-second reset for pressure spikes
- Name it: “This is stress, it will pass” — useful between patients or before you walk back onto the ward.
- Ground: 5 things you see, 4 you hear, 3 you can touch, 2 you smell, 1 you taste.
- Breathe: in for 4, hold for 4, out for 6 — repeat four times.
- Re-enter: pick the next single small task — the next patient, the next subject, the next question — not the whole list.
More ideas from the literature
- Feel-Good Productivity (Ali Abdaal, 2023): look for what energises study — play, a sense of control, connection — and notice the three blockers (fear, uncertainty, inertia) behind procrastination.
- Atomic Habits (James Clear, 2018): make good study habits obvious, easy, attractive and satisfying, and anchor them to identity (“I'm becoming someone who studies consistently”).
- The Only Study Guide You'll Ever Need (Jade Bowler, 2021): practise under real exam conditions and mark your own work against the scheme — closing that loop builds skill and confidence.
- The More or Less Definitive Guide to Self-Care (Anna Borges, 2019): build a personal toolkit across physical, mental, social and spiritual self-care, not just one “treat yourself” habit.
- Why Has Nobody Told Me This Before? (Dr Julie Smith, 2022): motivation often follows action — start the smallest version of the task and let motivation catch up; name what you're feeling rather than fighting it.
Extra tools for tougher moments
- Distress tolerance: when pressure spikes, use grounding techniques (slowing breathing down, getting a drink of water and focusing on this action, having a stretch, push your foot into the ground) to bring intensity down before problem-solving.
- Communication: tell a friend, family member or colleague what you need — practical help, a listening ear, or simply company. Isolation amplifies exam stress, especially when shift patterns already limit your time with people. Communicate your boundaries in relationships around exam periods so they know what you can or cannot do during this busy period.
- Self-care time: protect small, non-negotiable pockets of time for things unrelated to exams — they are part of the preparation, not a distraction from it.
If stress is becoming unmanageable, reach out early to a colleague, supervisor, GP or Clearhead. Asking for support is a sign of good clinical judgement, not a failing.
Remember, you get access to confidential and expert psychological support with NZMII,
up to six sessions per year with Clearhead.
References
- Abdaal, A. (2023). Feel-Good Productivity: How to Do More of What Matters to You. Celadon Books.
- Borges, A. (2019). The More or Less Definitive Guide to Self-Care. The Experiment.
- Bowler, J. (2021). The Only Study Guide You'll Ever Need. Blink Publishing.
- Clear, J. (2018). Atomic Habits: An Easy and Proven Way to Build Good Habits and Break Bad Ones. Avery.
- Smith, J. (2022). Why Has Nobody Told Me This Before? HarperOne.