My Internal Medicine Board Exam Anxiety Story
The night before my ABIM exam, I couldn’t sleep. My heart was racing, my palms were sweating, and I kept running to the bathroom every fifteen minutes. Sound familiar?
Three months earlier, I had been that resident who looked calm on the outside but was falling apart inside. Everyone around me seemed so confident about their board prep. Meanwhile, I was having what I now recognize as full-blown panic attacks just thinking about the exam.
If you’re reading this at 2 AM because you can’t stop worrying about your upcoming Internal Medicine boards, I get it. The anxiety feels overwhelming. But here’s what I learned: the anxiety isn’t just normal—it’s actually telling you something important about how to succeed.
The Breaking Point That Changed Everything
Two months into my study schedule, I had what my attending later called “productive anxiety breakdown.” I was reviewing cardiology cases when suddenly I couldn’t breathe. The room started spinning. I thought I was having a heart attack.
My wife drove me to the ED (ironic, right?). After they ruled out anything serious, the attending physician—Dr. Martinez—sat down with me. She had taken her boards fifteen years ago and still remembered her own anxiety.
“The fear isn’t about the exam,” she told me. “It’s about what the exam represents. You’re not just afraid of failing a test. You’re afraid of failing as a doctor.”
That hit me hard because it was true.
What Actually Worked (And What Didn’t)
After that night, I had to get serious about managing my anxiety. Here’s what actually helped versus what everyone told me would help:
What Everyone Says But Doesn’t Really Work
“Just relax” – Yeah, right. If I could just relax, I wouldn’t be having anxiety in the first place.
“You’re overprepared” – Maybe, but that didn’t stop my brain from catastrophizing every scenario.
“Think positive thoughts” – Positive thinking bounced right off my anxious brain like water off a duck.
What Actually Made a Difference
Breaking the study-anxiety cycle: I was studying 12 hours a day and getting more anxious, not less. Dr. Martinez helped me realize that exhausted brains can’t tell the difference between being unprepared and being overtired. I cut my study time to 8 hours max and my retention actually improved.
The 10-minute rule: When anxiety hit during practice questions, I’d set a timer for 10 minutes and let myself feel anxious. Really feel it. Then I’d move on. Fighting the anxiety made it stronger. Accepting it for exactly 10 minutes made it manageable.
Treating my brain like a patient: This sounds weird, but it worked. When my anxiety spiraled, I’d ask myself: “What would I tell a patient who came to me with these symptoms?” I’d prescribe myself the same things—regular sleep, exercise, proper nutrition, stress management.
The buddy system: I found another resident, Sarah, who was also struggling with anxiety. We started studying together twice a week. Not the whole time—just enough to normalize the fear. Knowing someone else felt the same way helped more than any pep talk.
The Real Turning Point
Three weeks before the exam, I had another breakthrough. I was doing practice questions and getting frustrated because I kept second-guessing myself. Then I remembered something from medical school: second-guessing usually means your first instinct was right.
I started tracking this. For two weeks, I marked every question where I changed my answer. 73% of the time, my first choice was correct.
This wasn’t just about test-taking strategy. It was about trusting my training. The anxiety was making me doubt everything I actually knew.
The Week Before: What Finally Clicked
That last week, instead of cramming more information, I focused on three things:
Sleep: I forced myself to get 7 hours minimum. Yes, even with all the studying left to do. Tired brains don’t retain information anyway.
Routine: I practiced my exact morning routine for test day. Same breakfast, same coffee, same drive route. By test day, everything felt familiar.
Perspective: I wrote down all the patients I’d successfully diagnosed and treated during residency. Real people whose lives were better because of my medical knowledge. The exam was just paper. My actual doctoring skills were proven.
Test Day Reality
The morning of the exam, I still felt nervous. But it was different—like an athlete before a big game instead of someone facing execution.
The questions were hard, just like everyone said they’d be. But here’s what no one tells you: they’re supposed to be hard. The exam isn’t testing whether you’re the smartest person in the room. It’s testing whether you’re competent to practice medicine.
About halfway through, I hit a string of questions that completely stumped me. Old me would have panicked. New me remembered: you don’t have to get everything right. You just have to get enough right.
What I’d Tell My Anxious Self (And You)
Your anxiety doesn’t mean you’re not ready. It means you care. It means this matters to you.
The exam isn’t trying to trick you. It’s not designed to make you fail. It’s designed to verify that you can safely take care of patients—something you’ve been doing successfully for years.
Your anxiety is giving you information. Listen to it, address what you can control, and accept what you can’t.
Most importantly: you already are a doctor. The exam doesn’t make you one. It just confirms what’s already true.
The Follow-Up
I passed. Not with flying colors, but solidly. More importantly, I learned that anxiety doesn’t have to be the enemy of success. It can actually be information that helps you prepare better.
Sarah passed too. We still text each other before big presentations or procedures. “10-minute rule?” one of us will write. The other always answers: “10-minute rule.”
If You’re Reading This at 3 AM
Take a breath. Set your phone down for 10 minutes. Go get a glass of water.
Your anxiety is real, but it’s not fortune-telling. You’ve successfully made it through medical school, residency, and countless patient encounters. You have more medical knowledge than 99.9% of the population.
The exam is just one more step. A hard step, yes. But just a step.
You’ve got this. Not because you’re perfect, but because you’re prepared. Not because you won’t feel nervous, but because you can feel nervous and succeed anyway.
Trust your training. Trust your instincts. Trust that your anxiety is trying to help, even when it doesn’t feel that way.
And remember: in a few months, this will all be behind you, and you’ll be helping the next anxious resident figure out their own path through.
What anxiety management strategies have worked for you during board prep? Have you found ways to channel nervous energy into productive studying? Share your experience—it might help another resident who’s struggling right now.
