Dr. FAHAD BASHEER
University exams are the fundamental factor that decides whether you have the eligibility to sit in the next year or whether you are eligible for the post nominal degree. University exams are inevitable when it comes to your undergraduate or postgraduate life. Depending on the status of the degree you take, you will have the bulk of topics and books to be covered and studied. For a higher degree like medical education you will indeed have a vast amount of topics to be covered for the upcoming exams. It’s tough, weary and stress worthy! Indeed no doubt about as everyone who passes through those stages of life normally witness these stress and are often subjected to this stress. Some may even avoid their sleep and some may even avoid their food in order to save the time for studying and covering subjects. Due to its vast topics medical students find it difficult to memorize the topics that they have previously learned. So the only thing that helps to write and pass their exams are nothing but the revision they starts before the day of the exams and luck in which the questions been asked from the topics they have learned for the exam. Because it is 100% impossible to cover up any medical textbooks for the exam due to its large volume of chapters and the vastness of the topics in it. This creates anxiety in not finishing the chapters that are yet to be studied. And creates tension as they tend to forget whatever they studied due to large amount of chapters they study within a short period of time. And while studying any data it is inevitable to use ones conscious mind for analyzing and rationalizing the subjects you learn. The overuse of one’s conscious mind will create the stress patterns in one’s body. As a result the students are subjected to the overuse of conscious mind, tensions and anxiety, whole of which contribute to the well-known term the “stress”. Apart from these other social fears like fear of failure in exams fear of aftereffects of failure contribute to Stress.
During stress, the adrenaline released shunts blood flow from forebrain that is essential to use your intelligence to the hind brain which regulates the reflex actions. This makes a person not able to focus on the tasks that he is focusing on. In other words the student won’t be able to focus on what he is studying. According to the American School Board of Journal June 2005 on “Test anxiety” It has been found that high anxiety can disrupt the student’s concentration and will result in low test score. Studies have discovered that when you are emotionally upset, “you can’t just think straight”. At the Heart Math institute, in their research they have found that, when we are stressed out our heart patterns becomes disorganized and non-coherent, the non-coherent heart patterns produces non coherent patterns in the brain. This decreases the brains ability to process information and in recognizing patterns and decreases the brains ability to solve problems and the brains ability to learn. This makes the student to feel that what he tries to learn doesn’t make any sense to him. As a result the student may get stressed up or throw off the book. Dopamine is a neurotransmitter that acts as a stimulant and sensitizes brain cells to look for patterns. Strong dopamine levels are reflected in individuals with sharper thinking and focused behavior. Stress can cause imbalance in the normal production of dopamine by either resulting in overproduction leading to anxious, hyper vigilant or perfectionist behavior or by resulting in underproduction leading to inattention and unmotivated behavior. In a research it was discovered that neurons in the brain of a chronically stressed individual may have fewer and shorter dendrites. This deficiency impairs communication with other dendrites reducing brains ability to process information effectively.Stress can severely affect our working memory and long term memory.
The stress that you undergo during your exams not only affects your learning process and memory but also badly affects your physical health. University examinations especially the one in the final lap of a course generally tends to stress out the students. I have been witness to many of my fellow classmates suffering from oral ulcers, fever, headache, skin ailments and constipation. In 2008, researchers led by imminent psychologist Simon Knowles of Swineburne University of Technology, Australia found that the stool samples of students facing an examination had fewer lactobacilli than that found when they had during a relatively stress- free period e.g. during the start of a semester. This lactobacillus is essential for the production of 95% of the mood elevating hormone the serotonin, nutrition of 70% of immune cells and for proper digestion.But the best part is that these are just temporary phenomena and get resolved immediately on completion of the examination. It is also noticed that the healing process of pre-existing wounds and diseases too slows down during this period. Yes, stress can even cause delay in healing by 25% or more. It had been found out from the research that dental students took 40 % or longer to heal a small standardized wound made prior to exams compared to an identical wound made during their summer vacation. Cortisol released during stress inhibits immune cells that produce inflammatory cytokines that are essential for the early part of healing process.
In a research on impact of academic exams on medical students, it was discovered that the medical students who underwent academic examinations had down regulation of NK cell activity which is essential to destroy tumor cells. The levels of NK cells are considered indicative of immune strength. They play the role of first defense in controlling infection in the early stages of the same. Psychological stress reduces the Natural Killer cells and thereby paves the way for infection/ disease. A study involving medical students as its subject has revealed some startling facts. It was noted that stressed medical students tested on the day of their examination showed significantly lowered levels of immune markers including lowered levels of NK cells. It was also noted that lack of social bonding too had an adverse effect on these cell levels. Lonely medical students had lower levels of NK cell activity when compared to their more socially active counterparts. In the same study it was found that these medical students has lower synthesis of gamma interferon by peripheral blood leukocytes after stimulation with concanvalin A, altered expression of interleukin2 receptor and impaired cellular immune system control of the reactivation of certain latent herpes viruses.This clearly shows that the stress that we undergo during our exam is powerful enough to shut down our immune system.
A study conducted at the Ohio State University threw up an interesting fact with the risk of getting hepatitis respect to exam related stress by injecting hepatitis vaccine on the 3rd day of 3 day continuous academic exam on 3rd year medical students. The results revealed that immune response of students who appeared for the final examination (they are the ones prone to higher level of stress) to hepatitis was less when compared to students who were not under stress of any kind. They discovered that seroconversion of hepatitis antibody from Hbs Ag to anti Hbs Ag which represented that shift from infectious hepatitis to inactive hepatitis or acquirement of immunity was decreased in medical students with anxiety during the academic exams. In other words the stressed medical students took more time for seroconversion or antibody production.
Studies have revealed that written examination may or may not increase the cortisol levels, but oral examination (viva) spiked up the cortisol in the body. The instant stress experienced by the medical students was measured using salivary cortisol. In 2007, vaidya and mulaonkar as per their research pointed that the increased academic pressure during the first year as the one of the most responsible cause for increased anxiety and stress in medical examinations.
In sum, our university exam and the curriculum through which we go puts us in a lot of pressure and stress that impacts our mental health, learning process, memory, immune system and body a lot. A crystalline clear action is needed either to create a new curriculum that helps the upcoming students to be friendly with. Or an inevitable need is required in developing the confidence in students through psychological motivation in classrooms and familiarity with the uprising curriculum set up in different universities.
THE SCIENCE OF EMOTIONS: Dr. FAHAD BASHEER