Experiencing USMLE Step 1 “mind blank” during this important exam may stem from obvious psychological factors like anxiety or pressure. After all, high levels of mental, emotional or physical stress can trigger the body’s “fight-or-flight” response that purposefully diverts resources away from other cognitive functions. This natural alerting mechanism can lead to a blanking of thoughts instead of supporting the person’s immediate need for finding answers.
“The human mind, for the most part, is considered to be constantly thinking during any awakened state” says Dr. Hans Wolf founder and CEO of WOLFPACC Physicians Achievement Concept Course. “Although the thought of experiencing mind blank when sitting for an important exam is horrifying, you may know from a personal experience that your brain can suddenly be empty, or at least become incapacitated, while trying to retrieve the memories you seek.”
Mind blanking is a distinct mental state that causes problems with connectivity, which can happen when you put your brain on the spot with too much focus on the details of the moment. In the case of today’s medical student’s, they experience months of pressure regarding their upcoming medical board exams, and collectively, it can become an overwhelming distraction to processing internal knowledge.
The amygdala signals the hypothalamus…
When a fight-or-flight response is launched, the brain’s emotional processing center (the amygdala) has detected a potential threat, which may be real or imagined. The amygdala then sends a signal to the brain’s region that regulates the autonomic nervous system (the hypothalamus). In turn, the hypothalamus activates the sympathetic nervous system, which is responsible for launching the fight-or-flight mechanism. The sympathetic nervous system originates in the spinal cord and has been said to function like the gas pedal for the brain.
Moreover, a primary function of the sympathetic nervous system is to manage arousal responses by stimulating the adrenal glands to release the two key stress hormones, adrenaline (epinephrine) and noradrenaline (norepinephrine) and provide the body with a burst of energy. To help one to get out of danger, the sympathetic nervous system activates responses to speed up their heart rate in order to deliver more blood via the thoracolumbar nervous system that connects to the psosas major, which is a lumbar muscle that will receive extra oxygen.
NOTE: The sympathetic nervous system is one of two primary sets of peripheral nerves located outside the brain and spinal cord, the other being the parasympathetic nervous system that is responsible for promoting “rest-and-digest” functions to maintain balance throughout the body. It is important to take note that a stressful situation like reporting to take one’s COMLEX Level 1 or USMLE Step 1 medical board exam can activate a cascade of stress hormones that can produce physiological changes due to being in a particular environment.
Hormones, Catecholamines and Brain Function
While cortisol hormone combined with both epinephrine and norepinephrine engage in the body’s stress responses, they do differ significantly in their roles and actions. Cortisol is a common steroid produced by the adrenal glands that helps to regulate metabolism and inflammation. It increases sugar levels in the bloodstream to enhance the brain’s use of vital glucose. Moreover, it supports gluconeogenesis from non-carbohydrate sources like fat or protein as well as increases the availability of bodily substances to repair tissue damage.
On the other hand, adrenaline and noradrenaline are chemical messengers that primarily trigger the body’s fight-or-flight response to prepare the body for potential action in stressful situations, such as taking one’s medical board exams. The neurotransmitters are released in response to stressors but also help control metabolism to produce fuel for the body. These catecholamines function as both hormones and neurotransmitters to prepare the body for action by increasing heart rate, blood pressure and blood sugar levels.
Catecholamines like epinephrine, noradrenaline and dopamine, function as both neurotransmitters in the brain and hormones in the endocrine system. Working together, they help regulate behavior by significantly impacting brain functions for modulating mood, attention, arousal, motor control, and memory processing. As part of the fight-or-flight mechanism, they prepare a person to take action in response to stress. Catecholamines modulate cognitive functions by influencing working memory, mental attention and decision-making.
Physiology of Why the Mind Goes Blank
Although not formally recognized as a medical condition, a blank mind on test day after you read the first couple of questions isn’t much fun. When you find yourself stuck for words, it is actually a neurocognitive phenomenon that occurs when attention and perception stop working together. Suddenly, instead of your mind wandering, it isn’t going anywhere and without a clear reason. Where it is normal to push the panic button, the increased anxiety may negatively affect other cognitive functions in the brain, such as:
- Hypothalamus – A small yet vital region in the midbrain that plays a key role in regulating essential bodily functions. It acts as a command center and one of its primary jobs is to control and distribute hormones that impact mood. It achieves this by stimulating or inhibiting the pituitary gland, which in turn manages the activity of other endocrine organs.
- Hippocampus – A vital part of the limbic system, the hippocampus participates in mental responses and serves as the brain’s “waiting room.” It’s where new memories are temporarily held before being stored as long-term memories. This region plays a crucial role in helping recall information, such as studying for an exam and remembering the right words.
- Prefrontal Cortex – Shaped by past experiences, this frontal lobe plays a vital role in controlling key aspects of who you are, including your reactions, and governs how you make decisions and respond. This region is critical for executive functions and manages working memory by filtering out irrelevant thoughts to stay on track by focusing on what matters most.
- Broca’s Area – Located in the left frontal lobe, Broca’s area is essential for language processing, enabling you to translate thoughts into spoken or written words. It also governs the syntactic aspects of language that combine words into meaningful sentences. Activities like following commands and engaging in writing tasks stimulates this part of the brain.
Just like mind wandering, mind blanking is actually an everyday phenomena. Fact is, it happens but most often goes relatively unnoticed. However, if you suddenly experience mind blank at the wrong time (like during your medical board exams), the absence of thoughts can quickly become a real threat of impaired performance. So, it’s important to let go of any negative thoughts, reset your attention to just before it happened, take a deep breath to calm the fight-or-flight response, and give your brain a little space.
Unparalleled One-on-One Board Exam Prep
When you’re studying for the COMLEX Level 1 or USMLE Step 1 exam in a calm, comfortable environment, your brain operates under what’s known as cold cognition. This is where logic and reasoning are in control. However, on test day once the stress kicks in, your brain may switch to hot cognition, where your emotions overpower rational thought. Once stress triggers your fight-or-flight response, the hormone disruption can temporarily shutdown the prefrontal cortex that manages your working memory.
“When you have a fear of not being properly prepared for a board exam, it will likely heighten your stress levels and temporarily boost anxiety,” adds Dr. Wolf. “Unfortunately, it is your own fears that can make having mind blank even more likely.” WOLFPACC’s experienced staff will ensure you understand the “how and why” to medicine, as it allows you to put a clinical understanding to the task at hand rather than the less-effective approach of having you memorize what you learned in the basic sciences.
At WOLFPACC we believe in your dream and want you to become a confident clinical physician, “The Power 5” approach is designed to help you avoid USMLE Step1 “mind blank” with the proper exam preparation, which makes it easy for you to identify the correct answers. You will feel far less anxiety and pressure when your board exams do not rely on your short-term memory which naturally fades with time. Your instructors will do everything they can to ensure you fully understand the questions being asked and know how to work your way through the process to determine the correct answer.
Photo credit Anne H.
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Since every facet of medical school takes so much of your time and effort to become a full-fledged doctor, WOLFPACC Physicians Achievement Concept Course was developed to provide allopathic and osteopathic students with a powerful approach to practicing medicine. We provide expert one-on-one support during a targeted exam preparation, so you can overcome test anxiety by feeling fully competent to apply what you’ve learned. If you are a medical student or IMG who wants or needs to score well on any USMLE or COMLEX-USA medical licensing exam, Dr. Wolf and his team of professionals look forward to helping you reach your goals.
