Fear and Education

This was my first blog post for The American Academy of Physician Assistants PA Blog in a recurring series called “Professor’s Corner”. 


           Fear is good.  It is a strong statement and is bound to invoke certain emotional feelings, which may not always be positive in nature.  Think back to the last time you were truly scared.  Chances are you can remember more than you think about the event in question.  Cognitive psychologists have studied the effect of fear on attention, as well as retention, and shows there may be a “sweet spot” for a “healthy amount” of stress that is beneficial to learners.  The trick is not only finding that perfect zone for each student, but also adjusting it throughout the 2.5 years of school. 

            The fear and stress at the beginning of the didactic phase of PA education is most commonly caused by grades and doing well on exams.  Many of you may have gone through undergraduate studies with very high marks, and maybe even didn’t have to study all that hard.  Then PA school hits you like a freight train.  So what happens?  You commit “academic bulimia”……binging on large amount of information for exams and then completely purging it from memory to make space for the next exam.  Very little retention takes place, but the fear of doing well in school is tempered.  Compare this to the end of the didactic year when you have your studying methods down, but you are preparing for clinical rotations and suddenly you think you “can’t remember anything”.  Now the fear is shifted from grades, to trying to remember as much as possible to take care of actual patients.  While on clinical rotations, your fear is redirected once again to trying to recall any information from your didactic year so you don’t look incompetent in front of your patients or preceptors.

            Our jobs as professors in PA programs is to instilling aliquots of fear in safe environments to get you ready to practice medicine.  Maybe it is using more simulation in a group setting.  Maybe it is calling on you in class.  Maybe it is pop quizzes.  Maybe it is comprehensive final exams.  The method to our madness……stress inoculation.  By doing small stressful tasks throughout your classroom instruction, we are trying to prepare you for learning in the clinical environment.  Simulation prepares you to make clinical decisions in low-stakes environments.  Calling on you in class prepares you for the Socratic method of teaching that permeates the halls of the hospitals.  Pop quizzes and comprehensive finals teaches you to be self-directed, intrinsic learners that will persist for your entire medical career.

              Fear is good.  No other profession has the life or death struggle that medicine embraces.  The moment you do not fear taking care of patients is the moment you may cause someone harm.  Part of the educational process of PA school is to teach you how to manage this fear.  Every time you overcome fear, you become stronger.  Suddenly, thinking about getting called out in class by a professor in a class of your peers is nothing compared to getting called on by your attending in front a group of strangers….or telling a patient they have terminal cancer.  Harnessing this fear and helping you focus it will not only help you be the best clinician possible, but it will indirectly help every one of your patients you take care for the rest of your career.


1)  Vermeulen N, Godefroid J, Mermillod M (2009) Emotional Modulation of Attention: Fear Increases but Disgust Reduces the Attentional Blink. PLoS ONE 4(11): e7924.

2)  Schwabe L, Joels M, Roozendaal B, Wolf OT, Oitzl MS.  Stress effects on memory:  An update and integration.  Neuroscience and Biobehavioral Reviews.  2012;36:1740-1749.

3)  Susskind JM, Lee DH, Cusi A, Feiman, Grabski W, Anderson AK.  Expressing fear enhances sensory acquisition.  Nature Neuroscience.  2008;11(7):843-850.

4)  Perry B.  Fear and Learning: Trauma-Related Factors in Adult Education Process.  New Directions for Adult and Continuing Education.  2006;110:21-27.

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