Dear editorWe note with great interest the work of Kötter and Niebuhr,1 with regard to reducing examination-related stress in medical students through short-term coaching. We highly commend their efforts to provide an evidence base for techniques that have been suggested in the literature. We would however argue that the use of coaching such as wingwave® may perhaps be too impractical and expensive to be used on a regular basis, and that the long-term efficacy of the approach is unclear. We would encourage further work into other methods and would specifically welcome trials comparing these techniques to the coaching described by Kötter and Niebuhr.Examples of the other methods include introduction of elective courses specializing in the teaching of coping strategies, such as breathing exercises, social coping skills, and elements of cognitive behavioral therapy. Not only would this aid in the reduction of stress related to examinations, but also this could equip future doctors with a mental framework that may help them deal with future stressful situations.2 Evidence of their efficacy comes from the study of Pereira et al,3 which looked at the benefits of these elective courses, with the further addition of reflective practices and psychoanalysis. They found that “67% reported less symptoms of stress at the end of the [elective] course”.3Furthermore, there has been a movement in recent years promoting the benefits of alternative self-care therapies.2 Arguably, the most well known of these include “mindfulness”, “a cognitive style that facilitates non-judgemental awareness”4 and allows users to notice symptoms of stress and anxiety much earlier than they normally would, that Slonim et al5 found to have “the potential … to decrease medical student distress and enhance well-being”.We look forward to seeing the response of the academic community, and hope sincerely that an effective solution may be found to this neglected problem.