Previous Familiarity with an Anatomy Laboratory Exam Does Not Influence Preferred Timing Structure or Test Anxiety

The bell‐ringer lab exam is a common assessment in anatomy education. Traditionally, students travel between specimen stations displaying anatomical material to the chime of a bell. Various professional programs have experimented with the timing structure of lab exams and report that senior level students prefer a self‐paced (SP) exam over a belled‐paced (BP) exam. However, we were unable to replicate these results among undergraduate students in an advanced dissection course; despite greater changes in pre‐ to post‐exam anxiety, our students preferred the BP exam because “the bell helps keep [them] on task”. Research Statement Continuing this line of investigation, this research sought to determine if previous familiarity with a traditional bell‐ringer lab exam influences either preferred timing structure or test anxiety. Methodology This research employed a randomized cross‐over design within an introductory undergraduate course in human anatomy and histology (n=71) with both a midterm and final lab exam (27 A/B specimen stations each). At the midterm lab exam students were randomly assigned to either the SP or BP timing structure, each with a 45min maximum time. Students crossed‐over to the alternative timing condition for the final lab exam. Familiarity was self‐reported at course initiation, test anxiety was measured pre‐ and post‐exam using a modified State‐Trait Anxiety Inventory (STAI), and timing structure preference was self‐reported upon completion of the final lab exam. Students justified their timing preference using open free‐text for qualitative thematic analysis. Test performance (%) and change in STAI were compared between the two conditions using paired t‐tests. Correlations determined if familiarity influenced preferred timing structure (Phi correlation) or test anxiety (point‐biserial correlation). Institutional REB #36496. Results Fifty‐five (78%) students consented; 20 had lab exam familiarity. Regardless of timing condition, students performed academically equivalent (SP: 76±17%, BP: 76±17%, p>0.05) with similar changes in pre‐ to post‐exam anxiety (SP: 3.1±7.5, BP: 3.3±7.4, p>0.05). Contrary to the research hypothesis, familiarity did not influence preferred timing structure (Phi=0.03, p>0.05) or change in test anxiety (r=0.52, p>0.05). Preliminary qualitative analysis suggests that students who preferred the BP structure (n=23) liked that they could focus on the exam questions instead of worrying about time management. Comparatively, students who preferred the SP structure (n=32) liked that they could determine the time they spent at stations based on difficulty. Context This research shows that familiarity with a traditional bell‐ringer lab exam does not influence student preference for timing structure, nor does it impact anxiety experienced by students during lab exams. Further, these findings align with previous work demonstrating that while more students prefer the self‐paced timing structure, timing structure itself does not affect academic performance. Thus, while allowing students to choose their lab exam timing structure may not influence their test anxiety or academic performance, it may provide students with much needed autonomy.