168 - Sounding the Alarm on the Traditional Anatomy Bell-ringer Lab Exam

Poster Board Number: 168
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Co-authors:

Danielle Bentley - Assistant Professor, Surgery, University of Toronto

Abstract Body : Introduction and Objectives: During the traditional “bell-ringer” exam, students are guided between timed question stations to the chime of a bell. Instructors who offer alternatives to this approach (i.e. self-pacing through stations) often aim to alleviate unnecessary student anxiety. However, literature on self-paced exams among undergraduate students remains inconclusive. As such, this research sought to evaluate the impact of a self-selected pacing structure on academic performance and test-related anxiety in a senior undergraduate anatomy course. It was hypothesized that the autonomy to self-select one’s pacing structure would reduce test-anxiety while maintaining academic rigor.









Methods: Senior undergraduate students with a background in human anatomy completed two lab exams at the MIDTERM and FINAL timepoints. Both were identical in the volume of tested content, time limit (34min), and number of stations (30 A/B split questions with 4 rest stations). Students were able to choose between the self-paced (SP) or bell-paced (BP) structure before each exam. Test-anxiety was measured pre- and post-exam using the State-Trait Anxiety Inventory (STAI, /60). For both timepoints, test performance and STAI scores were compared between the two pacing structures using the unpaired t-test. At course conclusion, students provided open-ended feedback of their selected pacing structures for thematic qualitative analysis. Statistical significance was set at p< 0.05, with results expressed as avg±SD. 




 




Results: Of 20 enrolled students, 18 consented to data extraction, with 17 complete data sets. During the MIDTERM, academic performance was consistent between students who self-selected into the SP structure (SP: n=4, 85±5%), and those into the BP structure (BP: n=13, 86±7%), despite significantly greater pre-test anxiety in the former (SP: 54±13 vs. BP: 42±12, p< 0.05). For the FINAL, two students switched from BP to SP and one from SP to BP. Interestingly, academic performance remained consistent between SP students (n=6, 78±7%) and BP students (n=11, 76±4%), with now similar pre-test anxiety observed in both (SP: 49±13 vs. BP: 50±14, ns). Aligned with our previous work, student feedback revealed that those who preferred the bell (n=13) were drawn to the chime as a time management aid, while those who preferred to self-pace (n=4) wanted to allocate more time to harder stations.









Conclusion and Significance: These results further challenge the traditional bell-ringer style. Designing assessments in anatomy courses should be purposefully, and directly aligned with course outcomes. If performance under pressure is not a direct course outcome, alternatives to the bell-ringer structure may bear more vocational relevance and mitigate student anxiety.