Comparison of examination performance and test anxiety during bell‐paced and self‐paced gross anatomy laboratory examinations

Pacing during anatomy laboratory examinations may influence both student performance and test anxiety. This study compared bell-paced (BP) and self-paced (SP) timing structures to assess their impact on students' test performance, test anxiety, and pacing preferences. Undergraduate students (N = 35) across two academic years completed two anatomy laboratory exams under randomized crossover conditions: bell-pacing (60 s/station, forward progression signaled by bell) and self-pacing (balanced for total time, student-directed forward progression). A modified State-Trait Anxiety Inventory measured three novel anxiety metrics: anticipatory test anxiety (pre-exam), consequent test anxiety (post-exam), and reactive test anxiety (pre-post change). Mixed-effects models assessed effects of pacing condition on exam performance and test anxiety (anticipatory and consequent), controlling for repeated measures. Open-text student feedback was thematically analyzed. Exam performance was consistent between pacing conditions (BP: 82.8% ± 6.8%; SP: 81.1% ± 8.1%, β = 2.07, 95% CI [-2.45, 6.58]). Although the overall pacing effect on test anxiety was not significant, post-hoc comparisons revealed that the BP condition significantly increased mean reactive test anxiety (M = 5.67, p < 0.01), whereas SP did not. Despite that, most students (23/35; 66%) still preferred bell-pacing. Qualitative student feedback revealed that BP offered organization and familiarity, while SP provided flexibility and autonomy. Most students paradoxically preferred a pacing structure that made them more anxious, suggesting that preferences need not necessarily align with an associated psychological benefit. These findings underscored the complexity of assessment design and the importance of considering both academic and psychological outcomes in this process.