Exam Day and Test Anxiety

You have studied. Now you have to show it, under a clock, with your heart beating a little faster than usual. This chapter gives you two sets of tools for exam day: strategies for multiple-choice questions, and strategies for the nerves that come with them.

Before the first question

Week 5 is usually when Exam 1 arrives in BIO 243. For many students, it is the first college science exam they have ever taken. It is normal to feel unsure about what it will be like. The good news is that a lot of what happens on exam day is in your control, starting before you read question one.

• Arrive early, or log in early. If the exam is on campus, give yourself extra time for traffic, parking and finding a seat. If it is online in Blackboard, sit down at your device several minutes before you plan to start, with everything charged and other apps and tabs closed.
• Read the instructions. How many questions are there? How much time do you have? Can you move back and forth between questions, or does the exam show them one at a time? This changes your pacing plan, as you will see below.
• Do the time math. Divide the minutes by the number of questions to get your average time per question. Then pick two or three checkpoints. For example, if you have 50 questions in 60 minutes, you want to be around question 25 at about the 30-minute mark, with a little time left at the end.
• Take one slow breath before you start. More on why that helps later in the chapter.

And one rule that never bends: the syllabus says that using any outside source or device during a quiz or test is cheating. That includes notes, websites, classmates, and AI. Put your phone away before you begin, so it is not even a temptation. Your own brain, trained by your practice, is the only tool you need.

Multiple-choice strategy

BIO 243 exams are multiple choice. That format rewards knowledge, of course, but it also rewards careful reading. Many points are lost not because a student did not know the content, but because they answered a slightly different question than the one on the page. Here is a five-step routine to use on every question until it becomes automatic.

1. Read the whole stem. The stem is the question part, before the answer choices. Read every word, all the way to the end.
2. Spot the key words. Words like NOT, EXCEPT, LEAST, FIRST, MOST LIKELY and BEST flip or narrow what the question wants. So do the specific terms: "osteoclast" is not "osteoblast," and "afferent" is not "efferent."
3. Predict the answer before you look. Cover the choices with your hand or scroll so you cannot see them, and answer the question in your head first. Then look for your answer among the choices.
4. Eliminate. Cross out choices that are clearly wrong. Every choice you remove raises your odds.
5. Choose the best answer, then move on.

Why predicting works

Predicting your answer before you look is a small habit with a big effect. Wrong answer choices on a good exam are written to look tempting. If you read them first, they can pull you away from what you actually know. If you already have an answer in your head, you are checking the choices against it, instead of letting the choices lead you.

Take this question: "Which cell breaks down bone matrix during remodeling?" If you say "osteoclast" before you look, then you can quickly pass over "osteoblast," "osteocyte" and "chondrocyte," even though all three look and sound similar. If you look first, all four words blur together. Predicting is also a bonus round of retrieval practice, the strategy from Chapter 6.

True, but not the answer

The trickiest wrong answers are ones that are true statements, but do not answer the question asked. Look at this one:

What directly causes tropomyosin to move off the myosin-binding sites on actin? (a) Acetylcholine binding to receptors on the motor end plate, (b) calcium binding to troponin, (c) ATP binding to the myosin head, (d) sodium entering the muscle fiber.

Every one of these really happens during a muscle contraction. Acetylcholine does bind the motor end plate. Sodium does enter the fiber. ATP does bind myosin. But the word "directly" asks for the one step that moves tropomyosin, and that is (b), calcium binding to troponin. If you learned the process as a story with "because" links, as Chapter 7 suggested, you can place each choice in the story and see which step comes right before tropomyosin moves.

Watch the words that flip the question

Questions with NOT, EXCEPT or LEAST are easy to misread, especially when you are nervous. Your brain expects to look for a true statement, and it grabs the first true one it sees. Some habits that help:

• Circle or underline the flip word if you are on paper. Online, say it in your head: "I am looking for the false one."
• Treat each choice as its own true-or-false statement. Write T or F next to each one, mentally or on scratch paper if your exam allows it. The odd one out is the answer.
• Be careful with absolute words like "always," "never" and "only" inside the choices. Biology has many exceptions, so a choice with an absolute word is often too strong. "Often" is not "always," though, so check it against what you know rather than ruling it out automatically.

Should you change your answer?

Many students have been told to "always go with your first instinct." It sounds wise, but the research does not support it as a rule. Studies of answer changing, going back many decades, have found that when students change an answer, the change is more often from wrong to right than from right to wrong.

Justin Kruger, Derrick Wirtz and Dale Miller (2005) looked at the answer changes of college students on a real exam and found the same pattern: more changes helped than hurt. They also found something interesting about why the myth survives. When a change turns out wrong, it stings and we remember it. When we stick with a first answer that was wrong, it bothers us less. So the painful memories pile up on the side of "never change." A study of medical students by Daniel Bauer and colleagues (2007) also found that answer changes were more often from wrong to right.

That does not mean you should change answers randomly. The research describes changes students chose to make, often for a reason. Here is a sensible rule:

• Change your answer when you have a reason. You realized you misread the stem. You remembered a fact. A later question reminded you of something. You worked the problem again and got a different result.
• Do not change it just because of a vague feeling that your first answer "seems too easy" or because you picked C three times in a row. Patterns in the answer key are not a reason.

Pacing: skip, mark and return

A single hard question can eat five minutes and shake your confidence. Meanwhile, three easy questions later in the exam are waiting for you. Good pacing protects you from that trap. The simplest method is the two-pass approach, shown in Figure 9.2.

A few more pacing tips:

• Check your checkpoints. At each checkpoint you set at the start, glance at the clock. If you are behind, speed up on the questions you know and lean on the mark-and-return method for the rest.
• Do not leave blanks unless the instructions say wrong answers cost extra points. A guess you narrowed down to two choices has a real chance of being right.
• Use later questions as clues. Sometimes question 30 contains a term or idea that helps you with question 12. That is a good reason to revisit a marked question.
• Know your exam's rules. Some online exams show one question at a time and do not let you go back. Your instructor's instructions tell you which kind you have. If you cannot go back, the "mark it" step becomes "make your best choice now," and the rest of the method still works.

Test anxiety is normal, and it is physiology

Some nervousness before an exam is almost universal. Your heart beats faster. Your breathing speeds up. Your palms get sweaty, your mouth gets dry, and your stomach feels fluttery. For some students those feelings are mild and pass quickly. For others they are strong enough to get in the way. A large review by Nathaniel von der Embse and colleagues (2018), which combined decades of studies, found that higher test anxiety is linked to somewhat lower test scores on average. The link is real but modest, and it does not mean anxious students are doomed. It means anxiety is worth managing.

Here is something useful about being an A&P student: you are going to learn exactly what is happening in your body. Those feelings are your sympathetic nervous system at work, the fight-or-flight division of the autonomic nervous system that you will study in Chapter 15 of OpenStax.

Knowing the physiology helps in a practical way. A pounding heart before Exam 1 is not a sign that something is wrong with you, or a sign that you will fail. It is a normal, ancient system doing its job. The question is how you respond to it. The tools below help.

Tools for the nerves

1. Slow breathing

Breathing is the one part of the stress response you can control directly. A simple pattern: breathe in through your nose for a count of four, then breathe out slowly through your mouth for a count of six. Repeat for one to two minutes. A systematic review by Andrea Zaccaro and colleagues (2018) found that slow breathing techniques, at around six breaths per minute, were linked with signs of increased parasympathetic activity and with reduced feelings of anxiety and stress in a number of studies. The number of high-quality studies is still fairly small, so think of slow breathing as a helpful tool rather than a cure. It costs nothing, it takes a minute, and nobody can tell you are doing it.

2. Write your worries down

Worry takes up space in working memory, the small mental workspace you use to hold and juggle information while you think (Chapter 5 covers it). If part of that workspace is busy with "what if I fail," less is left for the question about joint types. Gerardo Ramirez and Sian Beilock (2011) tested a simple idea: right before an exam, students spent about ten minutes writing openly about their thoughts and feelings about the test. In their studies, which included a high school biology class, students with high test anxiety who did this writing performed better than similarly anxious students who did not. Later research has found smaller or mixed effects, so it is not a guarantee. But it is easy to try. Before your next exam, or the night before, spend five to ten minutes writing honestly about what is worrying you. Then put the paper away.

3. Reframe the feeling: "This is my body getting ready"

The same racing heart can be read two ways. You can tell yourself a threat story: "I am panicking, this is bad." Or you can tell yourself a challenge story: "My body is getting ready to perform." This is called reappraisal. In a study by Jeremy Jamieson and colleagues (2010), students preparing for the GRE, a graduate school admissions test, were told before a practice test that feeling anxious and aroused does not hurt performance and can even help it. Those students scored higher on the math section than students who did not get that message, and their reported scores on the real GRE were also higher. It was one fairly small study, so do not expect magic. But the message is true to physiology: the sympathetic response really is a get-ready response.

4. Preparation is the best calming tool

The most reliable way to feel calmer on exam day is to have practiced under exam-like conditions. If you took a timed, closed-book practice test a few days earlier, as Chapter 8 suggested, the real exam feels familiar. You have already seen yourself answer hard questions under a clock. Familiar is less frightening.

5. If you blank in the middle

Almost everyone has had the moment where you read a question and your mind goes white. When it happens:

• Stop. Take two slow breaths with long exhales.
• Mark the question and move to the next one. Getting a few answers right rebuilds momentum.
• When you come back, try to find a way in. What chapter is this from? What figure would it be in? What is the story the question is part of? Often one detail brings the rest back.
• If you still do not know, narrow it down and make your best guess. One question is one question.

Testing accommodations

For some students, anxiety or another condition does more than make exam day uncomfortable. It keeps them from showing what they know, even when they have prepared well. If that sounds like you, or if you have ADHD, a learning disability, a chronic illness, a mental health condition, or another disability, you may qualify for testing accommodations. Common examples include extended time and a reduced-distraction testing setting.

At USC Upstate, accommodations go through Disability Services (864.503.5199). The most important thing to know is that accommodations are not retroactive. They apply from the time they are approved and shared with your instructor, not to exams you already took. So if you think you might qualify, contact Disability Services early in the semester, before Exam 1 if you can. The office will explain what documentation they need and how to share your accommodation letter with your instructors.

If your worry is more than exam nerves, if it is with you most days, keeps you from sleeping, or makes it hard to function, please reach out to Counseling Services (864.503.5195, counselingservice@uscupstate.edu). Enrolled students have access to 24/7 after-hours crisis support. If you are ever in crisis or thinking about harming yourself, call or text 988, the Suicide and Crisis Lifeline, at any hour. Asking for this kind of help is a strong, smart move, not a weakness. Chapter 12 and Chapter 13 talk more about stress and campus support.