Taking my first anatomy bell ringer exam was like going on a first date.

As I anticipated the coming day, I felt an anxiety that began as a constant tension in my chest and led to whirling thoughts and sleepless nights. This immense pressure was relieved only temporarily when the moment ended but returned as I analyzed in my mind everything that I had done and wondered about the results.

Luckily, both going on first dates and taking anatomy bell ringer exams gets easier the more you do it. But without the experience you can still feel like an expert by having some helpful strategies on hand from people that have been through the fire before you.

I’m not going to share how many first dates I’ve been on, but I’ve taken over 12 anatomy bell ringers exams as a student. Now, I help to set up bell ringer exams for chiropractic students studying anatomy and I’ve seen another 30 bell ringer exams this past year. I’ve talked with many of those students after their bell ringer exams and almost everyone says the same thing,

If you know the answer, you have time to kill. But if you don’t know it, there’s never enough time.

The question of how to take an anatomy bell ringer exam involves discussing how to make every second at each station count.

The strategies listed below are divided up into things you can do before the bell ringer to help you feel calm and confident and things you can do during the bell ringer to help you make your minute more efficient.

Before the Bell Ringer Exam

How fast the time at each station seems to go by depends on how you spent your time before the bell ringer exam. The following strategies are done before the exam to help you increase your confidence and decrease any anxiety.

1. Prepare and practice well ahead of time.

There is no strategy that replaces proper preparation and consistent practice. Different exercises are elaborated on in the previous post, “How to Prepare for an Anatomy Bell Ringer Exam”. A few takeaway points are to:

• Rewrite your lab list to learn the terminology.
• Separate anatomical structures into categories based on specific body regions.
• Define each anatomical structure using its relationship to points of certainty.
• Test yourself on your ability to recognize and find different structures.

2. Know the rules of the exam beforehand.

Follow the specific directions from your course’s lead instructor. They may post an instruction sheet and make announcements in class or before the exam. If you have questions about how the exam will run, ask them well in advance of the day of the exam.

For example, some of our directions to students about the bell ringer exams are to:

• Identify the landmark and its bone.
• Write the name of the cranial nerve and its number in Roman numerals.
• Use the cover sheet over your answers when you aren’t writing.

3. Think about the steps that you’ll follow at each station.

Develop a mental checklist for yourself to follow at the start of every minute at a new station. Here’s an example of the steps that I followed as a student taking a bell ringer exam:

• Breathe in and out once with eyes closed.
  • How long does it take to take a breath? Your body and brain need a constant supply of oxygen to perform well and I always felt that this breath helped me to relax and focus.
• Check the station card to confirm the correct station number and to look for a question card.
• Find the pin and answer the question.
• Use any extra time to identify other structures at the station.
  • This can help to confirm the answer you wrote down or may cause you to change it.

4. Reframe the exam as an exciting opportunity to test what you’ve learned.

Cognitive behavioral therapy (CBT) uses a technique called cognitive restructuring that involves reframing your emotions in a more beneficial way. For example, anxiety and excitement have many of the same physiological characteristics.

Are you feeling anxious about the exam or are you excited about it? Telling yourself that what you’re feeling is actually excitement turns the energy of your emotions from a harmful anxiety into a helpful excitement.

5. Keep calm and take care of yourself.

• Skip the late-night cram session in favor of getting a good night of sleep.
• Good nutrition and hydration the day of the exam will help you keep focus and energy during the exam.
• Meditate, pray, or listen to your favorite music in the hours leading up to the exam to keep calm.

During the Bell Ringer Exam

If you properly prepare and practice for the bell ringer exam most of the answers will come to you almost right away. When the answer doesn’t come immediately, nothing wastes time more than panic. Keep calm and follow these steps to think it through and to make your best guess.

1. Find the pin and orient yourself.

What body part are you looking at? Anterior or posterior? Which side is medial and lateral, or superior and inferior? What layer are you looking at, superficial or deep?

If you rewrote your lab list into categories, as described in How to Prepare for an Anatomy Bell Ringer Exam, you now have a short list of possible structures for this specific body region.

2. Observe the pinned structure.

What type of anatomy is it? Tendons, nerves, arteries, and veins all have characteristics that can help to distinguish them from each other.

3. Describe the relationship of the pinned structure to your point of certainty.

Find a structure that you know for sure, a point of certainty, and describe its relationship to the pinned structure. Because anatomy is about the relationships between structures, you can identify a structure based on where it is compared to other structures.

4. Look beyond the pin.

Sometimes the relationship you need to see to identify the structure isn’t exactly where the structure is pinned. Follow the structure as far as you can to see how it relates to other structures.

For example, follow a muscle belly to see where its tendon is attaching, or follow a nerve to see which muscles it passes between.

5. Keep calm and move on.

Write your best answer before the time is up and do NOT change it. Do your best to forget about this station and move on to the next one with a clear mind and a fresh start.

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Good luck with your upcoming anatomy bell ringer exam!

Keep learning,

Dr. K

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Comment below:

What is your biggest challenge when taking a bell ringer exam?

What strategies have helped you when taking a bell ringer exam?