Using collaborative two‐stage examinations to address test anxiety in a large enrollment gateway course
Abstract
Large enrollment foundational courses are perceived as "high stakes" because of their potential to act as barriers for progression to the next course or admittance to a program. The nature of gateway courses makes them ideal settings to explore the relationship between anxiety, pedagogical interventions, and student performance. Here, two-stage collaborative examinations were implemented to improve test-taking skills and address widespread test anxiety in an introductory human anatomy course. Test anxiety data were collected (using the Motivated Strategies for Learning Questionnaire) before the first examination and last examination. Most students experienced decreased test anxiety over the course of the semester; however, some students may have experienced performance limiting conditions due to test anxiety at the end of the semester based on academic ability in the course (in "C" students when compared to "A" students: P < 0.00006 and "B" students: P < 0.05), overall academic ability (in academically weaker students: P < 0.025), and demographic factors (in women: P < 0.025). The strongest performances on examinations were primarily observed in already academically strong students (mean individual performance: P < 0.000, mean group performance: P < 0.000). Furthermore, changes in test anxiety were not significantly associated with the group portion of the examinations. Patterns of changes in test anxiety over the course of the semester underscore a complex interaction betwee…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Cites
Reliability and Predictive Validity of the Motivated Strategies for Learning Questionnaire (Mslq)
Pintrich, P. R., Smith, D. A. F., Garcia, T., & Mckeachie, W. J. (1993) · Educational and Psychological Measurement · doi:10.1177/0013164493053003024 · Cited by 3,646 · see citing works
The Critical Importance of Retrieval for Learning
Karpicke, J. D., & Roediger, H. L. (2008) · Science · doi:10.1126/science.1152408 · Cited by 1,791 · cited 1× · see citing works
“As a result, the repeated nature of the examination protocol in the current investigation may have resulted in greater improvements due to the benefits of repeated testing (Karpicke and Roediger, 2008; Gilley and Clarkston, 2014; Soderstrom et al., 2016).”
BackgroundBrown, L. A., Forman, E. M., Herbert, J. D., Hoffman, K. L., Yuen, E. K., & Goetter, E. M. (2011) · Behavior Modification · doi:10.1177/0145445510390930 · Cited by 123 · cited 2× · see citing works
“Instead, focused interventions that target test-taking strategies specifically designed to reduce test anxiety have been more effective in improving academic performance (Bruch et al., 1983; Brown et al., 2011).”
BackgroundMethod
Flagged first, then by citations
Cited by
Sorted by citations
Temperament and brain networks of attention
Posner, M. I., & Rothbart, M. K. (2018) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2017.0254 · Cited by 87 · see citing works
The Cambridge Handbook of Personality Psychology
(2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822 · Cited by 140 · see citing works
Why Did Students Report Lower Test Anxiety during the COVID-19 Pandemic?
Ewell, S. N., Josefson, C. C., & Ballen, C. J. (2022) · Journal of Microbiology and Biology Education · doi:10.1128/jmbe.00282-21 · Cited by 40 · see citing works
“Test anxiety is defined by increased levels of discomfort and worry during an exam and results in a decline in academic performance that ultimately misrepresents student content knowledge (1, 2).”
BackgroundSelf-regulation and control in personality functioning
Carver, C. S., & Scheier, M. F. (2012) · Cambridge University Press eBooks · doi:10.1017/cbo9780511596544.027 · Cited by 59 · see citing works
Two-Stage Testing Reduces Student-Perceived Exam Anxiety in Introductory Chemistry
Rempel, B., Dirks, M., & McGinitie, E. G. (2021) · Journal of Chemical Education · doi:10.1021/acs.jchemed.1c00219 · Cited by 21 · see citing works
Team‐Based Ultrasound Objective Structured Practice Examination (OSPE) in the Anatomy Course
Weisskittel, T., Lachman, N., Bhagra, A., Andersen, K. J., Jeor, J. D. S., & Pawlina, W. (2021) · Anatomical Sciences Education · doi:10.1002/ase.2069 · Cited by 20 · see citing works
“These studies, however, take place in the context of multiple choice and practical examinations, not with skills examinations with specific task delegation which has been proposed to address negative aspects of team- based assessment design (Jackson and Harkins, 1985; Fournier et al., 2017).”
BackgroundKhong, M. L., & Tanner, J. A. (2020) · Biochemistry and Molecular Biology Education · doi:10.1002/bmb.21392 · Cited by 20 · see citing works
“Other studies showed the clear advantage even for the strong students in the class,(38,54) but effect on stress and anxiety seem to have somewhat mixed outcomes.(54,55) Students also proposed suggestions to improve the two-stage examination.”
BackgroundConceptual and Historical Perspectives
Cloninger, S. C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.004 · Cited by 7 · see citing works
DeYoung, C. G., & Blain, S. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.026 · Cited by 31 · see citing works
Bazelais, P., Breuleux, A., Doleck, T., & |, |. (2022) · Knowledge Management & E-Learning An International Journal · doi:10.34105/j.kmel.2022.14.021 · Cited by 9 · see citing works
“…Cooke et al., 2019; Bazelais et al., 2019a, 2019b; Gilley & Clarkston, 2014; Ives, 2014), increases collaboration and student feedback (Al-Sudani, 2020; Cooke et al., 2019; Gilley & Clarkston, 2014; Ives, 2014; Wieman et al., 2014), and reduces exam anxiety (Al-Sudani, 2020; Fournier et al., 2017).”
BackgroundThe Five-Factor Model of Personality: Consensus and Controversy
McCrae, R. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.013 · Cited by 18 · see citing works
Marakshina, J. A., Pavlova, A. A., Ismatullina, V. I., Adamovich, T., Mironets, S. A., Sitnikova, M. A., Lobaskova, M. M., & Malykh, S. B. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1275212 · Cited by 7 · see citing works
“Alternatively, MA may be primarily associated with the testing context, referred to as test anxiety (Fournier et al., 2017).”
BackgroundTwo-stage Examinations in STEM: A Narrative Literature Review
Lee, T., Pye, M. G., Lilje, O., Nguyen, H. D., Hockey, S., de Bruyn, M., & van den Berg, F. T. (2022) · International Journal of Innovation in Science and Mathematics Education · doi:10.30722/ijisme.30.05.005 · Cited by 6 · see citing works
Development of Personality across the Life Span
Atherton, O. E., Donnellan, M. B., & Robins, R. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.017 · Cited by 13 · see citing works
Factors influencing test anxiety in health professions education students: a scoping review
Wadi, M., Yusoff, M. S. B., Rahim, A. F. A., & Lah, N. A. Z. N. (2022) · SN Social Sciences · doi:10.1007/s43545-022-00459-9 · Cited by 8 · see citing works
“2019) followed by past history of poor academic performance (Fournier et al. 2017; Macauley et al. 2018; Rukholm and Viverais 1993; Tsegay et al. 2019).”
BackgroundInverted Two-Stage Exams for Prospective Learning
Belleville, P., Wolfman, S. A., Bradley, S., & Heeren, C. (2020) · ACM Technical Symposium on Computer Science Education (SIGCSE) · doi:10.1145/3328778.3366938 · Cited by 5 · see citing works
“Some research has shown significant advantages to two-stage exams [4, 13], but other has found less substantive or no positive results [1, 3].”
BackgroundFostering Evidence-Informed Teaching in Crucial Classes: Faculty Development in Gateway Courses.
McGowan, S., Felten, P., Caulkins, J. L., & Artze-Vega, I. (2017) · doi:10.1002/he.20261 · Cited by 6
Self-citationAdams, J. A., Dewsbury, B. M., & Tanzer, J. R. (2024) · Anatomical Sciences Education · doi:10.1002/ase.2469 · Cited by 5 · see citing works
“50,51 However, pedagogical approaches to these courses vary across colleges and universities in the United States, with some in-structors teaching anatomical structures systematically (i.e., nervous system, respiratory system) and others focusing on specific anatomical regions (i.e., anatomy of the…”
Bentley, D. C., Attardi, S. M., Faul, J., Melo, V., & Palmer, C. (2021) · Journal of medical imaging and radiation sciences · doi:10.1016/j.jmir.2021.08.017 · Cited by 6 · see citing works
Approach–Avoidance Theories of Personality
Corr, P. J., & Krupıć, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.025 · Cited by 10 · see citing works
Test Anxiety and Its Impact on Diverse Undergraduate Engineering Students During Remote Learning
Copp, D., & Headley, A. J. (2024) · 2021 ASEE Virtual Annual Conference Content Access Proceedings · doi:10.18260/1-2--37832 · Cited by 5 · see citing works
“As such, many researchers and educators are investigating anxiety interventions and their effects on student outcomes in science and engineering courses to improve student outcomes for underrepresented groups in STEM [12–15].”
BackgroundPsychometric properties of abbreviated math anxiety scale in Russian high schoolers
Marakshina, J. A., Pavlova, A. A., Ismatullina, V. I., Lobaskova, M. M., Adamovich, T., Mironets, S. A., Sitnikova, M. A., & Malykh, S. B. (2024) · Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук · doi:10.29413/abs.2024-9.1.16 · Cited by 4 · see citing works
Collaborative assessment as a learning tool for social work students
Atkins, P., Bagley, K., Downey, H., Gardner, F., Sanders, R., & Kanjere, A. (2022) · Social Work Education · doi:10.1080/02615479.2022.2118702 · Cited by 4 · see citing works
“Scholarly literature on collaborative assessment indicates that this practice has positive effects on test anxiety, test performance, and learner self-efficacy (Burgess & Medina-Smuck, 2018; Fournier et al., 2017; Riley et al., 2021).”
BackgroundThe Two-Stage Examination: Assessment for Collaborative Learning
Al-Sudani, S. (2020) · European Journal of Teaching and Education · doi:10.33422/ejte.v2i4.526 · Cited by 4 · see citing works
“Fournier et al. (2017) indicated that the group element reduces test anxiety.”
BackgroundMethodBasic Needs, Goals and Motivation
Szalma, J. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.030 · Cited by 3 · see citing works
Personality, Preferences and Socioeconomic Behavior
Ferguson, E., Zhao, K., & Smillie, L. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.044 · Cited by 6 · see citing works
Models of Physical Health and Personality
Heilmayr, D., & Friedman, H. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.019 · Cited by 2 · see citing works
Cognitive Processes and Models
Matthews, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.028 · Cited by 5 · see citing works
Mikulincer, M., & Shaver, P. (2020) · The SAGE Handbook of Evolutionary Psychology · doi:10.4135/9781446201022.n34 · Cited by 4
Collaborative Assessment That Supports Learning
Rieger, G. W., & Rieger, C. L. (2020) · Active Learning in College Science · doi:10.1007/978-3-030-33600-4_51 · Cited by 5 · see citing works
Dewsbury, B. (2021) · HAPS Educator · doi:10.21692/haps.2021.008 · Cited by 3
Personality Traits and Mental Disorders
Hakulinen, C. A., Jokela, M. M., Mika Kivimaki, B., & Elovainio, M. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.018 · Cited by 4 · see citing works
Jayawickreme, E., & Zachry, C. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.032 · Cited by 2 · see citing works
Anxiety, Depression and Cognitive Dysfunction
Eysenck, M. W., & Holmes, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.033 · Cited by 3 · see citing works
Personality in Cross-Cultural Perspective
Dragūns, J. G., & Tanaka‐Matsumi, J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.037 · Cited by 3 · see citing works
Active learning through flexible collaborative exams: Improving assessments across disciplines
Callaghan, K., Kestin, G., Klales, A., McCarty, L., & Deslauriers, L. (2026) · Active Learning in Higher Education · doi:10.1177/14697874251344293 · Cited by 2 · see citing works
“…removal of time constraints in the asynchronous format would enhance collaboration quality and further reduce exam-related anxiety, as anxiety reduction is known to be a benefit of standard two-stage exams (Fournier et al., 2017; Kapitanoff, 2009; Pandey & Kapitanoff, 2011; Rempel et al., 2021).”
Britson, C. (2022) · HAPS Educator · doi:10.21692/haps.2022.010 · Cited by 2
“Ideally, as educators we would like to see simultaneous increases in performance and engagement with decreases in anxiety and stress, and further investigation into the sources, effects, and mitigation of stress in A&P students (Fornier et al., 2017; El-Baze et al., 2018) is warranted.”
States and Situations, Traits and Environments
Asendorpf, J. B., & Rauthmann, J. F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.007 · Cited by 5 · see citing works
Investigating self-efficacy, test anxiety, and performance in college Algebra
Melnikova, Y. V., Long, V., & Stocker, R. (2020) · Mathematics Education Across Cultures: Proceedings of the 42nd Meeting of the North American Chapter of the International Group for the Psychology of Mathematics Education · doi:10.51272/pmena.42.2020-216 · Cited by 1
“Additionally, the students who earned an “F” experienced increased worry and had a preoccupation with performance over the course of the semester, consistent with Fournier et al. (2017).”
ResultPersonality and the Unconscious
Perugini, M., Richetin, J., & Costantini, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.008 · Cited by 2 · see citing works
Personality in Clinical Psychology
Widiger, T. A., & McCabe, G. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.042 · Cited by 4 · see citing works
Biesanz, J. C., & Wallace, J. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.006 · Cited by 5 · see citing works
Addendum: Statistical Analyses and Computer Programming in Personality
Corr, P. J., & Matthews, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.045 · Cited by 1 · see citing works
Robinson, M. D., & Sedikides, C. (2020) · The Cambridge Handbook of Personality Psychology · doi:10.1016/b978-0-08-097086-8.25081-2 · Cited by 1 · see citing works
Caprara, G., & Vecchione, M. (2020) · The Cambridge Handbook of Personality Psychology · doi:10.1017/cbo9780511596544.037 · Cited by 1
Reisenzein, R., Hildebrandt, A., & Weber, H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.009 · Cited by 26 · see citing works
Temperament and Brain Networks of Attention
Rothbart, M. K., Posner, M. I., & Sheese, B. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.016 · Cited by 6 · see citing works
Designing Calm in Digital Textbooks: Applying Multimedia Principles to Reduce Online Learner Anxiety
Huff, T. (2026) · The Open/Technology in Education Society and Scholarship Association Journal · doi:10.18357/otessaj.2025.5.2.108
“This may have evoked the feeling of a test, causing text anxiety (Fournier et al., 2017).”
Bentley, D. C., Sotto, A., & Lombardi, P. (2026) · Anatomical Sciences Education · doi:10.1002/ase.70215
“…may be an underlying component of familiar - Consistent with prior literature, 10,11 students identifying as women reported higher levels of reactive test anxiety than students identifying as men, even after controlling for assigned pacing con - dition ( β = 7.94, 95% CI [1.73, 14.16], p = 0.02).”
InfluentialThormodsæter, R. S., Ballen, C. J., Fagbodun, S., Foster-Hartnett, D., García-Ojeda, M. E., Gonsar, N., Henning, J. A., Robnett, R. D., Sanders, T., Wainman, J. W., et al. (2026) · CBE - Life Sciences Education · doi:10.1187/cbe.25-04-0055
“These findings replicate and extend previous work (e.g., Ballen et al. , 2017; Fournier et al. , 2017; Adesola and Li, 2018; Harris et al. , 2019) by demonstrating a link between test anxiety and performance in a large sample composed of students from diverse backgrounds and varied institution types.”
Theories and patterns of productive group interaction in two-stage introductory physics exams
Block, W. D., & West, C. G. (2025) · Physics Education Research Conference Proceedings · doi:10.1119/perc.2025.pr.block
“Current evidence is generally positive about the effects in affective domains [1, 2], and mixed-to-positive when it comes to effects on knowledge retention [3– 5].”
Özer, B., & Gençel, N. (2025) · European Journal of Psychology and Educational Research · doi:10.12973/ejper.8.3.127
Latulipe, C., Anvik, J., Lin, K., Nowrin, S., Railing, B. P., Reckinger, S. J., & Zarnegar, A. (2025) · ITiCSE-WGR · doi:10.1145/3760545.3783964
“TSEs have been employed and studied across a variety of science, technology, engineering and mathematics (STEM) disciplines, including computer science (CS) [18, 22, 35], and have been very well-received by students.”
Investigating How Course Features Correlate with Student Perceptions of Two-Stage CS Exams
Latulipe, C., McIntyre, S., Anvik, J., Lin, K., Nowrin, S., Railing, B. P., Reckinger, S. J., & Zarnegar, A. (2025) · Annual Conference on Innovation and Technology in Computer Science Education · doi:10.1145/3724389.3731279
“TSEs have been employed and studied across a variety of STEM disciplines, including computer science [3, 5, 7], and have typically been very well-received by students.”
“Math anxiety”, pseudo-scientific sophistications and methodological dead ends
Veraksa, A., Zinchenko, Y., Kalimullin, A., Рукшин, С. Е., Tsvetkova, L., & Yashchenko, I. (2024) · Lomonosov Pedagogical Education Journal · doi:10.55959/lpej-24-02
Collaborative Assessment in the Gross Anatomy Lab
Tubbs, R., White, F., Rotundo, N., & Heard-Booth, A. (2023) · The journal of the International Association of Medical Science Educators : JIAMSE · doi:10.1007/s40670-023-01908-7
“Interestingly, current literature shows a mixed response from students regarding their anxiety during this testing process [18, 30].”
Sallis, H., Smith, G. D., & Munafo, M. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.024 · Cited by 1 · see citing works
Weiss, A., & Deary, I. (2020) · The Cambridge Handbook of Personality Psychology · doi:10.4135/9781446215159.n847
Social Relations and Social Support
Austin, E. Q., Knack, J. M., Jensen‐Campbell, L. A., & Rex‐Lear, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.036
Personality Assessment Methods
Boyle, G. J., & Helmes, E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.011
Schermer, J. A., & Saklofske, D. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.014
Models of Personality Structure
Raad, B. D., & Barelds, D. P. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.012 · Cited by 4 · see citing works
Narrative Identity in the Social World
McLean, K. C., Syed, M., Haraldsson, K. G., & Lowe, L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.035 · Cited by 2 · see citing works
Personality in Nonhuman Animals
Bell, A. M., & Bensky, M. K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.023 · Cited by 1 · see citing works
Corr, P. J., & Matthews, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.002
Salgado, J. F., Anderson, N. R., & Moscoso, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.040 · Cited by 4 · see citing works
Lynam, D. R., Vize, C. E., & Miller, J. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.043 · Cited by 2 · see citing works
Corr, P. J., & Matthews, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.001 · Cited by 1 · see citing works
Corr, P. J., & Matthews, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108264822.046
- Authors
- Fournier, K. A., Couret, J., Ramsay, J. B., & Caulkins, J. L.
- Affiliations
- University of Rhode Island (US)
- Westfield State University (US)
- Corresponding author
- Fournier, Kimberly A.
- Venue
- Anatomical Sciences Education
- Publisher
- Wiley
- Published
- 2017-01-30
- Volume
- 10
- Issue
- 5
- Pages
- 409-422
- ISSN
- 1935-9772 (ISSN-L)
- 1935-9780
- OpenAlex
- W2581754950
- Cited by
- 68
- References
- 49
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 4 · 2020: 44 · 2019: 1 · 2018: 2 · 2017: 1
- FWCI
- 26.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anatomical Sciences Education (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Westfield State University
- Directorate for Biological Sciences
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Innovative Teaching and Learning Methods
- Social Sciences › Education › Student Assessment and Feedback
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Keywords
- test anxiety, gateway courses, high-stakes testing, human anatomy education, student performance, academic ability, gender differences, test-taking skills, Motivated Strategies for Learning Questionnaire
- MeSH terms
- Adolescent, Adult, Anatomy, Anxiety, Curriculum, Educational Measurement, Female, Humans, Male, Motivation, Perception, Surveys and Questionnaires, Social Behavior, Stress, Psychological, Students, Universities, Young Adult, Test Taking Skills
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review