Members of the Department of Family Medicine, along with an international team of researchers, have recently published a first-of-its kind study showing more than half of medical students with disabilities from a sample of U.S. medical programs were denied accommodations by the organization that administers the United Stated Medical Licensing Exam (USMLE) Step 1. Researchers found these rejections had detrimental impacts on students and the medical schools they attend.
Their paper, “Impact of USMLE step-1 accommodation denial on US medical schools: a national survey,” was recently published in PLOS One.
Researchers, including senior author Lisa Meeks, Ph.D., faculty member in the Department of Family Medicine at the University of Michigan, and first author Kristina H. Petersen, Ph.D., assistant professor of biochemistry and molecular biology at New York Medical College (NYMC), et al, conducted a study to investigate the rate of accommodation denials by the USMLE and to evaluate whether those denials impact medical school operations.
The USMLE Step 1 exam, typically administered after a student completes two years of medical school, assesses whether that student can apply key concepts of basic science underpinning the practice of medicine, with emphasis on principles of health, disease and therapy. It includes a one-day examination, divided into seven, 60-minute blocks and administered in one eight-hour testing session.
For medical students with a disability – which translated to roughly 4.6% of the U.S. allopathic medical student population in 2019, or about 1,200 students -- that intensive one-day test can be riddled with barriers. Time-dependent barriers are the most prevalent for students with learning disabilities; those who require adaptive or assistive devices; and students with physical or chronic health disabilities that make it difficult to take an eight-hour exam in one sitting.
“Within time constraints, the reading is often the largest barrier for students with disabilities,” said Petersen, who, in her role at NYMC, coaches medical students on synthesizing large amounts of dense scientific materials in short periods of time.
Researchers administered a 10-question survey to student affairs deans and disability resource professionals at all fully accredited U.S. M.D.-granting programs. They also included two open-ended questions about the school’s experiences with accommodations denials.
Of the 141 schools that received the survey, 73 responded. Results determined that in the 2018-2019 academic year, 276 students from 73 schools applied for Step-1 accommodations. Of these, 144 students (52%) were denied. Of those denied, 74 students (51%) were delayed entry into the next phase of medical curriculum and 110 (76%) took the Step 1 exam unaccommodated. Of the 110 students who took it without accommodations, 35 (32%) failed the exam and four (3%) withdrew or were dismissed from medical school following exam failure.
School personnel who participated in the survey said that they provided varied investments of time and financial support for students requesting accommodations. Most schools reported investing less than 20 hours and less than $1,000 per student of assistance. This prompted the research team to call for parity in medical school support for students with a disability applying for USMLE accommodations.
Qualitative data showed that the impact of denial on schools and students included:
- Frustration with the complex accommodations request process
- Burdensome financial and human resources allocation
- Delays in student progression
- Lack of resources and expertise in helping students request accommodations
- Emotional and financial toll on medical students who need accommodations
Meeks and Petersen said that submitting a request for accommodations requires intense work for the student – roughly 20-25 hours gathering all requested information – time the student could use to study for Step 1. Students with a disability sometimes need to submit the results of a neuropsychological exam with the accommodations request. This test requires eight hours to undergo and can cost between $3,000 to $7,000, additional prohibitive factors.
Meeks and Petersen also mention that students can wait upwards of three months from the USMLE to learn if their accommodations are granted. If the student’s request for accommodations is ultimately rejected, the appeals process is also a difficult one.
Meeks and Petersen, members of the Coalition for Disability Access in Health Science and Medical Education, have worked together to author definitive books on disability and to ensure equal access for students with disabilities. Authors Meeks and Neera Jain, Ph.D., postdoctoral research fellow at the Centre for Health Education Scholarship at the University of British Columbia, were also the Co-PI’s and authors of the American Association of American Medical Colleges’ special report on accessibility, inclusion and action in medical education, which described the lived experiences of learners and physicians with disabilities.
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Meeks and Petersen said their goal in publishing this study is to call for an examination of the USMLE accommodation request process. They also want to identify ways to streamline student requests and increase transparency in decision making. They assert that through the qualitative data they gathered, medical school administrators suggest that students perceive excessive challenges to requesting those accommodations. They add that many students with disabilities find the process disheartening and often choose not to apply, fearing a high probability of denial.
“Our goal is to make a more efficient accommodations request system – and more transparency around the decision-making,” Meeks said. “These students are not less intelligent or less able. Extra time to take the test is not going to give them more knowledge, only an opportunity to demonstrate what they already know.
“We’re not asking (the USMLE) to lower the standards for students who are disabled,” she added. “We’re just asking that the standards be reasonable.”
Article Citation: Petersen, K. H., Jain, N. R., Case, B., Jain, S., &; Meeks, L. M. (2022). Impact of USMLE step-1 accommodation denial on US medical schools: A national survey. PLOS ONE, 17(4). https://doi.org/10.1371/journal.pone.0266685