Episode 49: Ramsey vs. NBME Panel

Many trainees struggle with obtaining accommodations on the NBME Step examinations. In 2020, after a 3 year long engagement with the NBME, Dr. Jessica Ramsey affirmed the award of a preliminary injunction, requiring the NBME to provide accommodation. Dr. Ramsey and her attorneys established irreparable harm because she would likely be forced to withdraw from medical school if she could not take the initial test with accommodations and pass. 

This live recording took place in July 2022 in Cleveland, Ohio at the Coalition for Disability Access in Health Science Educations annual meeting.  

The panelist consist of disability consultants, faculty who study performance on NBME, and the attorneys who work with trainees denied accommodation on these exams. 

 

Bios:

 

Jessie Ramsay, MD is a Pediatrics Resident at Baylor College of Medicine San Antonio. Having siblings with special needs, Jessie’s passion for helping and advocating for others developed very early in life. Her own experiences living with disabilities led her to serve as a peer mentor and advocate for other learners with disabilities while pursuing higher education and a career in medicine. During her medical school training at Western Michigan University Homer Stryker M.D. School of Medicine (WMed), Jessie was recognized by her peers and the faculty for her service to others and was inducted into the UpJohn Humanism Honor Society, now the WMed chapter of Gold Humanism Honor Society (GHHS). She wishes to help make the world a more inclusive, equitable, and just place.

 

Jan Serrantino, Ed.D. In her 30+year career in the Disability field Dr. Jan Serrantino has worked to support students with disabilities, campus partners and to create inclusive policy in higher education.  Jan is the Past President of the Coalition for Disability Access in Health Science and Medical Education.  Jan is retired from her role as Director of the Disability Services Center at the University of California, Irvine where she was the primary case carrier for students with disabilities in the Schools of Nursing, Pharmacy, Public Health and Medicine. Currently Dr. Serrantino is a higher education consultant and focuses on faculty and staff training in health science education and regularly presents at national professional conferences. Jan is co-author of two chapters in The Guide to Assisting Students with Disabilities: Equal Access in Health Science and Professional Education (Springer Publishing). She co presented a webinar on Clinical Accommodation: Upholding Standards While Creating Equal Access, for the American Association of Medical Colleges (and a Faculty Training Module, Maintaining Privacy: Students with Disabilities.  (https://www.hsmcoaltion.org/faculty-support)

 

Kristina Petersen, PhD. Dr. Kristina H. Petersen is an Assistant Professor in the Biochemistry & Molecular Biology Department and the Assistant Dean of Academic Support Programs at New York Medical College. Since arriving at NYMC in 2014, she received three Student Senate Awards for enhancement of student life, six mentoring/teaching awards, and was inducted into the Alpha Omega Alpha Honor Medical Society. In 2021 and 2022, the NYMC AOA Chapter nominated her for the Robert J. Glaser Distinguished Teaching Award. Dr. Petersen leads a team that focuses on all aspects of academic support, including supporting students who receive accommodations. Kristina a co-author on two chapters in Disability as Diversity: A Guidebook for Inclusion in Medicine, Nursing, and the Health Professions. She began her appointment as President of the Coalition for Disability Access in Health Science Education in July 2022.

 

Larry Berger, JD. Larry Berger is Of Counsel to Reisman Carolla Gran & Zuba LLP. The primary focus of his practice is representing people with disabilities, including medical students and law students, obtaining fairness in professional licensing, testing accommodations for “high stakes” exams including the United States Medical Licensing Examination (“USMLE”) and other licensing exams, and the right of people with disabilities to live and work in the community. Previously, Larry practiced for more than 35 years as a partner in two Philadelphia law firms specializing in commercial litigation including class actions (both plaintiffs and defendants), antitrust and securities law, contract law, mortgage lending and other secured transactions. Larry also serves as an Arbitrator on commercial matters for the American Arbitration Association."

 

Charles Weiner, JD. Charles Weiner is a Pennsylvania attorney whose private practice is focused on Civil Rights Disability Rights. His practice  includes representing students with disabilities in education matters  from Pre-Kindergarten through college and graduate school. He  represents clients not only throughout Pennsylvania involving special  education and school discipline but he also represents individuals  with disabilities throughout the nation in obtaining accommodations in post-secondary entrance exams and professional licensing and  certification examinations such as the SAT, ACT, LSAT, MCAT, bar  exams and the United States Medical Licensing Exam (USMLE) and  COMLEX. He recently successfully tried cases against the National  Board of Medical Examiners in Berger v. National Board of Medical  Examiners and Hartman v. National Board of Medical Examiners. Weiner has conducted numerous seminars and workshops on  topics involving the Americans With Disabilities Act, Individual with  Disabilities Education Act and the Rehabilitation Act of 1973. Weiner served as a Commissioner on the American Bar  Association’s Commission on Disability Rights from 2014 to 2017 and  continues to be and active contributor on the Commission. Weiner  received his J.D. in 1988 from the University of Pittsburgh School of  Law. He is licensed to practice law in Pennsylvania and New York  and has been admitted pro hac in Federal District Courts in several states.

Transcript

Dr. Lisa Meeks:

Doctors with Disabilities exist in small but impactful numbers. How do they navigate their journey? What are the challenges?

Dr. Peter Poullos:

What are the benefits to patients and to their peers? And what can we learn from their experiences?

Dr. Lisa Meeks:

My name is Lisa Meeks.

Dr. Peter Poullos:

And I'm Peter Poullos.

Dr. Lisa Meeks:

And we are thrilled to bring you the Docs with Disabilities Podcast.

Dr. Peter Poullos:

Join us as we explore the stories of doctors, PAs, nurses, OTs, PTs, pharmacists, dentists and other health professionals with disabilities.

Dr. Lisa Meeks:

We'll also be interviewing the researchers and policy makers that drive medicine forward towards real equity and inclusion.

Dr. Lisa Meeks:

We are so excited to bring you this podcast, live and we have an incredible panel with us today. And we have some audience members who are going to participate and ask some questions later on in the broadcast. So what we're going to do first is have our audio, have our panel, excuse me, introduce themselves. And then Pete and I will ask our questions. And then you'll get an opportunity to ask yours.

 

So, do we want to start, Jessie, by you introducing yourself and then we'll go ahead and pass the mic around.

Dr. Jessica "Jessie" Ramsay:

Sounds good. Hi everyone. I'm Jessie Ramsay. I am a second year pediatrics resident at, um, Baylor College of Medicine in San Antonio. Um, and I'm, um, hear to talk about the NBME case, uh, that recently was finalized in 2020. 

Dr. Kristina Petersen:

Hi. I'm Kristina Petersen and I am an Assistant Professor at New York Medical College and also the Assistant Dean for Academic Support Programs. And I oversee the disabilities, uh, piece at our school. And I'm grateful to be here to talk a little bit about a paper that I've contributed to about Step One Accommodations.

Dr. Jan Serrantino:

Hello. My name is Dr. Jan Serrantino and I'm an independent higher education consultant and I work with universities with training and students who are looking for assistance when applying for accommodations on the USMLE.

Larry Berger:

Good afternoon. I'm Larry Berger. I am an attorney in New Jersey. Uh, I am one of the attorneys who represented, uh, Dr. Ramsay in her litigation with NBME and I also represent other medical students and residents with NBME issues.

Charles Weiner:

Good afternoon, everyone. I'm Charles Weiner or Chuck Weiner. I'm an attorney in Pennsylvania and I'm a disability rights attorney. I've represented numerous students, particularly medical students in accommodation matters. And I'm here to talk about, uh, handling appeals as well as litigation that I've handled involving the National Board of Medical Examiners and perhaps even the National Board of Osteopathic Medical Examiners.

Dr. Lisa Meeks:

Thank you. And I'm Lisa Meeks. I'm one of the co-hosts of the Docs with Disabilities podcast.

Dr. Peter Poullos:

And I'm Pete Poullos, the other cohost.

 

Question and Answer Session

Dr. Lisa Meeks:

We're really excited to do this with you today. All right. We're going to start by asking Dr. Ramsay a question. Dr. Ramsay, first, thank you so much for being here. And I think I probably am going to take some license and speak for our entire community to say that your courage and conviction in this case, I can't imagine how difficult it must've been to decide to go through this, we are all grateful that you did. You've given us one more thing to, to be able to hang our hats on as we work towards greater access on the board exams. So we are so grateful that you are here today.

 

Q: Can you tell us what, what was the driving factor in your decision to actually go through with this lawsuit?

Dr. Jessica "Jessie" Ramsay:

Yeah. Um, second, thanks for having me. This is a true privilege. I- this is something very, very close to my heart because I have lived it. Um, but I also have, uh, brothers with special needs and a lot of friends with special needs. And so, um, this is something I'm extremely passionate about. And I appreciate that all of you are here and very passionate about it as well. So thank you for supporting everybody like me and like you, probably (laughing). So I appreciate that.

 

Um, so driving my decision was- it was multifactorial. I h- there was a lot on the line for me. I was at a new school and so therefore I was the first one kind of going through this. I have, um, for those of you who don't know anything about the NBME case, um, that I had, uh, I am ADHD and dyslexic and have some other, uh, disabilities as well. And I was diagnosed late. And so I didn't have formal accommodations until college.

 

And then I had applied for accommodations for a Step One around the end of my second year, um, 'cause my class took the Step One after third year. And, um, so not only was that nontraditional but they hadn't encountered anybody with, uh, disabilities prior to me. And so there wasn't a lot of support. And I had applied, got denied, took Step One because they had urged me to take it anyway to stay on track even though I wasn't able to read enough questions to pass. And I knew that going in. Um, but they wanted me to do that and I did. And then I failed by one point.

 

So then I, at that point, kind of had to consider what the next steps were. And there was no one who had kind of any guidance for me. And then I luckily stumbled upon Larry in, um, a forum, actually, this coalition's forum, 'cause I was just Googling everything. And I discussed with him kind of my options. And so we went forward with applying again for accommodations with additional information and then got denied again. Did it again, got denied again. And this went on and on. And I ended up exhausting all of my options.

 

So after all of that I had to weigh whether or not it was worth it to me to keep going. Um, and to me it was. Because I couldn't- couldn't see myself doing anything else with my life. Um, this is what I feel like I was meant to do. Sorry.

 

Dr. Lisa Meeks:

Take your time, Jessie. It's okay.

Dr. Jessica "Jessie" Ramsay:

And then I just recognized, like, all of the other people who came before me who didn't have, like, the opportunity to keep going. And like thought about what it meant to everybody after me. And I just realized how important it was to fight back on this because it's, it's wrong to deny people access e- equitable access to exams that, like, affect their future when they've shown getting to this point that they can do it. They made it to med school. They know- they can show- they have the skills, they have the knowledge and the drive. And the only thing stopping them is this exam. And the exam really doesn't correlate with their performance as, as a physician. And I'm sure it's like that in other fields. Um, so it was important to me to keep going.

 

Um, and I also had to, like, consider whether it would be worth it to put in this time knowing that I didn't really have all the support, um, that I would've expected or needed, expected to have to be successful. Um, because I was at a new school so I didn't know what my school was going to do. Um, but after talking with Larry and identifying, um, other avenues and- of support, um, I felt like I was better prepared and better set up than other people had been prior to me. And I felt like I had a decent chance of success, enough that it would be worth moving forward and taking that, that leap of faith to, to try to take a step in the right direction in, in medical education.

Dr. Lisa Meeks:

Jessie, I, um, I- I'm sure our audience is just, you know, feeling every bit of what you're feeling right now. I know they've all watched this, witnessed this with their students who are thriving in many cases in our medical schools. And then this is the road block that they- that they face that could keep them from fulfilling their lifelong dream.

 

Q: Um, I'm curious, if you're able to, and we can come back to this if we-

Dr. Jessica "Jessie" Ramsay:

Okay.

Dr. Lisa Meeks:

Q:... need to, um, what were your biggest fears? This is a- this is a big decision and, and you knew your name would be on this case forever. And I think that drives a lot of people to not take this action. What, what were your biggest fears?

Dr. Jessica "Jessie" Ramsay:

Yeah. That's a very, very good question. I, I had a lot of them. Um, again, like I kinda touched on, um, being at a new school and not knowing what they were gonna do with, with the decision to file a, a, a lawsuit, um, was something I had to think about pretty heavily. I, um, was terrified that they were gonna try to kick me out or, um, or squeeze me out as, as, um, I think someone had mentioned. They had, um, asked them to voluntarily withdraw, which everyone knows is not voluntary. Um, and I, I was terrified of that.

 

But, again, I felt it was worth it because I also knew that if I didn't move forward with trying to get the accommodations, then I probably wouldn't make it anyway because I wouldn't have what I needed to show what I know and what I'm capable of. Um, and so that was one thing that kind of, like, tipped the scale in, in favor of still moving forward.

 

Um, one- and one of the other fears I had was that I would come across as sue-happy. So like if I did make it through, um, and I was able to apply for, um, residencies, that they would look at me and say, like, oh, she, she just is gonna sue us if we don't agree with her or give her what she wants. And that is not at all the case. I, in fact, never wanted to make it to the point of having to go through with a lawsuit. I would've much rather just been given the accommodations and gone ahead with my life. But, um, here we are. (laughs)

 

So, um, and then my fears too were that knowing that there weren't really many people ahead of me that had done this, I would- had I made the lawsuit and gone through with it and made it to the point where there was a decision, if that decision didn't go in my favor, it could also negatively impact all the people who come after me or came after me. And I didn't wanna make it harder for someone else to make that leap and to fight the fight if I failed. Um, and that actually, to me, was probably the heaviest weight. Um, and I really spent a long time considering that because I didn't know what the outcome would be. There was no way to know. And, in fact, based on everything before me, it, um, seemed like there was a very high chance that it would fail. But it was important enough that I wanted to see if I could get us a little closer to a more just, uh, provision of accommodations for people who need it.

Dr. Lisa Meeks:

Jessie, thank you so much. I know our audience will have more questions and we'll come back to this discussion. But again, I want to thank you for your strength and your conviction. And, and really what strikes me, as Pete and I are kind of looking at each other, is the thoughtfulness that you put into this decision and how it would impact your peers. And I just think that's remarkable, it's amazing. And, you know, I think something that's really important is that you're not alone in this experience. What you chose to do is very different from what most people, you know, have happen. But you're not alone. And that's evidenced in Dr. Petersen's article.

Dr. Peter Poullos:

Amazing. Yeah. Thanks, Jessie. Uh, the next question is for you, Dr. Petersen. 

Q: You recently published an article in Plus One reporting the first ever national estimate of rejection for students with disabilities on the USMLE Step One. Can you tell us what that percentage is?

Dr. Kristina Petersen:

It was 52%.

Dr. Peter Poullos:

Wow. In your article you also describe consequences to students, importantly, following those rejections. 

Q: Can you tell us and the audience a little bit more about what occurs downstream when students in your study were rejected?

 

Dr. Kristina Petersen:

Yeah. So of the students who were denied accommodations on Step One, 76% of them ended up taking the exam unaccommodated. And then of that group, 32% failed the exam. And that's in comparison to an overall national failure rate of 4-5%. So that's a huge increase. Also we saw that 3% of the students ended up withdrawing from the institution or being dismissed as a result of the failure.

Dr. Lisa Meeks:

Wow. Thank you so much for doing this work. And I know you've had this idea for years. This was your study, driven by your passion about this topic. And I can't tell you how much we appreciate the work.

Dr. Lisa Meeks:

Dr. Serrantino, I'm gonna go to you next. You are a nationally recognized consultant. You've worked with multiple medical schools specializing in working with students on the NBME, through the process of applying for Step One accommodations. Your counsel is even sought in litigation, maybe even in litigation that's at this table. 

Q: What, in your impression, are the biggest barriers to students as they're applying for these accommodations?

Dr. Jan Serrantino:

Thank you for the question and thank you for the invitation. And I want to thank Jessica for sharing one of the biggest barriers, which is lack of support. Lack of support in the medical school, lack of support from disability providers who don't know the process for applying for accommodations. And probably almost worse is the message that students get, don't bother applying. You're never gonna get accommodations. We've never had a student get accommodations on our campus, you're gonna waste a whole lot of time. So that's a huge, huge barrier and a- and a- definitely a confidence decreaser. And so many students, probably like, Kristina, Dr. Petersen has talked about, they- they either fail out or get dismissed.

 

Another barrier is the absolute complex process that the USMLE puts students through. First of all, it's hard to find out what you're supposed to do and where to find the information on the website. They frequently change their website around and make it, I think, more and more difficult to find, uh, where to- what tab to click on to find how to apply for accommodations, what they need to do, what the documentation guidelines are, it's very complex.

 

Another barrier is the timeline. Students don't have a concept that this is probably gonna take anywhere from 10, 11 months to go through the process of gathering information, which is another barrier, but going through the process and getting things submitted enough ahead of time so that you can wait 60 to 90 days to get a response. And if it turns out to be not the response that you are hoping for of a reasonable accommodation, then you would have to wait a minimum of another 60 to 90 days to get a response from USMLE. Well that sets in motion another entire timeline process of your medical school program in which you have timelines in which you're supposed to take Step One by, and so that might put you behind. You might have to take a leave of absence. So the timeline issue is a huge barrier.

 

Gathering documentation. When students start the program, their documentation might be a year or two old and it might be perfectly fine for getting accommodations in the academic environment, in the clinical environment. But that documentation may not meet the currency standards of USMLE by the time that they're ready to, um, apply for accommodations. So not only does the student now maybe have to get new documentation or updated documentation, find old documentation, contact their parents, do a search through the attic, and all the, uh, children's files that were kept behind, gathering all that. Um, and then the cost if the student has to get new documentation. This is a huge barrier.

 

I’d also add writing the personal statement as a barrier for the student. Because while all of their peers are working on studying for the exam, they're working on gathering documentation, maybe getting new assessment, and writing that personal statement. And if you have been a person who has persevered and done all you can to compensate for your disability and utilize accommodations, now in this personal statement, you have to talk about all your deficits. And not just academic deficits, your whole life is dissected. You know, your social life, your relationships, your finances. All of that stuff- all that kind of negative stuff is now having to be put in a letter so that you can convince the evaluators at USMLE that you are a person with a disability.

 

And the last thing I'll mention is just the amount of time it takes to put that accommodation packet together, get it submitted, and then wait.

Dr. Lisa Meeks:

Yeah. We've had so many students say that the amount of time it takes to just do everything, put the packet together, everything, detracts from what they're supposed to be doing, which is studying, which places them in a precarious situation. So I'm wondering Jan, if you only could give a learner one piece of advice about how to navigate this kind of, you know, multiple landmines, what, what is the advice?

Dr. Jan Serrantino:

If, if I knew that a student with a disability was planning to go to medical school, I would direct them immediately to the USMLE website. I would go through them- through that website with them and download the process. Give them a packet of information that could help them establish a timeline so that they could start year one and start gathering things so it's not detracting from what they're supposed to be doing. Start gathering information, thinking about their personal statement, maybe writing it kinda piecemeal along the way. And work with their, disability resource professional on editing and, making that personal statement perfectly relevant. And then asking the school, the disability resource professional to write a letter of support that highlights the impact of the disability and the evidence that is in the documentation to support it.

Dr. Lisa Meeks:

Thank you so much.

Dr. Peter Poullos:

So our next question is for Larry Berger. 

Q: Larry, as we heard from Jessie, it's very- can be a very difficult decision deciding to retain an attorney. And, I mean, when should a student consider retaining one? And then how do you decide if you're going to take a case?

Larry Berger:

The question of who needs an attorney to go through this process, it's impossible to give a complete answer. But, but Jessica's case illustrates, some of the- some of the indications for that. Um, a typical thing that NBME says in denying accommodations is, well, “this is a lifelong disability and you don't have any evidence that you had this disability until you were in medical school”, uh, many times. In her case, she did have accommodations in college. Another standard NBME answer is, “well, you took, uh, you took all these standardized tests without accommodations and you did okay, or you did great.”

 

Another indication is if the disability is a so-called invisible disability, such as a learning disability or ADHD or anxiety. Another thing that comes up frequently is, “well, how can you say that you have a disability when you've had all these academic successes in your career? You got into a college, sometimes a very prestigious college. You got into medical school. How could you possibly be a person with a disability?” After all the standard is a comparison with, with somebody in the general population and you have all these accomplishments that very few people have achieved. So, so those are some of the things.

 

And I guess one other one, because as Dr. Serrantino has described, the process of putting together the packet of information is, is a demanding one. If, for a variety of reasons, you are going to need assistance with that, you can't do it all on yourself. You don't have it all on your computer and just ready to go. Uh, that, that could be another indication.

 

Uh, so those are the main things, I think.

Dr. Peter Poullos:

Q: how do you decide whether or not you're going to take the case on?

Larry Berger:

I've only been doing this for about five or six years. And I have had the luxury of being able to decide just on my own evaluation of whether this was a worthy case and one that I believed in. And that really for me has been the main driver. But certainly, uh, it is a process that for an attorney can also require a very long period of time. The time from when Jessica first came to me until the case was completely resolved was about three years. That was also the time that her education was delayed. Um, and it wasn't just me because I, we, we brought in another, well, a very skillful attorney in this area, Mary Vargas, who also was, was co-counsel in Jessica's case. So there was a lot of attorney effort that went into it. And I think for all of us that, that- whether we believe in the case is a big part of it. I guess those are the main things for me.

Dr. Peter Poullos:

Yeah. We also heard from Jessie, um, the fears that she had. And, 

Q: What are the potential consequences of a student deciding to litigate?

Larry Berger:

Well, one question is, “is this information going to be available to everybody?” The, fact that I'm litigating about this? And the general answer is yes. Because litigation is a public process. The public generally has a right of access to, uh, court proceedings. You can ask a court for permission to proceed anonymously in a particular case. And that is sometimes done. And we discussed, uh, uh, with, with Jessie whether to do that. Uh, we decided- she decided, uh, not to make that request. So all of the proceedings in her case are on the public record. Uh, you can read the opinions of the courts. You can- you can see, uh, everything that led up to that.

 

And, and then what are the consequences of doing that? And I would say that it depends. Um, and, and this would be one thing that guides your decision about whether to ask to proceed anonymously or not. If you think that this publicity is gonna be harmful to you in your future life then that is a good reason to make that request. Um, I think that as it has turned out for, for Jessie, I am happy to say I think that this has only, uh, uh, enhanced certainly t- in my eyes and I think in many people's eyes, has only enhanced, uh, her, her reputation. But it's a hard decision to make. Uh, and as I say, it, it is all going to be public unless you make an effort and a specific request to go anonymously.

Dr. Peter Poullos:

Thanks.

Dr. Lisa Meeks:

Thank you so much, Larry. And thank you for your work on this case. Chuck, we're gonna turn it over to you and you're not a-

Charles Weiner:

Clean up?

Dr. Lisa Meeks:

You are not allowed to say any curse words. (laughs) Even though this topic may, may elicit those. In so many situations I find that a strategic approach, like when appealing, and you guys are gonna- you're, you're presenting tomorrow on appeals, I find that a focused appeal is highly effective. 

Q: In which cases should we consider a consultant, someone like Dr. Serrantino, versus an attorney? Or is a combination of the two working together a, a good practice for filing an appeal? And do attorneys advise students on appeal? Could you just go an appeal route if someone gets denied?

Charles Weiner:

So the definitive answer on whether to hire an attorney or to have a consultant is it depends. Uh, I, I think we come to the table with different skill sets. Uh, certainly, uh, I've got to believe that when I am presenting an appeal or presenting a matter to the NBME, since I've litigated cases against them before, I come with a certain skill set. And I'm not saying I'm the Big Bad Wolf or anything, but they've got to be concerned when they say no to me that may find them in court. And I think that's a skill set or perhaps a reputation which, you know, presents a party at- you know, in this case it might be the NBME, it might the NBMLE, it puts them in a certain mindset.

 

In terms of proceeding with an appeal versus proceeding with directly to litigation, by and large, uh, it's, uh, advantageous to try and pursue an appeal, an effective pe- appeal. And the reason why I say that is that, at least in my practice, I try to take a wholistic approach. And in that wholistic approach, I look at a s- at a medical student and a medical student's education is a marathon. And I mean not just a marathon in terms of time. It's a marathon in terms of the various steps and accomplishments they must do. And part of that is to take multiple testing. The majority of my clients come to me looking for accommodations on the USMLE Step One or the COMLEX Level One. And, uh, I'm not just thinking in terms of providing services for that particular test. I'm thinking about the Step Two or Level Two. I'm thinking of this Step Three or Level Three. I'm thinking of their Board Certification Exams.

 

And so taking a high stakes test is a major life activity. And so because of that, to jump into litigation so early without giving it a shot of trying to resolve it ahead of time, may, may not be the best approach for that student. Because one, they need- I've got to say almost every single client who comes to me for accommodations on the Step One, are coming to the end of their second year. They have to take the exam within a few months. And they just don't have the time, or feel that they have the time, to go and pursue litigation. Often (laughing) if we do pursue litigation, we have to move very quickly on that. And it is doable. But it's best to try and resolve the case ahead of time.

 

And if I look at my practice, my practice reflects that. I have probably handled, between the NBME and NBOME, several hundreds of cases. Maybe 300 cases. And if you look at the amount of cases that I filed litigation on, and this is anecdotal. I don't have a specific number. It's probably around 15 cases. So it represents an extreme minority of the type of cases I've handled. And I've been able to get accommodations for students without having to go litigation. So certainly that that's, you know, where I- where I look to first.

 

There are some exceptions and we're gonna be discussing a case tomorrow the, uh, Berger versus National Board of Medical Examiners, and that's a case where I didn't pursue an appeal first. And we'll probably discuss why I didn't in that case. But there are some exceptions to that.

Dr. Lisa Meeks:

A lot of real- real gratitude and, um-

Charles Weiner:

Thank you.

Dr. Lisa Meeks:

... for both of you. And, for Dr. Serrantino and Dr. Petersen. Jessie, I think we all- we just all hold a special place in our heart for you and your decision and thank you. And so I think Pete and I want to take it to the audience. And some of you sent in some questions. I want to just briefly say I'm not an attorney, but by virtue of you asking a question publicly, we are giving permission to record your voice, and your identity should you choose to do so. We do have three pre-determined questions. So we'll start with those. If those three people could gather just right here near, near Jen. Jen's gonna help us out with that. And then we'll take it to the audience. We'll see how the discussion goes, but again, if you choose to, to engage, you are also giving us permission to record and distribute your voice.:

All right, Jen, I'm going to turn the microphone over.

Jen:

Do you want them on camera or just- or right here is good?

Dr. Lisa Meeks:

Oh, okay.

Brandy Wiley:

Should I introduce myself?

Dr. Lisa Meeks:

It's up to you.

Brandy Wiley:

I'll introduce myself. I'm Brandy Wiley. I am from the University of North Texas Health Science Center. We are a DO school. So first of all, I want to say thank you though, Ms. Ramsay, um, so much for your courage. I'm curious about the lessons learned, um, and how to apply those to an osteopathic school. Um, and what in, in your, um, experiences has been effective, um, with the COMLEX exams.

Charles Weiner:

Much of what we discussed in earlier sessions about addressing, uh, appeals to the NBME would be applicable to the NBOMA. Uh, and, and that is, you have to complete the documentation. I would try to provide all, uh, the best history you can provide. And that may be earlier, uh, IEPs or 504 plans. If there is a history of informal accommodations, if there's a history of any type of remediation. So, for example, very often I hear about students who used th- a multitude of tu- tutors. And if you can get some kind of documentation. That documentation may be from the student's parent. If that tutor happens to be around, it may come from the tutor. And also the, um, the personal statement is important.

 

And one of the things that I would point out about the personal statement, it's not just about talking about your disability and how- your hardships and that type of thing. One thing that is really important, because this is true of every single medal- medical student with a disability. They didn't get into medical student, uh, necessarily because of their disability. They got into medical school by their use of compensatory strategies. So one thing that I think is really important in any personal statement is to discuss those per- those, uh, those, uh, the different self-accommodating, the, um, ameliorative effects of mitigating measures. And the reason that's important is, is, is because the law itself says that a testing entity cannot utilize the fact that someone is able to self-accommodate and make themselves appear as if they don't have a disability and say, "Well, you don't have a disability because you used these accommodative factors." So I think that that's a really important thing to present also.

Charles Weiner:

I think the- one of the most important things, I mean, this is what comes out of both the Ramsay case and Berger case, and it also comes out in the cases that went against the student, is history is key. It's the most important thing.

Brandy Wiley:

Thank you.

Emily Magee:

Hello. Thank you. My name is Emily and I'm from Eastern Virginia Medical School. Um, Jessie, I really just want to thank you for your vulnerability and your courage in this and being open with all of us. And it's really appreciated. Um, and congratulations on beginning your residency. That's very exciting.

 

Dr. Petersen, this question is for you. In regards to the research, we spoke about the 50% of applicants who were denied. Could those denials be due to poor or limited documentation? Is that something that was part of the review and the study? Could you elaborate a little bit on that?

Dr. Kristina Petersen:

That's a great question. Thank you. Um, so it was 52% of the, um, applications for Step One accommodations that were denied. So those 52%, um, we were not able to look at or review any of the documentation for the sampling. It was a survey. We were, um, we sent a survey to, uh, student affairs deans and also disability resource professionals at all the LCME accredited schools. And we're relying upon their record keeping and their information and self-report on their side. Uh, we don't have access to the documentation so it's impossible for us to quantify or make any sort of judgment as to how many of them may have submitted documentation that would've, in our opinion, warranted accommodations or not warranted.

 

So, um, I do think the most telling point, however, to what I think you're getting at is the fact that the national failure rate the same year that we collected the data was between 4 and 5%. Whereas those that were denied accommodations, their failure rate within our sample size was 32%. So that's a huge difference. And there has to be some kind of rationale or some kind of explanation for that. It needs to be further explored.

Charlotte O'Connor:

I'm Charlotte O'Connor and I am the Manager of Learning and Accessibility Services at the University of Michigan Medical School.

Dr. Lisa Meeks:

Go blue.

Charlotte O'Connor:

Go blue. Um, I have a question for Dr. Serrantino and Dr. Petersen, if you would like to take it as well, it's a practical question. What kind of resources are best? What's available, both for DRPs and for the students who are applying for accommodations when we're looking at Step accommodations?

Dr. Jan Serrantino:

I'll start with DRPs. I would say that one of the best resources is joining the coalition because we talk a lot on the coalition. There's a lot of, of chatter through the listserv about USMLE and, um, applying- and those accommodation- that accommodation process. The coalition also has a guide that can be very helpful for DRPs in understanding the process and how long it takes. And that can also be shared with students. Also DRPs can attend this symposium and meet colleagues who can help them in the process.

 

I will say for students a DRP that's knowledgeable is an amazing resource. The learning specialist at their university is a great resource. I know that there's resources that they can pay for, through Kaplan or USMLE. But, in order to study. But, preparing early and having access to the guide, the packet that I mentioned earlier, when they first meet with the disability, resource professional could really make the difference between getting accommodations and not getting accommodations. Because the amount of time it takes to gather all the information and write a comprehensive request packet.

 

So those two resources I think are really important. And DRPs sometimes utilize consultants or others to do some ghost writing and help in that process. But they have to verify every fact and make sure that it works along with the documentation, the evidence that's in the documentation.

Dr. Kristina Petersen:

I think you really covered a lot- a lot there, Dr. Serrantino. There's only one thing that I would add to that is just- I think along- along with the affiliation with the coalition, I think having access to other professionals doing the same thing. I know I have read other people's drafts of letters of support. And I've asked others to read mine. And I've been grateful for that, um, that feedback. It helps me to kind of remember what points I need to cover. Or, you know, sometimes I get caught in the weeds of the details and then I need to zoom back a bit. And so it's helpful to sometimes get feedback from a colleague.

Charlotte O'Connor:

Thank you so much. And I would be remiss not to thank the panel and thank you, Jessie. You are a hero. I really appreciate your bravery.

Dr. Jessica "Jessie" Ramsay:

I actually have something to add to your, uh, question. Because when I started, um, applying, I- being in a new program, we didn't have a learning specialist or a DRP. So I, I really had nobody to guide me through. And, um, I want to second the importance of having people, um, who are knowledgeable or at least willing to help you, um, find a way, reach out to other DRPs and, um, reach out and find their experience, what was helpful for them, what was not, and how the, like you said, the wording. Uh, that was probably the hardest part for me. I didn't know how much I was supposed to say, how little I was supposed to say, what exactly I was supposed to talk about. And it's really actually difficult to find any information on this if you don't already know it or know somebody who knows where to find that information.

 

And so the first time around, I knew none of that. And I would say that my personal statement and the application I put together was really- it- if you were not in medicine, you would be like oh, that's a really good application. She covered everything. But then knowing what I know now, it di- it lacked a lot of the crucial points that you guys have mentioned. And then the second time around, um, when I was working with Larry and we identified all these areas, um, it made a huge difference. Uh, and, and by that point I had already been out of school for a year. And my school realized that they needed a learning specialist and started the ball on that. But that's great. At- in that point in my life it was great for everybody after me, but I still wasn't benefiting from, from that.

 

So if I could say one thing about the most important part is, is the guidance from all of you. Um, so please keep providing that to your, your students and, and, um, residents even. Cause there are some residents who are just now applying for accommodations and they've already taken Step One and Two  in med school. And now are finding they need help. So please, please keep providing that to them.

Dr. Lisa Meeks:

Thank you so much, Jessie. I think, um, first of all, Dr. Petersen, that's a great idea. And I don't think I've heard that brought up before to, you know, develop a, a network within a network. You know? If you have a few people that can exchange letters and give feedback, sometimes it's hard for us to see something that someone else can easily identify. I think- I think that's a really good idea. And in some of these workshops, I know tomorrow we'll be going over actual letters that were successful with the national board.

 

I didn't hear mention of the chapter. How many of you have the book Equal Access? The entire room has the book Equal Access. Well, hallelujah. There is an entire chapter written on this by Neera Jane and myself. And I would say that that's a really great way to understand the landscape and understand that strategy. Chuck and I were talking about, um, that guide very helpful. It's the UCSF Guide to the Step One Exam, because we were at UCSF at the time. Um, and so that is actually coming out again next month, a revised, updated version of that. And so we'll post that on our Docs with Disabilities Initiative website. And then again, on the coalition website. So new information will be available to help support you in doing this, as Jessie said, really important work.

 

And I think the way that I would like to end this session, you know, Pete and I, we're so grateful. It's the- this podcast is really a labor of love and it's designed to be this asynchronous mentoring for students and trainees in the pathway, or, you know, just entering medicine or other health professions. And so I think we've done a wonderful job here today presenting really valuable information. And I thank the panelists.

 

Um, but I want to turn the mic over to Jessie for our conclusion. And Jessie, I think you probably have some people who have been really beneficial in this, including, your parents who- are they in the audience?

Dr. Jessica "Jessie" Ramsay:

They are not in the room. (laughs) I got too nervous and told them no.

Dr. Lisa Meeks:

Okay.

Dr. Jessica "Jessie" Ramsay:

(laughs)

Dr. Lisa Meeks:

So, I want to let you and our podcast, if you will, by thanking anyone you want to thank. And I want you to give the final piece of advice to the learner because you are the person that they will be looking up to.

Dr. Jessica "Jessie" Ramsay:

Uh, okay. (laughs) Um, also thanks for bearing with me as I stumbled through this and cried. Um, but I think the most important thing for any learner out there, whether it's in medicine or any other field, is to not let anybody else tell you what you can and cannot do. That's for you to find out and to decide. And you can ask for help. You should ask for help when you need it. And you shouldn't allow others to stigmatize something about you. You show them what you can do. And you tell them what you can do. And if they are telling you that, like, something that you know is wrong, show them. Just show them.

 

Because I have come across, like, so many points in my life where someone would say why are you going into medicine? You, you can't read. And I would just get the information somewhere else. Some way else. Um, and I have made it. I had a lot of help. And I reached out and found people that were willing to take the time and the- make the effort to help bridge that gap and get me to where I needed to be or spend a little extra time showing me a different way of doing something. And it made all the difference in the world. And I think that if you just take a step back and look at where you need to be and where you are and the best way for you to get there might be- probably is a different way than what everybody else is doing. Find somebody who's gonna help you navigate that path.

 

Um, and if no one else is there, try to do it yourself. Because it's important for us to find these ways and create these ways. Because there are gonna be so many people after us who are gonna need us for guidance. So, um, that's probably my biggest advice.

 

In terms of thanking people, my parents are definitely on that list. They put up with me from birth 'til now. Um (laughs), and all of my, um, resistance to homework. My mom, especially, sat up, like, every night trying to get me to do my reading. And when I couldn't finish it, read to me. And every paper that I ever had, like, and cried about when we got it assigned, she stayed up and, like, proofread it. And, um, still does that. So, sorry, Mom. And (laughs), and, um, but my parents have always been extremely supportive.

 

And I mentioned earlier I have two brothers with special needs. And they're also very supportive. But my parents had to spend a lot of time with them and on them. But still somehow found time to get me through this and support me. So, um, they're saints.

 

And (laughs), um, I'd also like to thank my husband because he's had to go through all of this with me. And it was a lot of stress for him as well. Um, he's also in medicine and had to watch me struggle. And then we were, um, different years and so that, uh, leave kind of threw a lot of wrenches in pretty much everything. So, um, Neil, thank you for putting up with me. (laughs)

 

And then I'd like to thank all of you and all of my friends who still support me. And pretty much all of the students out there and the learners out there who making this what it is and this important value in, in education that we need to keep supporting. So thank you everybody. (laughs)

Dr. Lisa Meeks:

Thank you so much to the panel. This was fun. Please keep listening to the podcast, and, and really helping us elevate these stories by sharing the podcast, with your friends and colleagues.