For medical students with disabilities, access to accommodations for licensing exams is possible—but the path is not automatic or simple.
The process of securing accommodations on the United States Medical Licensing Examination (USMLE) series or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) series requires advanced planning, detailed documentation and self-advocacy. Such adjustments can be made to the administration of these exams to ensure that medical students with disabilities have equitable access.
A guide put together by Docs with Disabilities—an organization focused on advancing inclusion and equity for medical learners and physicians with disabilities—offers a comprehensive, step-by-step breakdown of the process. Here are some key insights.
Start early
The process of requesting accommodations has several steps. Gathering documentation, undergoing evaluations, writing a personal statement and securing letters of support all take significant time.
Because of that, Docs with Disabilities recommends beginning the process a year out from when you plan to test. So for medical students who will take USMLE Step 1 at the end of their second year, it’s best to start before you conclude your first year of training.
Approval is possible, especially when medical students submit thorough, well-supported applications. A 2022 survey cited in the guide found that about 48% of students who applied for accommodations on Step 1 were approved, and the success rate is often higher at medical schools that offer strong institutional support through disability-resource professionals.
Dive deeper:
- Seven timeless tips for USMLE Step 1 study time
- USMLE Step 1 FAQ: How, what to study to pass the exam
- For your USMLE Step 1 study plan, follow the evidence on what works
- USMLE high-yield topics—in the eye of the beholder?
Work with on-campus staff
If you are pursuing accommodations, don’t try to go it alone.
Medical students should work closely with a disability-resource professional—or, where unavailable, a learning specialist or academic adviser—who can help guide them through the process.
“Your school should absolutely have somebody who can guide you, though they may not have experience with requesting accommodations for your particular situation,” said Emily Cleveland Manchanda, MD, MPH, director for social justice education at the AMA Center for Health Equity.
Common requests for accommodations include extra time, additional breaks, multiday testing and private testing spaces. Each accommodation must be backed by documentation and a clearly explained need. Your medical school’s disability-resource professional can help align your request with your documentation and previous support history.
A different standard
One common misconception is that having received accommodations on earlier standardized exams such as the SAT, ACT or even the Medical College Admission Test (MCAT)—means you're automatically approved for them when taking the USMLE or COMLEX series of tests. That is not the case.
The Docs with Disabilities guide highlights that prior accommodations can support your application by establishing a history of disability-related needs, but approval is not guaranteed. The National Board of Medical Examiners (NBME), which oversees the USMLE series, evaluates each request under its own strict criteria, using what’s known as the “average person standard.”
The NBME requires up-to-date documentation from qualified professionals—often dated within the past three years—and detailed accounts of functional impairments. This process often includes neuropsychological evaluations, which a test-taker may have to pay for out of pocket and can take time to schedule.
Another part of the process is a personal statement that details how your disability affects your daily life and test-taking ability. In this document, applicants should explain barriers, impairments and exactly why specific accommodations are necessary.
Dive deeper:
- Four keys to maintaining personal wellness during USMLE prep
- As Step 1 pass rates dip, take these study tips to heart
- Why failing Step 1 shouldn’t end your dream of being a doctor
- After Step 1 shift, research experience is a watchword for Match
Persistence is paramount
If your initial application for accommodations is denied, the NBME allows only one reconsideration per exam registration. In your appeal, you must address every reason cited in the denial letter and supply new documentation.
Dr. Cleveland Manchanda highlighted that accommodations exist to level the playing field, and that ensuring equal access to licensing exams is essential to “supporting all of the patients who these students will later care for.”
“This can be a complicated and challenging process and certainly requires self-advocacy on the part of people with disabilities,” said Dr. Cleveland Manchanda. “There are ways in which allies and folks in medical education leadership are working to try to make this process better, but it remains a challenging part of medical school.”
Learn more with the AMA about how ableism takes a toll on patients and physicians. Also, explore this primer on ableism in health care (PDF), which is part of the AMA’s 2024–2025 strategic plan to advance health equity.
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