Impact of USMLE Step-1 Accommodation Denial on US Medical Schools: A National Survey

Authors

Kristina H. Petersen, Department of Biochemistry & Molecular Biology at New York Medical College, Valhalla, New York, United States of America.Follow
Neera R. Jain, Centre for Health Education Scholarship, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
Ben Case, Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.
Sharad Jain, Department of Medicine, University of California, Davis, School of Medicine, Sacramento, California, United States of America.
Lisa M. Meeks, Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America.

Author Type(s)

Faculty

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DOI

10.1371/journal.pone.0266685

Journal Title

Plos One

First Page

e0266685

Document Type

Article

Publication Date

1-1-2022

Department

Biochemistry and Molecular Biology

Abstract

INTRODUCTION: In 2019, 4.6% of US-MD students self-identified as students with disabilities (SWD); many of these students will require accommodations on the USMLE Step-1 examination. Given the high-stakes nature of Step-1 for medical school advancement and residency match, SWD denied accommodations on Step-1 face considerable consequences. To date no study has investigated the rate of accommodation denial and its impact on medical school operations. METHODS: To investigate the rate of accommodation denial and evaluate whether Step-1 accommodation denial impacts medical school operations, a 10-question survey was sent to Student Affairs Deans and disability resource professionals at all fully-accredited US-MD granting programs. Two open-ended questions were analyzed using qualitative content analysis. RESULTS: Seventy-three of the 141 schools responded (52%). In the 2018-2019 academic year, 276 students from 73 schools applied for Step-1 accommodations. Of these, 144 (52%) were denied. Of those denied, 74/144 (51%) were delayed entry into the next phase of curriculum and 110/144 (76%) took the Step-1 exam unaccommodated. Of the 110 who took Step-1 without accommodations, 35/110 (32%) failed the exam, and 4/110 (3%) withdrew or were dismissed following exam failure. Schools reported varied investments of time and financial support for students denied accommodations, with most schools investing less than 20 hours (67%) and less than $1,000.00 (69%). Open-responses revealed details regarding the impact of denial on schools and students including frustration with process; financial and human resources allocation; delay in student progression; lack of resourcing and expertise; and emotional and financial burdens on students. DISCUSSION: Step-1 accommodation denial has non-trivial financial, operational, and career impacts on medical schools and students alike. The cause of accommodation denial in this population requires further exploration.

Recommended 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), e0266685. https://doi.org/10.1371/journal.pone.0266685