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Race and Disability Characteristics and Accommodation Disparities on the USMLE Step 1
Mytien Nguyen1, Gabriel Abrams2, Tiffany Hodgens3
1Yale School of Medicine, New Haven, Connecticut.
JAMA Network Open
|September 30, 2025
Summary
Medical students with disabilities (MSWD) face disparities in USMLE Step 1 accommodation requests and approvals. Asian MSWDs, those with psychological disabilities, and later diagnoses had lower rates, highlighting the need for equitable access.
Area of Science:
- Medical Education
- Disability Studies
- Health Equity
Background:
- Access to accommodations on high-stakes exams like the USMLE Step 1 is vital for medical students with disabilities (MSWD).
- Disparities in accommodation access can impact equal opportunity and the diversity of the healthcare workforce.
Purpose of the Study:
- To investigate factors associated with accommodation requests and approvals for USMLE Step 1 among MSWD.
- Examined the influence of gender, race/ethnicity, disability type, diagnosis timing, and disability resource professional (DRP) support.
Main Methods:
- Cross-sectional study of 295 MSWD from 9 US medical schools (graduating 2020-2023).
- Analyzed associations between student demographics, disability characteristics, DRP availability, and USMLE Step 1 accommodation requests/approvals using statistical tests.
Main Results:
- Asian MSWDs had lower request rates compared to White MSWDs. Students with psychological disabilities or diagnosed after matriculation had lower request and approval rates.
- Accommodation approval rates were significantly higher for students at schools with specialized DRPs (78%) versus those without (53%).
- Students with ADHD and chronic health conditions had higher accommodation request rates than those with psychological disabilities.
Conclusions:
- Significant disparities exist in USMLE Step 1 accommodation access for MSWD, particularly for Asian students and those with psychological disabilities or later diagnoses.
- Specialized disability resource professionals (DRPs) are associated with improved accommodation approval rates.
- Addressing these inequities is crucial for promoting diversity in medicine and ensuring a representative healthcare workforce.
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