Understanding Accommodations
Parts of an Accommodations Application
Types of Testing Accommodations
Dr. Moss' Resources & Advising
Resources & MCAT/USMLE/COMLEX Links
Embarking on the journey of applying for testing accommodations can feel overwhelming. I'm here to share my experiences, insights, and resources to help you navigate the process more smoothly.
As a psychiatry resident who has personally gone through the accommodations process for multiple USMLE exams, I hope to provide you with a roadmap to reduce some of the challenges ahead and empower you with the knowledge to advocate for yourself effectively.
I want to share some guidance on applying for accommodations on the MCAT, USMLE, and COMLEX if you have a mental or physical health condition that impacts your ability to take standardized exams.
I received accommodations for USMLE Steps 1, 2, and 3, and I have worked with dozens of pre-medical and medical students navigating this process.
The process can be daunting, especially if you've struggled with MCAT, USMLE, or COMLEX failures or other academic challenges. However, building a thoughtful and well-supported application can make a significant difference.
Presentation I Gave to Medical Students on Applying for Accommodations
My Story: Discovering Disabilities
Before medical school, I never saw myself as someone with a disability.
But midway through medical school, I was diagnosed with mental health and chronic pain conditions. This experience was eye-opening and helped me understand that disabilities can affect anyone — including aspiring physicians.
One of the hardest moments for me was failing USMLE Step 1 TWICE.
It was only then, after advice from a friend, that I considered seeking accommodations.
I had spent years avoiding help, shaped in part by an early educational system where I had never received this type of support. It took time, but I eventually learned that accessibility is not about receiving "special treatment."
It is about removing barriers and creating a more equitable testing environment.
Vlog Video of My Disability Story & Getting Accommodations in Medicine
Understanding Testing Accommodations
Testing accommodations are intended to remove disability-related barriers and allow individuals to demonstrate their knowledge and abilities.
They don't exist to provide an unfair advantage. They are intended to provide equitable access to an examination.
The Americans with Disabilities Act (ADA) provides legal protections for individuals with disabilities, including protections related to testing and education.
If you're struggling, know that requesting accommodations is not something you should feel ashamed of.
Medical schools typically have an accessibility or disability services office that can help students navigate accommodations within their institution.
Accommodations can take many different forms depending on your individual needs, including extra testing time, additional breaks, testing in a separate environment, or scheduling flexibility for medical appointments.
Key Components of Your MCAT/USMLE/COMLEX Accommodations Request
There are several important components that may help strengthen an accommodations application.
1. Letters: Clear Diagnosis & Documentation
Your physician, psychologist, therapist, or other healthcare provider's documentation should clearly describe your diagnosis and relevant functional limitations.
Documentation may include:
- Formal diagnoses
- ICD-10 codes for medical or mental health conditions when appropriate
- DSM diagnostic criteria when relevant
- Medical records describing the history of your condition
- Documentation describing how your condition affects test-taking
For physical conditions, supporting documentation might also include:
- Laboratory results
- Imaging
- Physical examinations
- Specialist evaluations
- Neuropsychological testing when applicable
The goal is to provide documentation that helps reviewers understand not only your diagnosis, but also how the condition functionally impacts you in a standardized testing environment.
2. Personal Statement: History of Challenges
Your personal statement is your opportunity to tell the story behind the documentation.
Even if your diagnosis is relatively recent, consider describing earlier patterns of difficulty throughout your education and standardized testing history.
This might include experiences with:
- AP exams
- ACT or SAT exams
- MCAT
- USMLE
- COMLEX
- School examinations
- Course failures or repeats
- Standardized exam failures
- Needing additional time
- Difficulty finishing examinations
- Informal accommodations or modifications you used before receiving a formal diagnosis
If you have experienced academic or standardized testing challenges related to your condition, explain those experiences clearly.
The goal is to help reviewers understand the longitudinal pattern rather than simply providing a diagnosis.
3. Explain the Connection Between Your Diagnosis & Functional Impairments
This is one of the most important components of the application.
Clearly explain HOW your medical or mental health condition affects your cognitive, physical, or psychological functioning during examinations.
Examples might include:
- Difficulty sustaining concentration
- Difficulty processing information within standard testing time
- Needing additional breaks because of pain
- Medication-related needs
- Difficulty sitting for prolonged periods
- Anxiety or other symptoms that worsen in specific testing environments
- Needing a distraction-reduced or separate testing environment
- Physical symptoms requiring access to food, water, medication, or restroom breaks
Your diagnosis alone does not necessarily explain what accommodations you need.
You want to clearly connect:
Diagnosis --> Functional Limitation --> Requested Accommodation
4. Be Specific About the Accommodations You Are Requesting
Be VERY explicit about what you are requesting.
Examples of testing accommodations may include:
- Extended testing time
- 1.25x testing time
- 1.5x testing time
- 1.75x testing time
- 2x testing time
- Additional break time
- Shortened testing blocks
- Smaller question blocks, such as 20 questions instead of 40 questions
- Testing over multiple days
- Separate testing environment
- Reduced-distraction environment
- Access to food
- Access to water
- Access to medications
- Additional restroom breaks
- Other disability-specific accommodations
Most importantly, explain WHY each accommodation is necessary.
For example, don't simply state:
"I need additional break time."
Explain the functional reason:
"I require additional break time because prolonged sitting worsens my pain, requiring me to stand, stretch, take medication, or use other symptom-management strategies between testing blocks."
The connection between your impairment and the accommodation should be as clear as possible.
Understanding Your Needs and Expressing Them
It is crucial that you recognize and thoroughly articulate your need for accommodations.
Think deeply about the difficulties you experience and how they affect both your academic performance and your ability to complete standardized examinations.
This is not the time to minimize your experiences.
Many people with chronic health conditions or disabilities become accustomed to compensating for their symptoms. As a result, it can sometimes be difficult to recognize just how much additional effort you are using to function in the same environment as everyone else.
Try to describe your challenges in tangible and specific ways.
When working on your personal statement, specificity is key.
Rather than simply saying:
"I have difficulty concentrating."
Consider describing:
What happens when you try to concentrate
How long you can sustain concentration
What symptoms interfere
What happens when your symptoms worsen
How those symptoms have affected previous examinations
What strategies you currently use to compensate
Why those strategies are insufficient under standard testing conditions
I've learned that framing your needs from the perspective of the reviewers can be incredibly helpful.
You know what your condition feels like.
Your job in the application is to help someone who has never experienced your symptoms understand exactly how they affect your ability to take the exam.
Evidence and Impact of Previous Experiences
Evidence from your medical history, educational history, previous testing conditions, and examination outcomes can help support your application.
If you've experienced challenges testing without accommodations — such as failing an exam, running out of time, leaving large numbers of questions unanswered, or having symptoms interfere with your performance — consider describing those experiences.
These examples can help demonstrate the potential impact of accommodations and provide context for why additional support is being requested.
Some applicants choose to include previous examination scores or other documentation highlighting patterns of difficulty without accommodations.
Your goal is to provide a complete picture of your academic and testing history.
Letters of Support for Testing Accommodations
Letters of support can be an important component of an accommodations application.
Documentation from physicians, psychologists, therapists, or other healthcare professionals can help establish both your diagnosis and your functional limitations.
When possible, documentation should come from clinicians who understand:
Your diagnosis
Your history
Your symptoms
Your functional impairments
How those impairments affect standardized testing
The accommodations being requested
Why those accommodations are appropriate
A physician who understands your medical condition may be particularly helpful for documenting physical or medical limitations.
A therapist or psychologist who has worked with you longitudinally may be able to provide valuable insight into longstanding psychological or cognitive difficulties.
If you're submitting multiple letters, consider prioritizing documentation that most directly connects your condition to your requested accommodations.
Different healthcare professionals may also provide complementary perspectives, particularly when you have multiple conditions affecting your ability to test.
Types of Testing Accommodations
Extended testing time is probably the accommodation most people are familiar with, but it is far from the only option.
Depending on your condition and testing organization, accommodations may include:
Additional testing time
Additional break time
Extended or stop-the-clock breaks
Shorter testing blocks
Reduced numbers of questions per block
Testing over multiple days
Separate testing rooms
Reduced-distraction testing environments
Permission to stand or move during breaks
Access to food and water
Access to medications or medical devices
Additional restroom access
Other individualized accommodations related to your disability
The accommodation you request should be tailored to your specific functional limitations.
You should also remain open to different accommodations that may address the same underlying barrier.
You Are NOT Alone
If you're navigating this process, you are NOT alone.
Many students have successfully secured accommodations and gone on to pass their exams.
Myself included!
Through my USMLE Accommodations Workbook, I've shared my FULL USMLE Step 1-3 accommodations requests, templates you can provide to physicians, and workbook pages designed to help you craft your personal statement and accommodations application.
Dr. Moss' Resources & Advising
Over the past several years, I have helped dozens of pre-meds navigate MCAT accommodations and medical students navigate USMLE and COMLEX accommodations.
If you'd like to have a 1:1 advising meeting with me to discuss your unique situation, I can help you think through your testing history, requested accommodations, documentation, and personal statement.
I also offer editing assistance for testing accommodations applications.
You can sign up for individualized advising here.
Your journey matters.
You are capable of advocating for the resources you need to reach your full potential.
Don't hesitate to seek help, use the resources available to you, and celebrate every win — big or small!
Dr. Moss' Accommodations Resources & Journey
Requesting Accommodations in Medical School
Requesting Accommodations for Step 1 on KevinMD
Disabilities Resource Collections
Navigating Medical School Hidden Curriculum E-Book
Podcast: "Life as a Patient-Doctor"
Download My USMLE Accommodations Workbook
Medical School Workbook — Includes Tips for Disability Disclosure
Editing Your Accommodations Request
USMLE UWorld Affiliate --> Use code STEPH10 for 10% savings!
Official Testing Accommodations Websites
NBOME: https://www.nbome.org/resources/test-accommodations/
USMLE: https://www.usmle.org/step-exams/test-accommodations
MCAT: https://students-residents.aamc.org/mcat-exam-accommodations/take-mcat-exam-accommodations
Docs With Disabilities Guide for USMLE