The USMLE program is committed to creating a reasonable and straightforward process for test takers requesting accommodations.
The video below provides an overview of how examinees can request test accommodations for the USMLE Step exams. Learn what to expect, what documentation is needed, and how to navigate each step with confidence.
Reasonable and appropriate accommodations are provided in accordance with the Americans with Disabilities Act (ADA), including changes made by the ADA Amendments Act of 2008 for individuals with documented disabilities. The purpose of test accommodations is to provide access to the examination program. While presumably the use of accommodations will enable the individual to better demonstrate their knowledge or skill, accommodations are not a guarantee of improved performance, test completion, or a particular outcome.
Determination of whether an individual is substantially limited in functioning as compared to most people is based on an individualized assessment of the current impact of the identified impairment. Supporting documentation is necessary to determine what, if any, accommodations are appropriate for the disabled individual in the examination setting and context. It is essential that supporting documentation provide a clear description of the functional impairment and a rationale for the requested accommodation that is relevant to the setting and context of the specific examination.
The USMLE program receives thousands of applications for test accommodations annually. The data presented here is a summary of the number of requests for test accommodations across all three Steps of the USMLE exam from 2020 to 2024.
| 2020 | 2021 | 2022 | 2023 | 2024 | |
|---|---|---|---|---|---|
| Step 1 | 841 | 1,022 | 1,380 | 1,804 | 2,511 |
| Step 2 CK | 564 | 724 | 820 | 1,204 | 1,662 |
| Step 3 | 315 | 338 | 481 | 581 | 712 |
| Total | 1,720 | 2,084 | 2,681 | 3,589 | 4,885 |
Historically, more USMLE Step exam accommodations requests have been approved than denied. In this infographic, approvals include any and all approved accommodations, including initial requests, subsequent requests, partially approved requests (e.g., when someone is approved for less additional testing time than they requested, or when someone is approved for additional break time instead of additional testing time) and requests for additional break time with standard testing time.
For screenreaders: Infographic titled "Percentage of USMLE Accommodation Requests Approved Fully or Partially." It displays a horizontal timeline from 2020 to 2024 using five circular icons connected by a line. Each icon shows the year and the percentage of requests approved fully or partially: 76% in 2020, 83% in 2021, 86% in 2022, 94% in 2023, and 92% in 2024. Below the timeline, three illustrated figures are shown: one standing and pointing at a laptop on a table, another seated and working on the laptop, and a third standing nearby.
Read the guidelines carefully. Share them with the professional who will be helping you prepare your documentation.
Read the instructions and complete the appropriate Request for Test Accommodations form.
If appropriate, have your medical school complete the Certification of Test Accommodations (CPTA) form.
Attach documentation of the disability and your need for accommodation. Send your request for test accommodations with supporting documentation to the email address noted on the form. Incomplete documentation will delay processing of your request.
The Disability Services team will acknowledge receipt of your request by e-mail within a few business days of receiving your request for test accommodations. If you do not receive an acknowledgement within that timeframe, please contact Disability Services at disabilityservices@nbme.org or 215-590-9700.
IMPORTANT: If you plan to request test accommodations, we suggest you complete your exam application and submit your completed request to Disability Services as early as possible to ensure there is ample time for your request to be processed. For example, if you select a June-August eligibility period, we recommend you submit your request no later than early March to allow for the 60-business day review process and time for you to select your exam dates.
There are four different types of test accommodations you can request:
If you have not previously received test accommodations for USMLE, complete and submit the Request for Test Accommodations form and supporting documentation to the address listed on the form at the same time you complete your Step exam application.
If you received test accommodations for a previous USMLE Step exam, complete and submit the Subsequent Request for Test Accommodations form to the address listed on the form. If you are requesting new or additional accommodations, please note you should submit new supporting documentation that wasn't previously submitted. Send your completed request form at the same time as you complete your Step exam application.
Examinees with medical conditions, such as lactation/nursing mothers and those with diabetes may apply for additional break time/standard testing time by submitting the Additional Break Time Only request form.
If you submitted a request for test accommodations and received our written decision letter, you may request that we reconsider our decision for the same Step exam registration(s). You may request ONE (1) reconsideration review per active registration. For example, if you made a request for Step 1 you may make one reconsideration request provided you have not tested, and your scheduling permit has not expired. Please see below for detailed information.
Nursing/breastfeeding individuals may test under standard conditions and request to bring and use their breast pumps during authorized breaks. Requests are required because Disability Services needs to let Prometric know in advance so that Prometric can ensure it has the appropriate space available.
Nursing/breastfeeding individuals may also choose to submit a request for additional break/standard testing time to express milk. Please note that additional break time makes Step 2 a two-day exam and Step 3 a three-day exam. Please also note that this arrangement requires you to have an accommodated permit. If you already have a scheduling permit for a standard time exam, please contact your registration entity to update or re-register with a hold for test accommodations.
If you submitted a request for test accommodations and received our written decision letter, you may request that we reconsider our decision for the same Step exam registration(s).
You may request ONE (1) reconsideration review per active registration. For example, if you made a request for Step 1 you may make one reconsideration request provided you have not tested, and your scheduling permit has not expired.
If your eligibility expires during the course of our review, or if you test before our review is complete, Disability Services will discontinue the reconsideration review process. It is your responsibility to monitor your registration status and eligibility period throughout the entire reconsideration process.
To request a reconsideration:
Carefully read, complete, and submit a Reconsideration Request Form.
Submit new and substantive supporting documentation or information that we have not already reviewed.
DO NOT re-send documentation that you previously submitted.
Letters written by you, or a qualified professional, that only convey previously provided information are generally not sufficient to support a reconsideration request. For guidance and examples of relevant supporting documentation, it may be helpful to review the General Guidelines to Request Test Accommodations and, if applicable, the Additional Guidelines for Specific Impairments.
As a reminder, requests for accommodations should generally be accompanied by appropriate, comprehensive documentation from a qualified professional dated within a reasonable time-frame sufficient to document your current specific impairment(s). If this information was not provided with your initial request, or was not comprehensive, we recommend that you provide it or supplement it in your request for reconsideration, if possible. We do not ask that you undergo any new or redundant evaluation, assessment, or testing when you seek reconsideration. We will consider only new objective evidence to support your request.
The pre-approved items listed below are permitted in the secure testing area subject to inspection by test center staff. If you have a medical need for one or more of these items during your USMLE Step 1, Step 2 CK, or Step 3 examination, you do NOT need to make a request or submit documentation to NBME for approval. Please show the item to test center staff when you check in for your examination.
If you have a medical condition that only requires the use of an item NOT on the list below, please submit a request for test accommodations by completing a Personal Item Only request form and submit that to disabilityservices@nbme.org.
If you already have a scheduling permit for a standard examination, please contact your registration entity to re-register and place your permit on hold for accommodations. If you have any questions, please contact us via email or 215-590-9700. *Please note any devices that have external communication capability such as cellular, wireless, Bluetooth, etc., require review and approval and may not be authorized in the secure testing room. This also applies to devices that may sound audible alerts, vibrate, or otherwise emit sounds.
All devices in the testing area must be on silent mode. If your device cannot be silenced, and makes any noise, including vibration, please contact Disability Services before you test.
All submitted disability related documentation is considered personal and confidential and is securely maintained. Access to such information is limited to those individuals responsible for processing and reviewing the documentation for the purpose of determining eligibility for test accommodations, including a professional review by experts in the appropriate area of disability. No information concerning a request for accommodations is released to a third party without a written request or consent from the individual, subject to any legal requirements to provide documents that NBME may have in its custody or control, and to the possible need to disclose such information to attorneys or other third parties in the event of any disputes relating to an accommodation decision.