The United States Medical Licensing Examination (USMLE) is a three-step process (Step 1, Step 2 CK, Step 3) required for medical licensure in the United States. It assesses the progression from foundational basic science knowledge to independent clinical practice under standardized testing conditions. To ensure fairness and accommodations are available for examinees with disabilities, as defined by the Americans with disabilities act (ADA), including conditions that substantially limit major life activities such as reading, seeing, or concentrating. Accommodation requests are individually reviewed based on submitted documentation, with decisions ranging from full approval to partial approval or denied requests.
In 2023, many accommodation requests were due to physical impairments, with diabetes being the most common. Both Type 1 and Type 2 diabetes require careful blood glucose monitoring due to risks of hyperglycemia and hypoglycemia. A recent article published in PLOS One aimed to provide empirical, population-level data on approval rates and processing timelines for USMLE test accommodations requests submitted by examinees with diabetes (Type 1 diabetes, gestational diabetes, and Type 2 diabetes).
In this study, data from 183 examinees requesting USMLE accommodations for diabetes between January 2023 and December 2023 were analyzed with prior consent. This study evaluated the approval outcomes, accommodation types, and processing times. Descriptive statistics, including frequencies and average timelines, were calculated using Microsoft Excel to summarize request patterns and decisions.
Among 183 examinees, 30.1% (n = 55) requested additional testing time, and 63.4% (n = 116) requested additional break time; others sought permission for a separate room, drinks, diabetic supplies, or food items. Overall, 86.9% (n = 159) received full approval, whereas 13.1% (n = 24) received partial approval, with no denials reported. All supply/separate room requests and all break-time requests were fully approved with a 100% approval rate among the 12 examinees who made such requests.
By exam Step, full approval rates remained high. Step 1 had a 78.7% full approval rate with 74 examinees, Step 2 CK had 94.5% with 52 examinees, and Step 3 had 97.1% with 33 examinees, with fewer partial approvals overall (Step 1 = 21.3%, Step 2 = 5.5%, Step 3 = 2.9%). Furthermore, processing averaged 10 business days; 77 requests or 42.5% were completed within one day, whereas 154 requests or 18.4% were completed within 30 days. All Step 1 and Step 3 requests were processed within 60 business days, while 98.2% of Step 2 requests, totaling 54 cases, were completed within the same timeframe. Fewer than 1.1% of examinees exceeded this threshold, and 42.1% of requests were approved within one business day. Average processing times were about one day for Step 1, ten days for Step 2 CK, and two days for Step 3.
This study’s limitations include its focus solely on examinees with diabetes, which limits generalizability to other conditions, reliance on data from a single year (2023), which may not reflect temporal trends, dependence on the accuracy of submitted documentation, and exclusion of perspectives from individuals who did not request accommodations.
In conclusion, the USMLE demonstrates a strong commitment to equitable testing by approving most diabetes-related accommodation requests, which are often fully or, in some cases, partially approved. High approval rates for break time and individualized decisions for testing time reflect tailored support. Processing times are typically faster than the 60-day standard, with very few delays, alongside ongoing efforts to improve communication and efficiency.
Reference: McGeehan L, Robbins MJ, Jurich D, Tucker S. Promoting equity on licensing exams: Test accommodations for medical students with diabetes. PLOS ONE. 2026;21(2):e0340975. doi:10.1371/journal.pone.0340975
