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I failed my STEP1 medical school board exam by 1 point. This was very hard for me to process, and I consistently wondered if I would have passed if I had just waited an additional week. This new challenge led me to reach out to a new resource - the Disability Office.
Never before had I considered my medical diagnosis of endometriosis, pelvic floor dysfunction, and anxiety as a “disability.” I had obviously done well enough to graduate undergraduate college with A’s and B’s and get into my favorite medical school. Although, I never seemed to be able to get average or top grades in my medical school class. I had always believed this was an explanation for being less intelligent than my peers. However, the disability office helped me realize that the standardized testing system was not equitable and did not allow me to do my very best in these exams.
Through this experience, I realized that I do have a disability. All a disability means is that you are not able to achieve what other people without this disability can achieve.Just like a boat uses a light to see in the darkness, similarly does a lighthouse. However, the boat also has to deal with the waves, so it needs extra support to not tip over so it can keep its light on. If you also have a hidden disability, remember: we have worked so hard to get to this level in our education. This does not mean that we are less intelligent. In fact, it is amazing that we have been able to get this far without additional support! If you are a student considering if you need special accommodations for Step1 or med school exams, contact your schools' disability Office. I wish that someone had offered me the possibility earlier in my education career, especially when I demonstrated a long history of struggling with exams.
Below is the letter I wrote to the medical association to request “special accommodations” for my next USMLE Step1 board exam. This request was approved for the retake exam, and my medical school will allow me to get accommodations for the rest of my medical school career. For this 8 hour Step1 exam I received extra break time, which will be extremely helpful for managing my anxiety and pain.
This personal statement explains my request for extra breaks over one day for my upcoming USMLE Step1 examination due to my diagnosis of endometriosis and anxiety disorder. Attached in my application are the following:
- Physical Therapy Physician Letter, MD
- Mental Health Therapist Letter, PHD
- Certification of prior accommodations: Medical School
Since I was in primary school I always knew I struggled with standardized exams. When we were administered the state required exams each year, I was usually the last to finish and always resulted in a mediocre score. Even when I took extra time to study for these exams I struggled to score well. This continued every year that I just began to accept it as part of my identity of not being as intelligent as my peers during standardized exams. In high school, when we were administered the pSAT, SAT, and ACT, I saw the same pattern of struggling during the exam and ending up with a lower score. I was thankful that I was able to attend my local state college where I did not have to take another standardized exam for a few years.
When it was time for my first MCAT exam during my third year of college, I knew that this was the time I would have to put in as many financial and academic resources I could acquire to do well. After completing a virtual curriculum and taking some practice tests I knew I was ready to sit for the exam. What I vastly underestimated was how my emotions and health would impact my exam. The morning of my first MCAT exam, I was a bundle of nerves. Sitting in the testing center in front of the computer, all I could pay attention to was everyone around me standing up at different times to go to their breaks, coughing, or the administrator peering over my shoulder, silently judging me. My heart raced, and my hands slipped off the mouse as I tried to use it to click through each question. I remember reading over the question stem multiple times as I could not remember what I read and how it related to the question asked. Rarely did I get through all the set of questions, and I had to quickly pick a random answer as the seconds counted down to the end.
I knew that my MCAT exam did not go well, but I was not prepared for how bad I would do. My extremely low score hit me hard. However, I knew that my anxiety attack would not prevent me from achieving my medical school dreams. Therefore, the next school year I spent double the amount of months studying, I did weekly timed practice tests, and practiced meditation and yoga. Finally, when I was scoring in the range I needed on the practice exam, I scheduled my exam, and was able to pass it.
Once I arrived in medical school, I was disappointed to learn that the testing environment would be a standardized format with little access to the restroom or our water bottle. The first couple times I took the exam in this environment went horrendously. The exam was almost 3 hours long, and my bladder screamed at me in agonizing pain after the first hour. I knew that if I got up to take a bathroom break I would lose time on my exam. I could not afford to lose that time on the exam. As expected, I did not do very well on that first medical school exam, and after a couple of poor exam scores I was provided tutoring support from the medical college. However, the tutors could rarely find any area which I did not understand well. Even on practice questions, I was doing well, so obviously I knew the material. Something was happening whenever it was a formal and standardized exam environment.
I brought this new observation to my therapist who I began to see at the beginning of medical school. In college, I learned how important it was for me to share my struggles with a licensed therapist. I learned I have a complex history with 5 Adverse Childhood Experiences (ACEs) including childhood physical and emotional abuse and neglect, and a parent with a mental illness. Unfortunately, my undergraduate university only provided me a few free therapy sessions per academic year and there was rarely continuity with the same provider. I knew I could not financially or socially afford to use my parents’ insurance to see a therapist because there would be continued verbal and emotional abuse at home for seeking out a mental health professional. However, in medical school, now living 1000 miles away from my parents, and given my own medical insurance through the school, I was ecstatic to start my recovery and finally receive the support and health care resources I needed.
The medical school provided health insurance empowered me to receive the medical care I was not able to access before. This led me to receive a primary care physician and visit multiple physician specialists to explore my various medical problems, which I didn't know were abnormal until I started learning about them in our medical school curriculum. The most significant problem I explored was my pelvic and abdominal pain which I had visited ER before, but had been told it was either normal period pain or an ovarian cyst. After I found myself checking off all the symptoms of endometriosis and other female reproduction conditions in our Sex&Reproduction block, I pursued the opinion of a specialist. At first, I was told it was just my anxiety and medical student brain freaking out that I had a medical problem. This medical gaslighting and anxiety led me to spend even more time outside of studying in search of a diagnosis. Unfortunately, this mental turmoil significantly impacted my academics and I ended up failing the block exam for this unit. In every question stem, I began to see myself, and my personal bias started to consider if I had that diagnosis.
Eventually, I found an OBGYN who agreed that my ten year long pelvic and abdominal pain was most likely endometriosis. In November 2020, I was able to have a laparoscopic surgery which determined I did in fact have endometriosis. The scar tissue removed did reduce my pelvic pain, but I continued to experience pain every hour when I needed to go and while going to the bathroom. Even after over 6 months of pelvic floor therapy, and visits to various medical specialists, I am still struggling with high tone pelvic floor dysfunction. About once an hour I start to feel a deep pinching sensation in my lower abdominal which every minute I wait becomes more and more painful. This pain is very distracting and increases the longer I wait. It is for this chronic health condition that I am seeking additional break time for my Step 1 examination. I require additional break time so I do not suffer additional pain, discomfort, and anxiety that can be detrimental to my body and test taking experience.
In conclusion, it is for these reasons that I am requesting additional break time during my USMLE Step 1 examination.
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