A Dose of Their Own Medicine

A recent settlement announced by the U.S. Department of Justice with the US Board of Medical Examiners highlights some of the issues faced by students taking standardized tests, such as the SAT, the ACT, or the US Medical Licensing Examination (USMLE).

All of these high stakes exams are governed by the requirements of the Americans with Disabilities Act (ADA) which requires that private entities such as the College Board or the National Board of Medical Examiners must offer their exams in an accessible place and manner to individuals with disabilities.

The regulations to the ADA explain that modifications to such exam can include things like extended time or the manner in which the exam is given. The regulations also give examples of what they call "auxiliary aids and services" such as Brailled or large print questions and answer sheets, or transcribers for individuals with manual impairments.

In the recent settlement, Frederick Romberg, a medical student, was denied test accommodations for the first part of his medical licensing examination (called Step 1) on the basis of dyslexia, a learning disability. The denial was based on the test organization's finding that Romberg failed to demonstrate that he was disabled within the meaning of the ADA, which requires that an individual be "substantially limited in a major life activity". Although this dispute was resolved by settlement, it is clear from its terms that the Justice Department did not accept the NBME position on how to determine whether a person is entitled to accommodations. In addition to the requirements that this settlement imposes on the NBME, other private testing organizations -- the College Board (SAT) and the ACT folks included -- can consider themselves reminded about what they need to do when faced with an application for disability accommodations.

The agreed-to terms of the settlement in the Romberg case include:

• The Board must limit its request for documentation to what is reasonable to demonstrate a disability
• Documentation should be focused on whether and how the applicant's ability to take the exam under standard conditions is impacted
• The Board must carefully consider the recommendation of qualified professionals who have observed the applicant in a clinical setting
• The Board needs to consider whether applicant's ability to read (since this was a dyslexia case) is restricted compared to the ability of most people
• Where, as here, an individual did not have his learning disability diagnosed until later in life, the Board must consider reasonably supported explanations, academic records, and other evidence about the applicant's reading ability
• Considerable weight must be given to past accommodations, such as in an IEP or 504 Plan

As for Mr. Romberg -- he was given a separate testing area and double the standard testing time for the first two parts of his medical licensing exam. In addition to providing the basis for the Justice Department to remind testing organizations of their responsibilities, we suspect this settlement will result in Mr. Romberg changing his title to Dr. Romberg within the next few years.