I failed my Step 1 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 and anxiety as a “disability.” I had obviously done well enough to graduate college and get into medical school. Although, I never seemed to be able to achieve top grades in my 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 one is not able to achieve what other people without the disability can achieve.
Below is a portion of the approved letter I wrote to the medical association to request “special accommodations” for my next USMLE Step 1 board exam.
Since primary school, I knew I struggled with standardized exams. When we were administered the state-required exams, I was usually the last to finish, resulting 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.
When it was time for the MCAT exam, I knew that this was the time I would have to put in as many 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 focus on was other students standing up, 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 read over the question stem multiple times as I could not remember what I had previously read. Rarely did I get through all the questions, and I had to quickly guess the answers 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 poorly 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, I spent double the amount of months studying the next school year, 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 a water bottle. The first couple of times I took the exam in this environment went horrendously. The exam was almost three 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. Something was happening whenever it was a formal and standardized exam environment.
The medical school-provided health insurance empowered me to receive additional medical and mental health care I previously could not access. In class, I found myself checking off all the symptoms of endometriosis and other female reproduction conditions, so I pursued a specialist’s opinion. At first, I was told it was just my anxiety and my medical student’s brain freaking out. This medical gaslighting and my 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. I began to see myself in every question stem, and my personal bias started to consider if I had that diagnosis.
Eventually, I found a physician who agreed that my ten-year-long pelvic and abdominal pain was most likely endometriosis. I was able to have laparoscopic surgery, which determined I did have endometriosis. The scar tissue removed did reduce my pelvic pain, but I continued to experience pain. I start to feel a deep searing pressure in my lower abdomen about once an hour, which becomes more painful every minute I wait to go to the restroom. For this chronic health condition, I am seeking additional break time for my retake 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.
If you are a medical student who also suffers from a hidden disability, remember: we have worked so hard to get to this level in our education, and this does not mean that we are less intelligent. If you are considering whether you also need special accommodations for exams, contact your schools’ disability office. I wish someone had offered me the possibility earlier in my educational career, especially when I demonstrated a long history of struggling with standardized exams.
Stephanie E. Moss is a medical student.
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