If you have received accommodations for your education at any point in the past, you have the right to seek test-taking accommodations for the USMLE Step 1. The National Board of Medical Examiners (NBME) is obligated to comply with the American Disabilities Act (ADA) and offer testing accommodations to students who have a documented disability.
From the USMLE website: "The ADA defines disability as a physical or mental impairment that substantially limits a person’s ability to perform one or more major life activities as compared to most people in the general population. Examples of major life activities include, but are not limited to, seeing, hearing, reading, concentrating, and thinking."
A completed and signed request form based on the type of request you're making.
You can find all the links to the various forms on the USMLE's site (opens page and subsection>>).
A personal statement.
This is a four part essay with specific prompts around "History," "Current Functioning," "Rationale for Accommodations," and "Supplemental Information." These prompts each ask multiple questions and can be found under the Personal Statement dropdown of the Guidelines subsection on the USMLE site's Make a Request page (opens page and subsection>>).
We recommend copying and pasting the prompts into a word processor and breaking them down into discrete parts to ensure you are answering every part of each question.
Clinical documentation by a licensed treating and/or evaluating professional with training and direct experience in the diagnosis and treatment of adults in the specific area of disability that is the basis for your request.
Comprehensive documentation should include:
A discussion of how diagnostic criteria are currently met and a detailed and personalized description of current symptoms (e.g., onset, frequency, severity, duration, etc.). If available, your supporting physician should provide the results from relevant assessments that were used in making the applicable diagnosis.
A description of the full extent of your current functional limitations due to the disability in daily life activities as well as in the context of standard testing conditions.
A recommendation for accommodations and a clear rationale for why each recommended accommodation is necessary to enable you to take the exam in an accessible manner.
Other objective evidence such as records of functioning that demonstrate how a major life activity is substantially limited and document the real-world impact of the disability.
The USMLE site gives such examples as:
Prior clinical evaluations, diagnostic reports, treatment plans, or other relevant medical records from professionals other than the treating or evaluating professional(s) who provided documentation in direct support of your request for accommodations on the USMLE.
Written feedback from teachers or supervisors.
Official academic records and transcripts.
Official score reports for nationally normed standardized tests (e.g., SAT, ACT, MCAT, LSAT, GRE, GMAT, professional licensing or certifying exams, etc.).
Performance evaluations from training programs, military service, or employment settings (e.g., part-time/full-time volunteer/paid jobs, clerkship/internship/residency, etc.).
Official records verifying approved accommodations from schools [e.g., Section 504 plans or Individualized Education Programs (IEPs)] or other testing entities, listing the specific accommodations approved and the dates they were provided.
The USMLE site gives further guidance tailored for ADHD, Specific Learning Disorders, Psychiatric Impairment, Visual Impairments, Hearing Impairments, and Other Medical Conditions, so please scroll down to the Impairment Specific Guidelines & Requirements section to peruse any relevant dropdown on their Make a Request page (opens page>>)!
Submit all forms and documentation to disabilityservices@nbme.org.
The USMLE site provides the following guidance (opens webpage>>):
To avoid delays processing your submission, please ensure the following:
Scanned documents are legible, typed rather than handwritten, and complete without missing pages.
Documents are in English. Please provide certified English translations of non-English documentation.
Documents are not duplicate copies of documents already submitted. For example, if you are asking for additional accommodations in a subsequent request or are asking for a reconsideration, you do not need to resubmit documents submitted with your initial request.
The USMLE site says, "Please allow approximately 60 business days to receive a decision about your request for test accommodations," and links this Business Days Calculator (opens webpage>>).
New Request, if you are seeking:
Additional break time with shortened test blocks over one to two days.
Additional test time (25%, 50%, or 100%) over two days.
Additional break time and additional test time (25%, 50%, or 100%) over two to four days.
Reconsideration Request, if you received a written decision letter denying your accommodations and would like to appeal.
Students may only make one reconsideration request.
Additional Break Time Only Request, with standard testing time and standard blocks.
Personal Item Request, if you need to bring a personal item to the testing site with you that is not on the pre-approved items list.
The list of pre-approved items can be found on the USMLE site (opens page and subsection>>).
If you're a breastfeeding parent who would like to bring your pump, you can fill out a Personal Item request form accompanied by any basic documentation you have available about your circumstances, without the need for a personal statement or the same degree of extensive objective evidence as is required for a disability request.
If you would like extra break time to express milk, you can instead fill out an Additional Break Time Only request form and explain on that form that you will be bringing your equipment as well. For this kind of request, only basic documentation is required; again, you do not need to fill out a personal statement or provide additional objective evidence.
These requests generally receive a response within 14 business days. To make the request, your registration must be completed and your scheduling permit on hold. Formal requests are required in order to coordinate with the testing site to provide a private, appropriate space.
The downloadable forms can be found on the USMLE's website (opens page and subsection>>).
The Docs with Disabilities Initiative has created both a downloadable step-by-step guide and a webinar series to assist with understanding the details and best practices for requesting accommodations. You can find links to both on this page (opens page>>).
As Learning Specialists, we're happy to be a second set of eyes on documents such as your personal statement. However, it's best to work with a professional in disability services to benefit from their expertise.
If you have further questions, you can contact the NBME via their form or phone number listed on their Contact Us page (opens page>>).
This page last updated 10/22/2025.