Curious because at what point would it compromise a physician’s ability to practice (think/evaluate/conclude quickly) if extra time is always needed?
Yes, you can get accommodations for the USMLE exams.
See:[USMLE Accommodation]( http://www.usmle.org/test-accommodations)
See: [Accommodation Guidelines](http://www.usmle.org/test-accommodations/guidelines.html)
See: [How to Request Accommodations](http://www.usmle.org/test-accommodations/requesting-accommodations.html)
The bar for qualifying for accommodations for the USMLE is higher than for the MCAT and requires substantial documentation. Evaluations are very strict and most requests are denied.
Accommodations for shelf exams are at the discretion of the individudal medical school and its disability office.
Most accommodation are not for extra time, but other accommodations–like a quiet testing space or extra breaks.
As to when extended time testing will endanger the patient–
I think it depends on the specialty and individual. Not all medical specialties have a time dependent criticality. Emergency medicine—possibly. Surgery–possibly. Anesthesia–possibly. Pathology, radiology, internal medicine, psychiatry–probably not.
Having good clinical judgement is not the same as performing well (and quickly) on memory recall biased standardized exams.
Can’t imagine a medical student can graduate with visual or hearing impairment. Every student needs to pass the pathology lab and surgery rotation. If they can’t see or hear with correction devices how can they pass all those?
Tim Cordes, blind since birth, graduated from U Wisconsin SOM in 2005 and is now a practicing psychiatrist. Dr. Stanley Yarnell, lost vision in both eyes at age 21 due to optic neuritis. A graduate of OSU SOM, he’s a PM&R specialist. Dr David Hartwell, another psychiatrist, lost his vision when he was 8; he graduated from Temple U SOM. Dr. Stanley Wainapel, a graduate of Boston U SOM, lost his sight when he was 8; he’s clinical director of the PM&R Dept at the Montefiore Medical Center. Dr. Jeffrey Lawler graduated from Western U COM in 2004; he’s a psychiatrist. Dr Jeffrey Illiff, an OMM specialist, is on the faculty at Western U COM.
There are a number of deaf and severely hearing impaired physicians. About 50 or 60 in current practice, including Dr. Philip Zazove who the Chair of the Family Medicine Dept at U Mich SOM.
Try telling the onc surgeons that there’s no time-dependent criticality to the pathologist reading the intra-op frozen section 
I remember the movie about the Temple SOM blind doc. It was the only SOM to take a chance on him.
Not sure how he passed everything, but maybe things were a bit different back then.
It seems that those with those kind of impairments (sight/hearing) pick specialties where it matters less.
Obviously, a blind surgeon would have difficulties in a surgical rotation!
And not sure how a totally-deaf surgeon hears thru a stethoscope. Maybe uses touch/sense instead?
My bigger concern is all of these kids clamoring for add’l time based on anxiety, etc. I don’t have a lot of confidence in a physician that needs a lot more time because of anxiety, unless the specialty really isn’t time dependent.
Hmmmm…wonder if in the courtroom, these lawyers with time-accommodations get the judge to give them more time…
There are amplified and visual display stethoscopes:
And there are stethoscopes that transmit directly to a coclear implant or hearing aid.
I’ll let you in on a little secret: unless it’s a cardiothoracic surgeon, they’re probably not listening to the heart anyway. Between the pre-op clearance and the anesthesiologists they don’t bother.
I think one situation where someone could need extra time on an exam that really wouldn’t translate to needing extra time in practice is dyslexia. Most of clinical medicine - especially time critical medicine - is communicated verbally, not in multi paragraph text.
I’ll share a secret–D1 is dyslexic. She has several of the classic dyslexia symptoms–slow reading speed, inability to spell and an inability “sound out” unfamiliar words in her head. Her reading processing speed in the 5th percentile. (Yes, you read that right–she reads more slowly than 95% of people.) But she has developed excellent compensating skills and wasn’t formally diagnosed until she was a medical student–though I always knew there was something wrong with her reading.
D1 has exceptional auditory recall and her retention of material she’s read is at the 99%tile. Spelling, however, is quite difficult for her. (Phonics for her is an exercise in random guessing.) Spelling she manages by sheer effort of will and rote memorization.
I once asked how she copes working long shifts in a time-critical specialty. She said that by the end of her shift, when she’s tired, spelling is a real issue for her because she can’t always spell drug names because she’s tired they all kind of look alike to her. She can tell you the right name, but she can’t always spell it correctly. Because of this she always double and triple checks all her drug orders and if she’s unsure, she will have someone double check her order to see that she actually wrote what she thought she wrote. Using an EMR helps because there are pull-down screens and sliders for drug orders.
D1 would have qualified for extended time on her USMLEs for her dyslexia, but the process of getting extra time is onerous and she couldn’t be bothered.
DD had a processing disorder (not dyslexia, but similarly a slow slow reader) Dx in elementary school, she got double time on the SAT, and scored in the same percentile as her sister who finished early. With the extra time on standardized tests she could show herself to be excellent, once she was an university the standard changed, in HS it’s not able to work to your potential, post-secondary it’s something about working X standard deviations below the mean. So an LD kid with an IQ of 150, but who works at the level of 100 without extra time would get extra time in HS. Once in university, no extra time for you. Same with the MCAT. We ran all the qualifiers by a school district psychologist who agreed, don’t waste your time applying, even though it’s dumb. Dd had a low MCAT, not too low, but lower than she wanted.
So, Dd appears in med school to be quite average on standarized testing, she will never test well, but she will test OK. Luckily, IRL, she does not need to read long paragraphs and be tested on them, only, you know, Step exams and board exams. I’ve always told her, the exams are nothing to do with your real performance on your real job, just do you the best you can and let the LORs and subjective reports show that you are more than the numbers.