{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:19:02Z","timestamp":1792077542179,"version":"4.4.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009157","name":"National Institute on Disability, Independent Living, and Rehabilitation Research","doi-asserted-by":"publisher","award":["90RTHF0005"],"award-info":[{"award-number":["90RTHF0005"]}],"id":[{"id":"10.13039\/100009157","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000867","name":"Robert Wood Johnson Foundation","doi-asserted-by":"publisher","award":["82590"],"award-info":[{"award-number":["82590"]}],"id":[{"id":"10.13039\/100000867","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["T32GM136651"],"award-info":[{"award-number":["T32GM136651"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015691","name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["F30AI157227"],"award-info":[{"award-number":["F30AI157227"]}],"id":[{"id":"10.13039\/100015691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["R35GM153263"],"award-info":[{"award-number":["R35GM153263"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000010","name":"Ford Foundation","doi-asserted-by":"publisher","award":["149113"],"award-info":[{"award-number":["149113"]}],"id":[{"id":"10.13039\/100000010","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>With the transition of USMLE Step 1 to pass\/fail, USMLE Step 2 Clinical Knowledge (CK) has become a high-stakes component of residency selection. This shift raises concerns that increased reliance on Step 2 CK may exacerbate existing inequities, particularly for medical students with disabilities and those with intersecting marginalized identities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine differences in USMLE Step 2 CK performance by disability status, race, ethnicity, and their intersections among U.S. medical students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional analysis of the Pathways II dataset, comprising deidentified student-level data from nine U.S. MD-granting medical schools. Graduated students from the 2020\u20132023 cohorts were included. Medical students with disabilities were defined as those formally registered with institutional disability resource offices and were matched 1:2 with nondisabled peers by institution, gender, graduation cohort, and MCAT score. Race and ethnicity were categorized as White, Asian, underrepresented in medicine (URiM, including American Indian\/Alaska Native, Black\/African American, Hispanic\/Latino, and Native Hawaiian\/Pacific Islander), or Other. Disability categories included ADHD, learning, psychological, mobility\/sensory, chronic health, or other. Multivariable linear regression models estimated adjusted Step 2 CK score differences by disability status, race, ethnicity, and their interactions, adjusting for MCAT score and clustering standard errors at the school level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,350 students, 448 (33.2%) had a registered disability. The mean Step 2 CK score was 244.3 (SD, 15.1). Students with disabilities scored lower than nondisabled peers (mean 239.6 vs 246.7; adjusted \u03b2, \u22127.02; 95% CI, \u22128.76 to \u22125.28). Students with ADHD, learning, or psychological disabilities scored 9\u201311 points lower than nondisabled peers (P\u2009&lt;\u2009.001). URiM students scored lower than White students overall (adjusted \u03b2, \u22128.50; 95% CI, \u221210.74 to \u22126.25). Intersectional analysis demonstrated that disparities were largest among URiM and Asian students with disabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Medical students with disabilities experience significant disparities in Step 2 CK performance, particularly those with cognitive-based disabilities and intersecting marginalized identities. As Step 2 CK plays a larger role in residency selection, addressing structural barriers in assessment and accommodation processes is critical to advancing equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349774","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:34:17Z","timestamp":1779384857000},"page":"e0349774","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["USMLE Step 2 Clinical Knowledge performance by disability, race, and ethnicity in U.S. medical students: A multi-site study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7343-6882","authenticated-orcid":true,"given":"Mytien","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Pereira-Lima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Hodgens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Juliao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Holman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. T.","family":"Sangsland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dowin","family":"Boatright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3647-3657","authenticated-orcid":true,"given":"Lisa M.","family":"Meeks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"issue":"2","key":"pone.0349774.ref001","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/ACM.0000000000005061","article-title":"The association between USMLE Step 2 Clinical Knowledge scores and residency performance: a systematic review and meta-analysis","volume":"98","author":"C Shirkhodaie","year":"2023","journal-title":"Acad Med"},{"issue":"2","key":"pone.0349774.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0279911","article-title":"One test to rule them all: a qualitative study of formal, informal, and hidden curricula as drivers of USMLE \u201cexam mania\u201d","volume":"18","author":"JR Geraghty","year":"2023","journal-title":"PLoS One"},{"issue":"6","key":"pone.0349774.ref003","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.18310","article-title":"Prevalence of disability and use of accommodation among US allopathic medical school students before and during the COVID-19 pandemic","volume":"6","author":"K Pereira-Lima","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"5","key":"pone.0349774.ref004","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.10914","article-title":"Examination of medical college admission test scores and US medical licensing examination step 1 and step 2 clinical knowledge scores among students with disabilities","volume":"4","author":"J Purkiss","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"9","key":"pone.0349774.ref005","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.34621","article-title":"Race and disability characteristics and accommodation disparities on the USMLE step 1","volume":"8","author":"M Nguyen","year":"2025","journal-title":"JAMA Netw Open"},{"key":"pone.0349774.ref006","doi-asserted-by":"crossref","DOI":"10.1097\/ACM.0000000000004271","article-title":"The performance and trajectory of medical students with disabilities: results from the pathways project","volume":"96","author":"LM Meeks","year":"2021","journal-title":"Acad Med"},{"key":"pone.0349774.ref007","doi-asserted-by":"crossref","DOI":"10.1097\/ACM.0000000000006125","article-title":"Compounded challenges: the impact of race and disability on leave of absence and time to graduation during undergraduate medical education","volume":"100","author":"WH Eidtson","year":"2025","journal-title":"Acad Med"},{"issue":"4","key":"pone.0349774.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0266685","article-title":"Impact of USMLE Step-1 accommodation denial on US medical schools: a national survey","volume":"17","author":"KH Petersen","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pone.0349774.ref009","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.54180","article-title":"Disability status and induction into US medical honor societies","volume":"8","author":"M Nguyen","year":"2025","journal-title":"JAMA Netw Open"},{"issue":"18","key":"pone.0349774.ref010","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1001\/jama.2024.5000","article-title":"Outcomes of the main residency match for applicants with disability","volume":"331","author":"M Nguyen","year":"2024","journal-title":"JAMA"},{"key":"pone.0349774.ref011","unstructured":"Docs With Disabilities Podcast. Episode 49: Ramsay v. NBME panel; 2022 [cited 2026 Feb 23]. 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Test accommodations: test accommodations application process. USMLE.org. [cited 2026 Feb 19]. 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