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Posted at 6:30 AM ET, 01/20/2010

Does this sound fair?

By Valerie Strauss

The National Board of Medical Examiners denied a request by medical student Frederick Romberg to have extra time to take the United States Medical Licensing Examination. Romberg, who has dyslexia, is appealing the decision.

Here is what Romberg told the board, and what the board told him. How would you decide the case?

Romberg, now a 41-year-old student at Yale University’s School of Medicine, had a troubled childhood. His father abandoned the family when he was young, and he was raised, along with his mentally and physically disabled brother, by his alcoholic mother. She died when he was 16. He attended inner city schools where he was sometimes assaulted.

No childhood records were kept on him, but as early as he can remember, Romberg had great difficulty with reading.

“I often made mistakes in the order of the letters or said the wrong word,” he told me. He hated reading aloud because he stumbled a lot and tried to avoid it at every turn. When he was 16, his school guidance counselor, noting his failing grades, told him he was lazy and that he should leave school.

He did. He took jobs that included being an auto mechanic, which allowed him to learn through visual means and manual dexterity rather than reading text. But he was very smart and wanted an education, so while he worked, he earned a GED.

He eventually started taking remedial-level coursework at Montgomery College but experienced academic difficulty because of his problems with reading and writing, and he also had a short attention span. He got tutoring and teachers allowed him extra time on exams but he still had trouble with humanities assignments and could not learn a foreign language.

He wound up graduating in 1995 from Virginia Tech, taking seven years to earn a bachelor’s degree in electrical engineering.

Because he was so smart, he was accepted for a masters program at prestigious California Institute of Technology, which waived his scores on the Graduate Record Exam because he did not complete the exam. He did not know at the time that he had dyslexia or that he could have sought extra time.

A few years later, he decided to go into medicine and went to Occidental College to do post-graduate medical studies to prepare for medical school. It was at Occidental that his professor in freshman introductory biology asked him why he was taking so much longer than anyone else to finish a 10-question quiz.

She set him on a course that led to a diagnosis of the most common learning disability, dyslexia, an unexpected difficulty in reading in people who have the intelligence and motivation thought to be necessary to be fluent readers.

The brains of people with dyslexia have difficulty taking images that they see or hear and turning it into understandable language, explained Sally E. Shaywitz, co-director of the newly formed Center for Dyslexia and Creativity at Yale University. As a result, dyslexics may have trouble not only with reading and writing but also with speaking--even though the disability has no relation to their IQ. Very bright and highly accomplished people can have dyslexia.

Romberg also learned that he has attention deficit hyperactivity disorder, or ADHD.

Between his various degrees Romberg took a number of jobs, all of them relying on technical engineering expertise. They included working as a senior administrator at Caltech in the Division of Student Affairs, as an engineer at NASA's Jet Propulsion Laboratory and as a U.N. weapons inspector in Baghdad (for six weeks in 1997).

Before being accepted to Yale Medical School he took the standardized admissions test for medical school, the MCAT, and was ultimately granted extended time and reduced distraction testing environment accommodations by the Association of American Medical Colleges, which runs the MCAT.

He chose Yale Medical School because its system of medical education allows students to learn curriculum at their own pace; he expects to take one year more than his classmates. Yale, too, has allowed him extra time on exams. While at Yale, has had received treatment for his ADHD and his worked with Shaywitz, one of the nation’s leading researchers on dyslexia.

Romberg said he feels he can make an important contribution if allowed to become a doctor. But when he applied to the National Board of Medical Examiners for extra time to take the U.S. Medical Licensing Examination, the board refused.

In a letter signed June 24, 2008, the board said that only people covered under the Americans with Disabilities Act (ADA) are given accommodations on the licensing exam--and to quality someone needs to be “substantially limited” in a major life activity as the result of a disability. Accommodations, the board said, are intended to provide “equal access” to the licensing exam for people covered under the act.

It said that Romberg’s accomplishments and the results of a psycho-diagnostic evaluation indicated that he did not have a severe learning disability and questioned his claim that he has dyslexia.

It said, “Individuals with learning disabilities typically present a long history of academic difficulties and poor achievement dating back to elementary school,” and noted that prior accommodations afforded by other schools and agencies were not enough to establish coverage by the ADA.

I called the medical examiners board to ask them about Romberg and about their policy but did not receive a return call.

Romberg has appealed the decision through an attorney.

“They act like I’m cheating,” he said, “like it’s going to give me some extra knowledge. The exam is already eight hours. It does not give me any more knowledge. It allows me to process.”

He recalled that when he first took the MCAT, with no accommodations, he was in the 10th percentile in the section in which he is strong, physical science. When he retook the MCAT with extra time, he was in the 90th percentile without additional studying.

What do you think of this case? Let me know in the comments or at I’m going to write more about the educational problems faced by people with learning disabilities. If you have a story you want me to know, email me.


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By Valerie Strauss  | January 20, 2010; 6:30 AM ET
Categories:  Learning Disabilities  | Tags:  learning disabilities, test accommodations  
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Tough case. Assuming a moderate to severe difficulty with reading and processing, Mr Romberg, to my mind, would have to define what type of medicine he plans to practice before anyone could render a judgment as to whether he could practice safely. There are real barriers to safe practice (in many medical specialities and in many settings) for those who need a lot of extra time to read or who might mis-read material on a regular basis.

Posted by: jane100000 | January 20, 2010 9:46 AM | Report abuse

Is this fair? Unsure but because Romberg is going into the very challenging field of medicine, the levels of potential liabilities may outway levels of fairness.

What is very troubling is "...When he was 16, his school guidance counselor, noting his failing grades, told him he was lazy and that he should leave school."

Unbelievable (but probably more the norm)is that a school counselor telling this young man that he should leave school and labeled as "lazy" because of his learning difficulties. One can only imagine how many lives this "guidance counselor" negatively impacted.

Hopefully Romberg will continue his journey and remains successful. Maybe he should consider providing counseling of his own toward youth that are in similar circumstances.

Posted by: TwoSons | January 20, 2010 10:35 AM | Report abuse

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