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Specialty board not required to adapt exam for doctor with disability

An accomplished physician who had suffered impairment from multiple brain tumor surgeries was not entitled to an alternative exam in his quest for recertification, the U.S. Court of Appeals for the Third Circuit held September 3 (Rawdin v. American Board of Pediatrics).

While attending college, David Rawdin was diagnosed with a brain tumor that required brain surgery, chemotherapy, and radiation. Rawdin completed and graduated from medical school, but twice failed Step III of the United States Medical Licensing Exam (USMLE), a multiple-choice format section of the exam.

A neuropsychologist consulted by Rawdin concluded that he had cognitive impairment due to the cancer treatment of his brain tumor. This impairment affected his memory retrieval system, according to the doctor, which would make it difficult to capably complete a multiple-choice medical exam.

Shortly following the neurological examination, Rawdin’s tumor came back and he needed to have more surgery and treatment. Those led to numerous complications, and he left the medical profession for four years.

Rawdin returned and based on the neuropsychologist’s diagnosis, submitted a request for accommodations when taking Step III for the third time, which was granted. He was provided double time to take the exam, an individual testing room, and “off the clock” breaks.

Rawdin passed Step III on this attempt, achieved his Pennsylvania medical license in 2000, and began practicing at the Children Hospital in Philadelphia (CHOP) after completing a pediatric residency. According to reliable accounts, Rawdin “flourished” at CHOP and successfully treated more than 10,000 babies.

However, the hospital required its physicians to achieve board certification within five years through ABP (American Board of Pediatrics). Among the requirements to achieve board certification is passing a multiple choice exam (the General Pediatrics Certifying Examination).
Rawdin failed twice, and went to be reevaluated by his neuropsychologist, who used a variety of tests. The tests revealed that Rawdin’s memory “was weak” in comparison to his general intelligence. The neuropsychologist determined that Rawdin’s memory “was not efficient,” specifically citing Rawdin’s struggle retrieving information out of context.

A second neuropsychologist, Edward Moss, agreed with the findings, noting that Rawdin had difficulty pulling “together on command discrete bits of unrelated information” and that Rawdin would “perform at a higher level” on the exam if it was given in a different format. Like Rawdin’s neuropsychologist, Moss noted that Rawdin’s overall intelligence was within the “average range.”

Rawdin wrote to ABP, explaining his impairment and requesting an alternative route to achieving certification. ABP rejected Rawdin’s request, asserting he had to pass the exam in its current format; otherwise it would “fundamentally alter the nature of the certification process.”

Rawdin did not pass the exam by the five-year deadline to achieve his certification. The hospital gave Rawdin an extra year to obtain certification based on a letter from Moss explaining Rawdin’s impairment, while noting Rawdin’s “excellent performance” as a doctor. After he failed to pass the exam in the extra year given, he was terminated in 2010.

In 2011, Rawdin applied to take the exam again, and his neuropsychologist told the ABP of Rawdin’s diagnosis. The ABP granted the request for extra time and short breaks, but denied the request for open-book and advance knowledge accommodations since the ABP would not be able to “adequately, reliably, and validly” test Rawdin’s knowledge.” Rawdin’s request to write an essay instead of a multiple-choice exam was also denied. The ABP stated that an essay would not be as reliable and would be too expensive.

After again failing the exam, Rawdin filed suit against the ABP, asserting that they failed to accommodate his disability. ABP claimed that its exam items do provide context and do not require test takers to “dredge up the information out of nowhere.” Thus, ABP said, Rawdin should not be granted special accommodations beyond extra time and short breaks. The court agreed, noting that since the doctors who evaluated Rawdin did not know the specifications of the exam in question, their testimony was not credible.

Furthermore, the court wrote, “even if Rawdin’s impairment fell within the categories of disabilities that the regulation covers, ABP has shown that the exam “best ensures that its results will accurately reflect Rawdin’s aptitude rather than his disability.”

While acknowledging Rawdin’s aptitude and prowess as a doctor, the Court denied his suit against ABP, finding that he was not disabled and not entitled to accommodations because such accommodations were unreasonable and would “impose an undue burden on ABP.”