To the Editor.
—In a recent issue of JAMA, Dr Dawson and colleagues1 investigated the performance of men and women from various racial and ethnic backgrounds on the NBME Part I examination. Many factors contributing to the differences in performances were discussed. However, one possible vital confounder unfortunately was never mentioned: undiagnosed adult learning disabilities.Undiagnosed adult learning disabilities could pose serious undermining of the validity of the examination, especially for the medical students who failed the examination. Recently, there has been an increase in the diagnosis of adults with learning disabilities such as dyslexia, dyscalcula, and attention-deficit hyperactivity disorder. A stimulating hypothesis is that bright, undiagnosed learning-disabled medical students are unable to compensate for their learning disability on standardized examinations. As a result, these previously academically successful students do poorly on the Scholastic Aptitude Test, the Medical College Admission Test (MCAT), and the NBME. In these scenarios, an