BACKGROUND Medical students are at risk of exposure to bloodborne pathogens, yet few data are available about U.S. medical schools' policies to protect students. METHODS A cross-sectional survey of the student affairs deans at the 126 U.S. medical schools was conducted in May 1994. A confidential questionnaire inquired about policies regarding vaccination for hepatitis B virus (HBV), blood and body-fluid exposures, universal precautions training, and health and disability insurance for students. RESULTS A total of 108 (86%) of the schools participated in the survey. Most (99, 92%) required either HBV vaccination, evidence of immunity, or a signed waiver refusing vaccination. Nearly all (94, 87%) required health insurance, and almost all (101, 94%) offered a plan (at a mean cost of $690 annually), but fewer schools (69, 64%) offered disability insurance. The schools frequently held students responsible for the costs of HBV vaccination (73, 68%), postexposure serologic testing (22, 20%), and treatment of training-related medical problems (43, 40%). CONCLUSIONS Most medical schools comply with current recommendations for preventing training-related exposures to bloodborne pathogens, illness, and injury, but students face a substantial financial responsibility for these services at a time when many have large debts. Many schools do not have disability insurance readily available for students. Medical schools should review their student health policies to protect students adequately.