How USMLE Discipline Issues Can Affect Medical Licensing

Physicians know all about the USMLE step exams. Simply hearing step exams brings back the many hours spent studying for these rigorous exams that determine eligibility to practice medicine in the United States. Finishing the step exams rightly fills a medical graduate with a sense of relief and accomplishment.

Yet getting accused of step exam misconduct, or what USMLE officials call irregular behavior, brings instant confusion, even dread or despair. A finding of step exam misconduct, and the license suspension or revocation that could follow, can have devastating consequences for a physician's job and career. Learn here how to handle a USMLE irregular behavior charge so that you can benefit from the medical license and career for which you worked so hard.

What is USMLE?

The United States Medical Licensing Examination, or USMLE, tests a medical student's or graduate's ability to apply their education to real-life medical practices. The National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) administer the USMLE together. Passing the USMLE is a non-negotiable requirement for Americans who graduate with medical degrees and international medical school graduates. Some international students may first have to take and pass the Educational Commission for Foreign Medical Graduates (ECFMG) exam before they are eligible to take the USMLE.

The USMLE's three steps are as follows:

  • Step 1 (Clinical Skills): a one-day exam early in medical school that takes a total of eight hours and assesses whether or not examinees can understand and apply the basic concepts of medicine
  • Step 2 (Clinical Knowledge): a two-day test that requires students to answer multiple-choice questions on clinical sciences and requires students to examine patients
  • Step 3: a two-day test after the first year of residency determining whether a medical graduate is ready to practice medicine unsupervised

As every physician knows, the USMLE exams are notoriously difficult. They require many hours of study and preparation. In fact, passing the USMLE is such a daunting challenge that the exam is often cited as one of the most difficult in the world. If you are a licensed physician, you know the relief of having finally succeeded in passing the USMLE. If, though, you have received the USMLE's accusation of misconduct, then you also know the confusion and despair that follows.

What Does the USMLE Consider Irregular?

The USMLE lists what the examiners consider to be irregular behavior. The list includes:

  • registering for an exam for which the applicant is not eligible
  • soliciting exam materials, either in-person or online, when not eligible
  • reproducing exam materials in any capacity for any reason
  • communicating or attempting to communicate about test content with former or potential examinees
  • making false statements on an application form
  • impersonating an applicant to take the exam for them
  • providing unauthorized assistance during the exam
  • taking notes while in the test center
  • failing to follow any USMLE rule or policy
  • failing to follow direction from test center staff
  • physically or verbally harassing a test center staff member
  • taking a photograph during an exam
  • possessing a device that could track or monitor the exam area
  • manipulating test scores
  • making threats to a test center staff member or USMLE member
  • failing to cooperate with a USMLE investigation

The above list includes obvious examples of examination misconduct. Yet other behaviors that the USMLE also deems inappropriate may appear harmless. A USMLE accusation of irregular behavior can come as a complete surprise. Innocent-seeming behaviors that could result in a charge of exam misconduct include:

  • attending a USMLE prep course that uses actual USMLE exam questions for study materials, whether the applicant knows or not
  • glancing at your phone during the exam
  • most worrying of all, completing your USMLE application incorrectly.

As innocent as some of these forms of misconduct sound, they may nonetheless result in severe consequences. The physician facing USMLE charges of irregular behavior must take those charges most seriously, no matter their seeming innocence or peculiar form.

How Do I Know if I Am Suspected of Irregular Behavior?

If USMLE officials have you under investigation for irregular behavior, its Committee for Individualized Review (CIR) must notify you. You have liberty interests in practicing medicine and property interests in your license to do so. Constitutional due process requires that officials provide you with due process before depriving you of those interests. Due process includes fair notice and a hearing. Thus, after you receive CIR notice of investigation, the Committee will give you an opportunity to provide exonerating evidence, refuting the accusations.

Do not do so on your own, without attorney representation. If you receive the USMLE's notice charging you with an irregularity during your examination, you must dispute the accusation promptly. The best way to defend yourself is with representation by a premier professional license defense attorney who has experience in academic misconduct matters. The Committee can use anything you say against you. The Committee will especially construe against you any exaggerations, mistakes, gaps, or misrepresentations in your response. You need the help of a skilled professional license defense attorney to prepare your accurate, comprehensive, and effective response.

How Common Are Charges of Irregular Behavior?

USMLE officials accused 433 examinees of irregular behavior between 1992 and 2006. From 2006 to 2015, that number was 170. In the latter period, the two most common charges of irregular behavior were falsified information and security violations. The most common punishment was a ban from taking the USMLE for a minimum period.

Don't underestimate the impact of even so mild a punishment as a ban from the USMLE exam for a certain time. A delay in taking the USMLE interferes with a medical student or graduate's ability to place in a residency program and become licensed and, as a result, advance their career. Indeed, the second study showed that only 16% of those USMLE officials accused of misconduct, or only one in six examinees, eventually received an unrestricted medical license.

What Are the Consequences of Irregular Behavior Charges?

A USMLE accusation of irregular behavior on your step exams can have devastating effects on your medical career. Here are some of the most common domino effects.

Hospitals, Residency Programs Notified. If the CIR determines that irregular behavior has occurred, they will report findings to the Physician Data Center (PDC) maintained by the Federation of State Medical Boards. This report means that all medical employers, including hospitals, can see the irregular behavior charge any time they search the database for an individual. That visibility can curtail or sharply limit the physician's chance of getting hired.

An irregular behavior charge may also affect residency program acceptance decisions. Many programs see an irregular behavior charge as akin to cheating and disqualify an applicant based on the charge report alone.

Loss of Time and Money. Physicians invest a colossal amount of time and money into preparing for their medical careers. An irregular behavior charge can derail your career. You may find the financial investment you made in your medical career at risk.

Voided Score. If you are found guilty of irregular behavior, USMLE officials will void your step exam score, which means you must retake the exam. You will not be able to take the exam immediately and will have to wait a year minimum to retake the exam. That delay means a lost year of medical practice, development in your professional skills, and income.

How Can a USMLE Misconduct Charge Affect Medical Licensing?

A USMLE charge of irregular behavior can seriously affect a medical graduate's ability to obtain a license. If USMLE officials determine an examinee guilty of irregular behavior, they have the power to inform all licensing authorities, graduate medical educational programs, medical schools, and any other applicable entity. These notices and disclosures mean that a medical graduate may not only have difficulty matching with a residency program, but they may also be unable to obtain a license and practice medicine at all. Everything, in other words, is at risk. The physician who receives USMLE notice of an irregular behavior charge should immediately retain a premier professional license defense attorney with experience defending academic misconduct charges.

What Should I Do If the USMLE Accuses Me of Misconduct?

Some physicians whom USMLE officials accuse of irregular behavior do not realize the severity of the possible consequences. Understand the situation's gravity. Then, don't panic. Instead, focus on the steps that you should immediately take to move forward. Here's where to start.

First, contact and retain a premier professional license defense attorney who also handles academic-misconduct matters, indeed, one who handles USMLE accusations. Very few attorneys have that experience. Do the research, and retain the best available professional license defense attorney who is familiar with USMLE procedures.

Second, preserve and gather all materials related to your step exam preparation. Be sure to include study group emails, text messages, and similar electronic communications and information. You cannot over-preserve or over-prepare. You don't yet know what will help your defense. Organize those materials, and share them with your professional license defense attorney.

Third, collect evidence of your good study disciplines and good moral character. Include academic achievements, awards, and reference letters from professional and academic contacts. Organize those materials, and share them with your retained professional license defense attorney.

Fourth, ensure that your retained professional license defense attorney promptly requests an in-person hearing. Ensure you have the Committee's written proof of the in-person hearing's time, date, and place. Plan on attending that hearing with your retained professional license defense attorney, prepared to make a compelling presentation in your defense. The Committee for Individualized Review is responsible for providing hearings according to its procedural rules set out in its Policies and Procedures Guide. A CIR hearing will consist of statements, testimony, evidence, and arguments before medical professionals, including medical professors, doctors, or members of professional organizations.

Do not under any circumstances address the Committee alone, without skilled attorney representation. Do not, for instance, think that you can apologize and have your name cleared on the spot. In such instances, more often than not, the accused professional makes matters worse, admitting to wrongs that the professional did not commit or inadvertently sharing incriminating information that makes their situation worse. Only communicate as your professional license defense attorney directs.

What Can I Expect at a Committee Hearing?

Preparation for a hearing before the Committee on Individual Review is the key to your successful defense. Your retained professional license defense attorney will direct your preparation. Here are some things that you should expect you and your professional license defense attorney to accomplish before the hearing:

  • obtain a complete copy of USMLE files including investigation notes
  • draft and file your statement and explanation before the deadline
  • request an extension well before any deadline passes
  • plan your testimony with supporting documentation
  • anticipate the hearing officials' questions, and have complete answers
  • practice hearing conditions including cross-examination
  • obtain the testimony and statements of any key supporting witnesses
  • request a hearing adjournment well in advance if unable to attend
  • ensure that your attorney has the skills of an experienced trial lawyer

Do not overestimate your ability to think clearly and articulate accurate and complete answers in the hearing setting. As many as twenty officials may be present, prepared to ask tough questions. Medical professionals are accustomed to the pressures of a clinical environment. They are not trained for courtroom-like settings. Do not trust that your instinct will kick in and that you will know what to do. Instead, ensure that your professional license defense attorney has USMLE experience and can guide you through the hearing process.

Retain a Premier Professional License Defense Attorney

If you or someone you know has received notice from the Committee for Individualized Review of charges of USMLE irregular behavior, then it's time to retain a premier professional license defense attorney who is also experienced in academic misconduct defense. Promptly retaining a preeminent professional license defense attorney is the best way to protect yourself and your professional license. You have invested far too much in your medical licensure to do anything less than get the best help. Protect your placement, job, career, reputation, and financial investments at all costs.

Professional license defense attorney Joseph D. Lento has represented countless professionals in license defense proceedings and college, university, and graduate school students in disciplinary proceedings. Attorney Lento knows USMLE rules and procedures to help you navigate the system. He is also an experienced criminal defense lawyer adept at exercising aggressive and effective trial and litigation skills. The Lento Law Firm has helped hundreds of aspiring doctors and other professionals across the United States and beyond. Let professional license defense attorney Joseph Lento and the Lento Law Firm help you overcome your USMLE issues, just as they have helped countless others. Call today at 888-535-3686.


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