International medical graduates can face issues with the United States Medical Licensing Exam (USMLE), which affects their ability to obtain a medical license from a U.S. state medical licensing board. International medical graduates can face special challenges qualifying for the USMLE exams, taking the USMLE exams, and obtaining their USMLE exam results, all affecting their qualification for a U.S. medical license. If you are an international medical graduate facing USMLE issues, retain the Lento Law Firm's premier Student Defense Team to effectively address and favorably resolve those issues. Call 888.535.3686 or use our contact form now for our skilled and strategic representation.
The USMLE Exam
The USMLE is a three-step exam that medical students must pass to qualify for U.S. state medical board licenses. The Federation of State Medical Boards and the National Board of Medical Examiners sponsor the USMLE. The USMLE evaluates a candidate's application of medical knowledge and skills for safe and effective care of patient disease and health. Medical students must pass Step 1 and Step 2 before taking Step 3. Students generally take Step 1 at the end of their second year, Step 2 in their fourth year, and Step 3 during postgraduate residency training. USMLE content generally matches the knowledge and skills students or graduates have acquired at those medical education stages.
IMGs and the USMLE Exam
International medical graduates must take and pass the United States Medical Licensing Exam (USMLE) step exams to qualify for U.S. state medical board licensure. U.S. state medical licensure is, of course, necessary to practice medicine in the U.S. International medical graduates take the USMLE to qualify for U.S. medical practice. However, international medical graduates also take the USMLE and qualify for U.S. medical licensure to demonstrate their expert medical knowledge and skills for practice elsewhere in the world, including examining and treating U.S. expatriates seeking U.S.-standard medical services. If you are an international medical graduate, you know that U.S. medical licensure based on passing the USMLE certifies your medical credentials as meeting the proverbial gold standard.
USMLE Issues Affecting State Medical Licensure
As just indicated, taking and passing the USMLE exam is a critical step, among other steps like graduation from an accredited medical program, in qualifying for a U.S. state medical license. USMLE issues, then, can affect state medical licensure. If, for instance, an international medical graduate fails to qualify to take the USMLE, the IMG will not pass the USMLE and thus will not qualify for state medical licensure. Qualifying for the USMLE can be a huge first hurdle for international medical graduates, far greater than the challenge U.S. medical graduates face in qualifying. Passing the USMLE with an acceptable score can be a second challenge for international medical graduates, greater than the challenge U.S. medical graduates may face. Obtaining the USMLE passing score, amid cheating or other allegations of suspicious behavior, can be a third challenge for international medical graduates, greater than the challenge U.S. medical graduates may face. First, though, consider some common USMLE issues that both international medical graduates and U.S. medical graduates face.
Common USMLE Exam Issues
The USMLE presents medical students and graduates with arduous study and examination challenges that can lead to unfortunate but common exam issues. International medical graduates can face the same USMLE Step 3 exam issues as U.S. medical graduates. Those common issues for both international medical graduates and U.S. graduates can include any of the following concerns. Let us help if you are an international medical graduate facing one of these common issues.
USMLE Anomalous Performance as a Common Exam Issue
USMLE officials may notify you of anomalous performance that USMLE officials detect from your aberrant exam responses alone. USMLE officials do not disclose their analyses that trigger an anomalous performance notice, but anomalous performance generally means a pattern of responses that indicates that you were not prepared or motivated for the exam. An anomalous performance notice often includes a one-year ban from retesting. If you receive an anomalous performance notice that you believe to be in error in some respect, let us help you review your explanation for extenuating circumstances. We may be able to help you avoid the one year ban.
USMLE Invalidated Exam Score as a Common Exam Issue
USMLE officials may alternatively notify you of an invalidated exam score. Unlike a notice of anomalous performance based on exam responses suggesting unprepared or unmotivated performance, a notice of invalidated exam scores indicates a response pattern suggesting prior access to exam answers or other evidence of the violation of exam rules against undue advantage. In other words, an invalid exam score may indicate that USMLE officials believe that you cheated on the exam in some form or fashion. Unlike anomalous performance flagging, the USMLE provides a procedure for challenging an invalidated exam score. Let us help you initiate those procedures to defend yourself against allegations that you cheated on the exam or otherwise violated exam rules or protocols.
USMLE Extenuating Circumstances as a Common Exam Issue
You may alternatively have fallen ill, suffered injury, or had some other unanticipated circumstances arise on the day of your exam, interfering with your exam performance. If you do not properly notify USMLE officials within ten days of the exam of your extenuating circumstance, USMLE officials may construe your unusually poor exam performance as an anomalous performance and bar you from the exam for one year without appeal. If you do notify USMLE officials of your extenuating circumstance in a timely manner, you may be able to avoid an anomalous performance exam bar. Let us help you promptly and properly notify the USMLE of your extenuating circumstances so that you do not suffer a one-year anomalous performance ban.
USMLE Exam Retake Limit as a Common Exam Issue
You may alternatively have failed to achieve a passing score on one or more of the USMLE step exams, requiring you to retake the exam. USMLE rules limit retake attempts to four attempts for each of the three step exams. Let us help you evaluate your options if you are approaching or have met the four retakes limit. You may have extenuating circumstances excusing one or more of your exam attempts.
Special IMG USMLE Exam Issues
While international medical graduates face the same above common USMLE issues as U.S. medical graduates, international medical graduates can also face special USMLE exam issues that U.S. medical graduates do not commonly face. International medical graduates can also face a greater risk of the above common issues that U.S. medical graduates face. Here are some of the special issues international medical graduates can face when taking the USMLE.
USMLE Invalidated Score Based on International Site
International medical graduates face an extra risk that the USMLE may invalidate their score based on aberrant performance at the international testing site. The USMLE has, for instance, invalidated test scores of a group of examinees taking the USMLE in Nepal after scoring indicated that the group of examinees may have had prior access to exam content. International testing centers and sites may add an extra degree of uncertainty around the USMLE's conveyance and administration at that site. International testing centers and sites may have greater variety in their quality controls, testing personnel skills and experience, and testing facilities and procedures than U.S. testing centers and sites. As an international medical graduate, you are subject to that extra degree of uncertainty when taking your USMLE step exams at an international site. Let us help if you face a USMLE issue like the issue for the Nepalese candidates, based on the national site.
Other USMLE International Location Issues
International medical graduates can also face extra risks around their USMLE exams based on their access to and familiarity with the exam's international location. The USMLE offers the exam at sites worldwide, not just in the U.S. International medical students studying at their foreign medical school often take the USMLE Step 1 and Step 2 exams at the foreign location nearest their foreign medical school during the course of their pre-graduation studies. They may also take the USMLE Step 3 exam at an international location if convenient to their post-graduate residence, citizenship, schedule, or travels. That international location may be at a formal testing center dedicated to administering exams or at a temporary site requisitioned just for the USMLE exam. International medical graduates unfamiliar with remote environments in their international locale may have difficulty locating the testing site, missing or delaying the start of their exam. They may have difficulty performing at the international site due to varying temperatures, lighting, sound, furnishings, or other environmental distractions and conditions. They may also have difficulty understanding and following the instructions of international proctors. All these challenges can produce anomalous performance. Let us help if you have had testing location issues affecting your USMLE performance, delaying the release of your results, or invalidating your results.
USMLE Extenuating Circumstances as a Special IMG Issue
International medical graduates can also face extra risks involving extenuating circumstances on the day of their USMLE attempt at an international testing site. International medical graduates preparing for and taking the USMLE exam at an international site often deal with greater health variables than U.S. medical graduates would face at home. U.S. medical graduates may be able to control variables affecting their exam preparedness and performance better than international medical graduates, who can control those variables, both out of familiarity with those variables and their ability to positively influence them. Examples include:
- food intake, including eating consistently and eating safe food without food poisoning on the day of and days leading up to the exam;
- liquid intake, especially adequate amounts of clean water, to avoid dehydration or intestinal infection issues on the day of and days leading up to the exam;
- exposure to infectious diseases and prompt and effective treatment of infectious diseases on the day of and days leading up to the exam;
- physical injury from a motor vehicle accident, pedestrian accident, or other hazardous conditions;
- travel interruption or delays and mental trauma or distraction from drug interdiction efforts, war or threats of war, terrorism, gang activities, government coups, and other social unrest.
Let us help if one or more of these extenuating circumstances, or other similar circumstances, interrupt, delay, or otherwise affect your USMLE performance, leading to anomalous performance, invalidated score, delayed release, or other issues.
IMG Issues Qualifying for the USMLE
As introduced briefly above, international medical graduates also face special issues, greater than U.S. medical graduates generally face, in qualifying to take the USMLE. If an international medical graduate cannot qualify for the USMLE, the IMG will not take the exam, obtain a passing score, and qualify for U.S. state medical licensure. For IMGs, qualifying for the USMLE can be their biggest obstacle to U.S. state medical licensure. Taking the USMLE exam at an international site can certainly introduce complicating variables, as the discussion above shows. However, international medical graduates can face significant extra obstacles simply getting the appropriate information and documentation in order to qualify to take the USMLE. Consider the following examples.
IMG ECFMG Issues Qualifying for the USMLE
The complications that international medical graduates face qualifying for the USMLE often arise out of their dealings with the Educational Commission for Foreign Medical Graduates (ECFMG). U.S. medical graduates generally use the Electronic Residency Application Services (ERAS) maintained by the Association of American Medical Colleges (AAMC) to apply for U.S. residencies. They may apply directly to the USMLE for the exam with their U.S. medical school's support. By contrast, international medical graduates generally use the ECFMG and its Electronic Portfolio of International Credentials (EPIC) service both for their residency application and to qualify for the USMLE. In effect, the ECFMG certifies the IMG's foreign medical school as meeting U.S. state licensing board education standards and USMLE standards for admission. International medical graduates have an extra administrative hoop through which to jump compared to U.S. medical graduates. An incomplete or deficient ECFMG file can prevent an international medical graduate from qualifying for the USMLE Step 3 exam. Any of the following issues, addressed in greater detail below, can lead to ECFMG rejection of an IMG to sit for the USMLE Step 3 exam:
- ECFMG issues with the IMG's foreign medical school, that the school wasn't accredited for the duration of the IMG's medical school attendance;
- IMG misconduct issues at the IMG's foreign medical school, inadequately resolved according to ECFMG documentation standards;
- IMG character and fitness issues raised at the foreign medical school's international site and inadequately resolved according to ECFMG documentation standards;
- IMG citizenship and immigration issues, lacking adequate passport, visa, or other documentation to meet ECFMG standards;
- IMG medical school transcript, degree, or other records issues meeting ECFMG documentation standards;
- IMG criminal court or other government agency records issues meeting ECFMG documentation standards; and
- IMG issues authenticating, transmitting, or translating records to ECFMG documentation standards.
IMG ECFMG Medical School Issues Qualifying for the USMLE
To qualify for the USMLE Step 3 exam, international medical graduates must attend a foreign medical school that the ECFMG recognizes as capable of meeting U.S. state licensing board educational standards. IMGs typically make that determination at the outset when applying for admission to their foreign medical program. You chose a foreign medical school that met ECFMG standards so that you could qualify for U.S. state medical licensure. However, once you begin your foreign medical school studies, ECFMG may have an issue with your school's accreditation according to ECFMG standards. That issue could affect your ability to qualify under ECFMG standards to take the USMLE Step 3 exam. Let us help if you face this issue.
IMG ECFMG Misconduct Issues Qualifying for the USMLE
International medical graduates can also face ECFMG issues related to their alleged misconduct at their foreign medical school. IMGs, like U.S. medical students, can face academic misconduct, behavioral misconduct, and sexual misconduct charges at medical school. IMGs, like U.S. medical students, can also face academic progression issues at medical school, failing to make the necessary grades. Medical students must address those issues to persist and graduate. We help medical students resolve school misconduct charges. However, international medical graduates can face greater challenges satisfying ECFMG that they did address those issues. Foreign medical schools may inadequately document the proper resolution of pending charges. ECFMG may reject an IMG to sit for the USMLE Step 3 exam because of pending or inadequately resolved misconduct charges. Let us help you if that is your obstacle to USMLE Step 3 examination.
IMG ECFMG Character and Fitness Issues Qualifying for the USMLE
International medical graduates can also face ECFMG issues around their character and fitness to obtain a U.S. medical residency and sit for the USMLE Step 3 exam. Medical students, both in the U.S. and internationally, can have addiction and dependency issues, physical impairments, mental illness or disability, morality issues around pornography or gambling addiction, domestic violence issues, and unprofessionalism issues in disputes with clinical supervisors, colleagues, or patients. Medical students, both in the U.S. and internationally, must generally resolve those issues to their medical school's satisfaction to persist and graduate. However, international medical graduates face an extra layer of ECFMG scrutiny over those issues. An IMG's foreign medical school may have failed to adequately document the IMG's satisfactory resolution of the character and fitness issue to meet ECFMG documentation standards. Let us help if you have an open character and fitness issue preventing ECFMG from certifying you to sit for the USMLE Step 3 exam.
IMG ECFMG Immigration Issues Qualifying for the USMLE
International medical graduates can also face citizenship and immigration issues that satisfy the ECFMG and qualify to sit for the USMLE Step 3 exam. IMGs must either be U.S. citizens with a U.S. passport or other appropriate documentation of that citizenship, or obtain a U.S. visa to enter the country lawfully, to meet ECFMG documentation standards to approve the IMG for USMLE Step 3 examination. These citizenship or immigration issues mean that IMGs must provide ECFMG with additional documentation in the form that ECFMG requires if those IMGs are to qualify for the USMLE Step 3 exam. ECFMG offers its Visitor Sponsorship Program to help international medical graduates qualify for U.S. J-1 visas. However, the Visitor Sponsorship Program has its own documentation requirements. U.S. medical graduates face none of these citizenship and immigration issues. International medical graduates, by contrast, can easily get tripped up by these issues. Let us help you resolve your citizenship or immigration issues with ECFMG so that you can qualify to take the USMLE Step 3 exam.
IMG ECFMG Medical School Records Issues Qualifying for the USMLE
International medical graduates can also face ECFMG issues documenting their medical school graduation in good standing, with the requisite grade-point average and completed coursework and clinical components. ECFMG generally requires specific transcript documentation. Incomplete transcripts, inaccurate transcripts, or the wrong documents other than the official transcript that ECFMG officials expect and demand can delay an international medical graduate's qualification for the USMLE Step 3 exam. Because ECFMG receives transcripts in widely varying forms from medical schools worldwide, international medical graduates can face special challenges convincing ECFMG officials that their foreign medical school's transcript or other documentation meets ECFMG standards. Let us help if you have medical school records issues with ECFMG, keeping you from taking the USMLE Step 3 exam.
IMG ECFMG Criminal Court and Other Agency Records Issues
International medical graduates can also face ECFMG issues, such as documenting their clear criminal history or other proper resolution of civil court cases or other government agency issues affecting their character and fitness. Medical students, both inside and outside the U.S., face criminal charges and civil court cases involving restraining orders, bankruptcy, or other serious matters. Depending on the outcome of those charges and cases, the medical graduate may face disqualification from U.S. medical residency and USMLE Step 3 examination. International medical graduates may not be able to readily obtain an appropriate record from their foreign criminal or civil court or other government agency accurately reflecting an appropriate resolution of the matter. ECFMG may refuse to certify an IMG for the USMLE Step 3 examination because of inadequate documentation of that criminal or civil matter. Let us help if you face such a documentation issue.
IMG ECFMG Authenticating Records Issues Qualifying for the USMLE
International medical graduates can also face ECFMG issues authenticating the medical school transcript, criminal or civil court record, or citizenship, immigration, or other record that ECFMG requires to qualify the IMG for USMLE Step 3 examination. ECFMG doesn't just take documents in any form. Depending on the document, its subject, and its country or agency of origin, ECFMG may require an original document, original signature, original seal, letterhead, attestation by a notary public or other qualifying official, or other indication that the document is what it purports to be. Authentication issues can delay your ECFMG review and cause ECFMG officials to reject your application to sit for the USMLE Step 3 exam. Let us help if you have ECFMG document authentication issues.
IMG ECFMG Transmitting Records Issues Qualifying for the USMLE
International medical graduates can also face ECFMG issues transmitting records to and from ECFMG in the form, manner, and timing that ECFMG, USMLE, or others require. ECFMG protocols may, for instance, require that a medical school transcript, court record, agency record, citizenship or immigration record, or other document come to ECFMG straight from the document's source, electronically or by mail, rather than from the international medical graduate or a third party. Or ECFMG protocols may require that certain documentation comes from the IMG rather than the document's originator or a third party. The transmission route of the document may affect ECFMG's willingness to accept the document as authentic. Let us help if you face ECFMG document transmission issues affecting your ability to qualify for the USMLE Step 3 exam.
IMG ECFMG Translating Records Issues Qualifying for the USMLE
International medical graduates can also face ECFMG issues translating records that ECFMG requires for the IMG's qualification for the USMLE Step 3 exam. International medical graduates studying at a location where school officials and court, immigration, and other government officials speak a native language other than English may find that their required documentation is in that other language, in whole or in part. ECFMG may require documentation in English, meaning that the IMG must obtain a document's translation. But ECFMG may also require authentication that the translation is reliable. Translation issues can delay an IMG's application or even cause ECFMG to reject an IMG's effort to qualify for the USMLE Step 3 exam. Let us help if you face ECFMG document translation issues.
ECFMG Irregular Behavior and the USMLE
When international medical graduates face any of the above issues satisfying ECFMG officials to qualify for the USMLE, they may end up facing charges under the ECFMG's policy and procedure on irregular behavior. Any suspicious anomaly in an IMG's effort to adequately document the IMG's ECFMG file or to address and favorably resolve USMLE exam issues could lead ECFMG officials to charge the IMG with irregular behavior. The ECFMG policy on irregular behavior threatens such charges on a complaint that the IMG committed an act “that would or could subvert” ECFMG “examination, certification, or other processes, programs, or services.” If the ECFMG believes that you submitted a false document or induced another to do so on your behalf, or cheated on a USMLE exam or attempted to do so, ECFMG may delay or deny your application for the USMLE Step 3 exam based on that allegation.
We Can Help Address Your IMG USMLE Issues
Fortunately, the ECFMG's policy and procedure on irregular behavior offer protective procedures for international medical graduates facing cheating, false documentation, or other subversion charges. Our attorneys can strategically and effectively invoke those ECFMG protective procedures to help you address and resolve your USMLE issues. We may be able to appear at the ECFMG investigation stage to show investigators that you did not subvert ECFMG processes or cheat on a USMLE exam, thus avoiding referral of your charges to the ECFMG Credentials Committee. Alternatively, we can appear on your behalf before the Credentials Committee, drafting and submitting your written statement in defense with appropriate, reliable documentation. We can also invoke a formal hearing before the Credentials Committee, at which point you can present your exonerating evidence and challenge adverse witnesses through cross-examination. We can also take an ECFMG appeal to its Review Committee if you have already lost your Credentials Committee proceeding. Our attorneys have the substantial skill and experience in academic administrative matters to provide you with the defense representation you need.
Stakes in USMLE Issues Affecting State Licensure
Keep in mind the stakes you face in your USMLE issues affecting state licensure. You may have attended a fine Caribbean medical school like St. George's University Medical School, Saba University School of Medicine, Ross University School of Medicine, American University of the Caribbean School of Medicine, American University of Antigua School of Medicine, or Medical University of the Americas. Or you may have attended another fine international medical program in another worldwide region. No matter your program, you doubtless invested substantial time, trouble, and expense in completing that program. If your medical career depends on U.S. state medical licensure, your USMLE issues place your entire investment in your medical education at risk of loss. Keep those stakes in mind when deciding what to do. Retain our highly skilled attorneys is your best move.
Premier Student Defense Available for USMLE Issues
If you are an international medical graduate facing USMLE issues, promptly retain the Lento Law Firm's premier Student Defense Team for the highly skilled, strategic, and effective attorney services you need for your best outcome. Call 888.535.3686 or use our contact form now to tell us about your case.
