By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At The Health Law Firm, we frequently receive calls for consultations from medical students and medical school graduates who receive a letter from the National Board of Medical Examiners (NBME), concerning the United States Medical Licensing Examination (USMLE). The letter may accuse the student or medical resident of “Irregular Behavior” concerning one or more of the USMLE Step examinations. In many cases, the person receiving the letter is a graduate of a foreign medical schools who have applied through the Educational Commission for Foreign Medical Graduates (ECFMG).

Irregular behavior can consist of many different actions taken by the applicant, before, during or after taking a USMLE step exam. What you must know is that, in effect, you are being accused of cheating or a similar type of infraction.

Types of Irregular Behavior.

Examples of the types of conduct which we have seen before include:

– Attending a commercial USMLE preparation course that provides some of the actual examination questions.

– Soliciting information on the actual contents or actual questions on the examination.

– Using a smart phone during the examination.

– Talking with another person during the examination.

– Sharing information on the types of questions or cases that were on your examination with another person or on a blog over the internet.

– Leaving the test room and looking up answers in a text during the examination.

– Setting the building on fire during the examination so that you won’t have to complete the examination.

– Forging your Step Exam grade or a document containing it and providing it to your medical school or residency program.

These are just a few. For more examples, please see an article I wrote on this by clicking here.

Most Common Errors You Will Make When Accused of Irregular Behavior.

We have represented students accused of irregular behavior by consulting with them before and after USMLE or ECFMG hearings and on appealing the results. We have represented a number of examinees at the hearings held before the NBME at its headquarters in Philadelphia, Pennsylvania, and before the ECFMG, which hearings are also usually held in Philadelphia, Pennsylvania.

From our experience in such cases, the following are the most common errors made by the individual when accused by the USMLE or the ECFMG of irregular behavior:

1. Failure to retain the services of an attorney experienced with such cases immediately upon receipt of a letter from the NBME or ECFMG accusing you of irregular behavior. Take this as a formal charge accusing you of, in effect, cheating. THIS IS SERIOUS.

2. Telephoning, writing or e-mailing the NBME or ECFMG to explain “your side of the story.” Such a writing or conversation will be full of admissions that will help prove the case against you and you will not even understand this. (Please note that under U.S. law any statements you make, oral or written, can be used as evidence against you in any civil, criminal or administrative proceeding. This is not the case with statements that your attorney makes on your behalf.)

3. If you submit documents or statements to the NBME or ECFMG in support of your case, these will not be well-organized, well-labeled and in a form simple and easy to understand. In many instances, you will not even understand the legal issues you are facing or how to refute them.

4. You will fail to request or attend in person the hearing before the NBME or ECFMG Committee on Irregular Behavior or Committee on Individual Review (“The Committee”) in Philadelphia. You will mistakenly believe that a written statement and documents alone will carry the day and persuade them not to take adverse action against you.

5. You will fail to take an attorney experienced in such medical administrative hearings to represent you at The Committee hearing in Philadelphia.

6. You will not know how to properly present your evidence or present your own position to The Committee, if you do attend the hearing.

7. You will not know when or what kind of evidence (expert witness reports, statistical expert affidavits, affidavits of fact witnesses), you need to use to prove issues in your case before The Committee.

8. You will fail to understand and correctly respond to the questions that the many different Committee members (usually 12 or more) will ask you during the hearing.

9. You will fail to correctly follow all procedures in order to preserve your rights in the proceedings.

10. You will falsely believe that if you lose at The Committee hearing, it will be easy to win on appeal or somehow sue in court and prove you are right. This is almost never correct. You will have only one real chance at proving your case and this is at The Committee hearing in Philadelphia.

11. You will incorrectly believe that even if you are only suspended from taking the USMLE Step exams again for a short period of time, this will have no effect on your education or career. (Note: Your USMLE transcript will note this fact and this may prevent you from ever getting into a good residency program. See #1 above.)

Invest in Your Future Career.

You and your family have invested tens of thousands, if not hundreds of thousands of dollars, on your education so that you can become a physician. You have spent years of sacrifice and studying in order to become a physician. This is not the time to be cheap and to think that the cost of hiring an experienced legal counsel is too high. You could lose everything you and your family has invested in this. Do not be “penny wise and pound foolish.” You will need professional help if you are to get through this successfully. If you don’t care about these matters or you don’t believe this is a serious matter worthy of an investment for attorney’s fees, then go ahead and ignore this advice.

If you are not reading this until after you have lost the case and been found to have committed “irregular behavior” by the USMLE Committee on Irregular Behavior or by the ECFMG Committee,, I am sorry for you, but it is probably too late to be able to really do anything about it.

Contact Experienced Health Law Attorneys For Irregular Behavior or USMLE Issues Today.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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