The road to becoming a physician is paved with many unique challenges. The uphill battle begins with rigorous undergraduate course work, followed by the MCAT and medical school applications. Upon acceptance into medical school, you are faced with the USMLE (United States Medical Licensing Examination) and its STEP 1 and STEP 2 exams. At any of these stages, a student can be accused of numerous faults including cheating, misrepresentation, falsification of information, unfair advantages and the many faces of “irregular behavior.”

On Wednesday, the challenges of a pre-med student were discussed. Today’s post focuses on the challenges imposed on a student after entering medical school.

So you made it to medical school. Congratulations! After years of slaving away in biology and chemistry labs, it is finally time to get your hands on medical textbooks. Like your work as a pre-med student, medical school courses will be rigorous and challenging, calling on every neuron you possess to fire efficiently. You will be tested, in more ways than one, and ditch the MCAT for a new acronym – USMLE (United States Medical Licensing Examination).

The USMLE is a three-step exam required for medical licensure in the United States, sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®). Most students start with Step 1 at the end of their second year of med school and take Step 2, which includes a Clinical Knowledge component (“Step 2 CK”) and a separate Clinical Skills component (“Step 2 CS”), sometime in their fourth year. Step 3 is usually taken during the first or second year of postgraduate training.

Because the USMLE is the barrier between you and your medical licensure, it is an extremely important component of your medical education. Many students prepare with a prep course or study group, but even the most knowledgeable student can encounter issues with the exams.

One such issue is being accused of “irregular behavior” during an exam. This broad label includes anything from cheating to disruptions during testing. In the event that your test is invalidated due to irregular behavior you will want to correct the situation immediately, or you may be prohibited from taking future exams (meaning you won’t be able to obtain your license).

If you are accused of irregular behavior or if you feel that you were faced with inadequate testing conditions, resolving the issue may be as simple as requesting a rescoring of the exam. Sometimes, because of problems at a test site or because of technical problems, retesting is an option.

However, more serious cases may result in a lawsuit initiated by the NBME and FSMB. In one such case, the NBME and the FSMB filed federal suit requesting an injunction and other relief against Optima University (a USMLE test prep course provider) for alleged copyright infringement. The federal complaint claimed that Optima exposed the students who attended review courses to exam questions that were improperly obtained by using examinees who recorded the tests questions. It is believed that Optima may have also paid students in Eastern European Countries to take the examinations for the purpose of copying or obtaining the questions.

Some students involved in this case were foreign medical graduates who were told that Optima would provide housing and test preparation so that they could take the USMLE. Students ended up sleeping in the New Jersey office building that hosted Optima and were also sent to Tennessee. Once in Tennessee, students were required to assist in the construction of another Optima facility. These students – who came to the United States with promises of fulfilling their American dreams to become physicians – were digging ditches for drain pipes.

Having no knowledge that were being fed actual test questions, these students took the USMLE and were flagged for irregular behavior. Although the students were permitted to retake the exam, the situation left the students with a negative reputation with the NBME. Read more about the case here.

After years of schooling, don’t allow allegations of cheating to prevent you from reaping the benefits of your hard work. For more information visit or read this article concerning USMLE and ECFMG challenges and representaion.