Cheating, Irregular Behavior and Other Maladies Plaguing Future Physicians: A Two-Part Series

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, the USMLE (United States Medical Licensing Examination) and its STEP 1 and STEP 2 exams provide another hurdle. 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.”

Today’s post focuses on the challenges imposed on a student prior to entering medical school. On Friday, the implications of various forms of “misconduct” for med students will be dissected (including USMLE irregular behavior and the case of NBME and FSMB v. Optima University LLC).

Prior to medical school, pre-med students must be ambitious, inquisitive and extra cautious about any disciplinary action. A minor blemish on a pre-med student’s academic record (from academic dishonesty or other accusations), will become a major red flag once that student begins the process of applying to med school. Not only will any kind of discipline record hinder a student’s chances of acceptance into med school, an infraction can also ruin that student’s reputation as they apply for residency and beyond.

Because the process of becoming a physician is difficult without having a discipline record, any  charge against a pre-med student must be taken with the upmost seriousness. If a student is accused of any kind of inflammatory behavior (cheating, academic dishonesty, plagiarizing, misrepresentation of information, falsification of information, etc.) that student needs to immediately try to correct the accusation. If a professor or another student is responsible for the accusation, the accused can try to fix the situation by meeting with the accuser before it advances. However, if this fails and the complaint is taken to a higher administration, it is best for the student to consult a legal expert who can represent them in front of an academic committee.

Often, these cases can be resolved informally,through negotiation or mediation. However, occasionally it is necessary that a civil suit be filed against the school, in order to protect the reputation of the student and prevent retaliation. The student must discuss what legal route will work best for their case in order to have the best chances of a positive outcome.

If a pre-med student makes it through undergrad without any kind of discipline record, there is still a chance that something could go wrong during the MCAT, leading to an investigation by the AAMC (Association of American Medical Colleges).

In the event that a student is accused of cheating on the MCAT or disruptive behavior during the test administration resulted in a voided test, it is best for the student to seek legal representation. If a student takes no action, or fails to correct the situation independently, they may be banned from taking the MCAT and have no chance of entering medical school.

After surpassing each obstacle on the way to med school acceptance, students may still be presented with a challenge during the admissions process. Students attempting to be admitted to medical school who are wrongfully denied for various reasons, need to seek legal advice. In one case, a student who was a whistle blower found himself being the subject of retaliation by a medical school professor for whom he had worked in college. After seeking legal counsel, this student was successful in countering the retaliation of the medical school professor and was admitted to the medical school of his choice.

Becoming a physician may be challenging, but the results can be rewarding and worth any sacrifices. A clean slate during your days as a pre-med student will pay off during your medical school admissions cycle and beyond. For more information visit or read this article concerning Education Law.

Cheating, Irregular Behavior and Other Maladies Plaguing Future Physicians: A Two-Part Series

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.

Accused of “Irregular Behavior” on Your USMLE Step Exams: What to Do

Health Law Attorney HeadshotMany students, foreign medical graduates and those applying to receive a medical license in the United States find themselves accused of “irregular behavior” while taking the Step 1, Step 2 or Step 3 exams of the United States Medical Licensing Examinations (USMLE) administered by the National Board of Medical Examiners (NBME).  Often the conduct turns out to be something that is not significant, was inadvertent, was not intended to provide any unfair advantage to the test-taker or is otherwise justifiable or explainable.  Nevertheless, because of the extremely serious consequences a finding of “irregular behavior” may have, the applicant should act immediately upon being advised of a pending inquiry;  he or she should take appropriate steps to attempt to defend himself or herself.

The USMLE defines “irregular behavior” as conduct that includes (but is not limited to) the following:

1. Seeking, providing, or obtaining unauthorized access to examination materials.

2. Providing false information, making false statements, or similar conduct in relation to application forms, scheduling permits, or related documents.

3. Taking an examination when the examinee is not really eligible for it (or attempting to do so).

4. Impersonating another test-taker or engaging a different person to take the examination for the actual applicant.

5. Obtaining, giving, or receiving assistance during the examination or attempting to do so (except for certain authorized acts).

6. Making notes in the secure areas of the test center, except for notes on the writing materials provided at the test center for this purpose.

7. Failing to comply with or follow any USMLE policy, procedure, or rule.

8. Failing to follow instructions of the test center staff.

9. Abuse or harassment (verbal or physical) of test center staff or any other disruptive or unprofessional behavior at the test center.

10. Being in possession of any unauthorized materials, including photographic equipment, or communication or recording devices, including electronic paging devices and cellular telephones, in the secure testing areas.

11. Changing or misrepresenting your examination scores to others.

12. The unauthorized reproduction of any examination materials or dissemination of them by any means, including via the Internet (this includes, for example memorizing them and repeating them, restructuring them, discussing the actual questions and answers, etc.).  Note: all test questions and testing materials are copyrighted.  You could be prosecuted or sued for violation of the NBME’s copyrights, and this has actually happened.

13. Communicating or attempting to communicate about specific test questions, answers, items, or cases with any other examinee, potential examinee, or preparation group at any time.

Some of the foregoing actions seem to be fairly common sense as far as what any person should know is prohibited.  However, other forms of more innocuous behavior can result in accusations which fit within the above.

For example, we have been consulted by examinees accused of “irregular behavior” when they have done the following:

1. Wearing a wrist watch during the examination.

2. Taking a nationally advertised examination preparation course attended by hundreds of people when the preparation course allegedly had obtained unauthorized access to actual examination questions.

3. Using a cell phone, Blackberry or other communications device at the exam center.

4. Talking with another exam taker in a bathroom during the test.

5. Discussing test questions and the testing process on a blog.

6. Discussing the substance of test questions and cases with others.

7. Writing or marking something down prior to being instructed to do so.

8. Making a stray mark on an examination after being instructed at the exam center that you were not allowed to do so.

9. Failing to follow the orders of a proctor at an exam center.

10. Not being able to produce the correct form of identification (in this case, the monitor requested a photo driver’s license, when the applicant did not have one).

If you are accused of “irregular behavior” we advise you to immediately consult with an attorney who has actual experience in dealing with these matters.  If the event is considered to be significant, you will be advised of this in writing and will be given an opportunity to explain it.  Have your attorney help prepare this;  don’t attempt to do it yourself.

If you are given the right to an appeal or a hearing in this matter, be sure to request this in writing by at least two different forms (e.g., via U.S. mail, via telefax, via Federal Express) that include proof of sending and proof of delivery.  DO NOT RELY ON E-MAIL ALONE.  Be sure that it is received at the NBME office (or the address specified in the letter you receive) within the time specified in the letter or the Bulletin setting forth the procedures you must follow.  You have a number of procedural rights given to you in these matters.  Exercise them in a timely and effective way.

Retain the services of an attorney who has experience working on NBME matters to represent you.  Plan on attending any hearings (these are usually held at the NBME offices in Philadelphia, Pennsylvania), in person.  All documents, statements, photographs, and other materials upon which you intend to rely should be clearly labeled, organized, indexed, copied and submitted ahead of time (similar to how it would be done in a court trial or hearing).  Be sure that your attorney attends the hearing with you.  Don’t retain the services of an attorney for this process if the attorney is not going to be available to represent you in person at the hearing in Philadelphia.

Unfortunately, many who are accused of “irregular behavior” do not realize the serious consequences that a confirmed finding of this can have.  Although technically, it is not the same as “cheating” it can carry the same adverse stigma that “cheating” can have.  It can prevent you from becoming licensed on time, delay your career, prevent you from obtaining desirable residencies and fellowships, prevent you from obtaining desirable employment, and have other consequences.

For additional information and documents related to “irregular behavior” and other legal matters visit our website at

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