Headshot of attorney George IndestBy Ritisha K. Chhaganlal, J.D. and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health

The United States Medical Licensee Examination (USMLE) Step exams are a major component of students’ journey through medical school.  Most students focus on preparing a study plan and earning the ideal score to get into a residency program of their choice.  However, many medical students are not aware of the potentially career-damaging finding of “Irregular Behavior” on their USMLE Step transcript.

In this two-part series blog, we will discuss what constitutes irregular behavior and what the next course of action should be if there is a finding of irregular behavior.

What is Irregular Behavior?

In short, irregular behavior is typically regarded as cheating by medical school officials and residency program directors, even though it is not exactly the same thing.  Any such finding will be stamped on a USMLE transcript with a detailed letter of explanation attached to it.  This letter may come from the National Board of Medical Examiners (NBME), the USMLE, or the Educational Commission for Foreign Medical Graduates (ECFMG).  Regardless of the organization it came from, the letter alleging irregular behavior typically states the following:

-A bulletin or policy related to the exam stating that irregular behavior is not permitted.

-The facts alleging irregular behavior in this case.

-The opportunity to respond to the allegations, in person, with counsel.

What a Finding of Irregular Behavior Can Mean for Medical Students.

A finding of irregular behavior can be a career ending event.  At the very least, it may delay graduation from medical school.  It may also disqualify medical graduates from many jobs or residency positions.  Additionally, USMLE Step scores are withheld from the test-taker while the USMLE Committee reviews the matter, or until a hearing has been held.

If a finding of irregular behavior is made, then usually the test-taker’s best score is voided and he or she must retake the exam.  The USMLE committee may also require the test-taker to wait a year or more to retake the exam.  Further, the finding of irregular behavior will be stamped on the test-taker’s USMLE transcript and visible to anyone that views it.

Conduct Defined as “Irregular Behavior.”

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; and

(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.

Other Negative Findings by USMLE That May Be Detrimental.

In addition to irregular behavior, USMLE has also accused a test-taker of “Anomalous Results.”  This means that a test-taker made answer selections that look suspect (i.e., putting down answer choice “C” for every question).  For more information about other negative findings by USMLE, contact our office.

Stay tuned for the second part of this two-part blog series on irregular behavior where we will discuss the steps that are recommended to combat a finding of irregular behavior.


Have you been accused of irregular behavior? How did you handle this allegation? Do you think a report of irregular behavior would hurt your professional career in any way?

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in the following areas: in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), discrimination due to race, sex, national origin, sexual orientation and any other matters, reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in state or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenants (covenants not to compete).

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

4 Indest-2009-3About the Authors: Ritisha K. Chhaganlal, J.D., is an attorney with The Health Law Firm.  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.  www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: United States Medical Licensee Examination (USMLE) Step exams, irregular behavior, graduate medical education (GME), medical graduate attorney, Association of American Medical Colleges (AAMC), Accreditation Council for Graduate Medical Education (ACGME), graduate medical education attorney, lawyer for medical students, medical resident attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, medical students legal counsel, National Board of Medical Examiners (NBME) lawyer, health law attorney, The Health Law Firm, Educational Commission for Foreign Medical Graduates (ECFMG), anomalous results, USMLE Step transcript

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2016 The Health Law Firm. All rights reserved.