After medical students graduate with an M.D. or D.O. degree, they will typically complete a residency at one of many teaching hospitals offering hands-on training to continue their medical education. Before students become licensed physicians, however, they will have to pass a multi-part exam.
The United States Medical Licensing Examination (USMLE) is administered by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The USMLE assesses a physician's capabilities to employ the concepts, knowledge, and principles learned during medical school and on-the-job training. Moreover, the exams will determine the physician's essential skills surrounding injuries, diseases, procedures, and the general healthcare that constitutes effective patient treatment and support.
It will take a medical student years to study and prepare for the USMLE. Since there is a maximum number of times an individual can sit for each part of the exam, there is no doubt that degree-holding, license-seeking physicians want to ensure they adhere to the rules and regulations governing the USMLE. The following will describe the steps of the USMLE, prerequisites, timelines, exam accommodations, exam irregularities, the USMLE adjudicatory body, consequences of exam violations, and steps to take in defending against allegations.
What Are the Steps of the USMLE?
The USMLE is divided into three distinct steps: Step 1, Step 2 Clinical Knowledge (CK), and Step 3. To apply for USMLE examinations, individuals must submit an application through the appropriate registration portal. For medical students and graduates of Liaison Committee on Medical Education (LCME) or Clinician Outreach and Communication Activity (COCA) accredited medical programs in the U.S. or Canada, Step 1 and Step 2 CK exams may be sought through the NBME. Individuals outside the U.S. and Canada will apply through the Educational Commission for Foreign Medical Graduates (ECFMG). After Steps 1 and 2 CK are completed, individuals from LCME, COCA, or ECFMG-accredited institutions will apply for Step 3 through the FSMB.
Step 1 will assess whether medical school students or graduates can apply vital concepts of the foundational sciences to the practice of medicine and treatment. Typically, the Step 1 exam is taken at the end of a student's second year of medical school.
Step 2 CK exams assess an individual's ability to employ medical knowledge, skills, and understanding of clinical science in supervised patient care. This exam is commonly taken before an individual begins a medical residency program.
Step 3 will determine whether medical school students or graduates can implement medical knowledge and their understanding of clinical science for the unsupervised practice of medicine, focusing on patient management. Medical school graduates generally sit for the exam at the end of the first year of medical residency. All exams are eight-hour computer-based assessments composed of seven 60-minute blocks of a maximum of 40 multiple-choice questions per section. Occasional 15-minute breaks will be given to test takers.
USMLE Timelines and Scheduling Restrictions
Individuals may only take the Step 1 exam three times within one year. Moreover, the subsequent attempts at the exam must be at least 12 months after the first attempt and at least six months after the most recent effort. The NBME will only allow individuals to attempt each exam Step a maximum of four times, including incomplete attempts.
All USMLE exam scores are valid for seven years. If a particular Step is passed, an individual is prohibited from retaking it. The only exception is complying with a time limit imposed by a U.S. physician licensing authority for the completion of all exam Steps or by another authority recognized by the USMLE program, per the USMLE website. If Step 3 has not been successfully completed and an individual must retake a previously passed Step to fulfill the aforementioned, failure to retake the Step will cause the individual to be ineligible to sit for the Step 3 exam.
USMLE Testing Accommodations
Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act require entities like the NBME and USMLE program to provide reasonable accommodations to qualifying disabilities. Individuals must complete a Request for Test Accommodations form in seeking exam modifications. Along with a signed copy, the documentation must include the following:
- A personal statement describing the disability for which accommodations are requested
- Documentation from an evaluating or treating professional providing specific evidence of impairment
- Objective records demonstrating how a major life activity relevant to the setting and context of the specific exam is substantially limited by the disability
The USMLE Management Committee will review the accommodations request and submit their decision in a letter. If accommodations are denied, individuals may request a reconsideration review, which is limited to one per registration.
Individuals must complete and submit a Reconsideration Request Form. Redundant information will not be considered, and only new and substantive supporting documentation will be accepted.
USMLE Exam Rules of Conduct
As mentioned above, each exam step is completed on a computer over the course of a day, with seven one-hour sections. Beforehand, an individual agrees to adhere to the following USMLE exam conduct requirements:
- The individual that is scheduled to take the exam is the one who sits for the exam.
- Test takers may not "seek, provide, or obtain" any assistance during the examination or break periods.
- Study materials, notes, books, or any electronic devices are prohibited in the secure areas of the test centers.
- Before entering the testing room, all personal belongings must be placed in a locker or cubicle.
- Individuals may only leave their testing station during a break and while the "break screen" is visible on the computer monitor.
- Cell phones and other personal communications devices may only be used outside the confines of the secure testing area and during an authorized 15-minute break.
- Exam content may not be removed from the testing center at any time.
- Individuals may only write on the laminated note boards provided by testing center officials.
- All test takers must maintain the confidentiality of the exam materials.
Like any standardized test, the rules surrounding exam taking are strict. Even the most insignificant infraction may garner implications of cheating.
If any of the Rules of Conduct are violated during the exam, an individual may be directed to leave the test center. Afterward, USMLE officials will take action under the USMLE Policies and Procedures Regarding Irregular Behavior. If an individual is found responsible for a violation, their score may be canceled, and they may be barred from taking future USMLE exams.
USMLE Irregular Behavior
"Irregular behavior" is any action that violates the USMLE's Rules of Conduct. Nevertheless, there are clear definitions. According to the USMLE website, conduct that constitutes irregular behavior is any that includes, but is not limited to, the following:
- Registering, taking, or attempting to sit for an exam in which the individual is not eligible or not scheduled, taking or trying to sit for someone else's exam, or employing someone to take an exam for another person
- Providing false identifying information on an application for, scheduling permit, or any USMLE-related document
- Communicating or attempting to communicate about test items before, during, or after the exam to any actual or potential exam taker
- Seeking, obtaining, or providing, unauthorized access to or reproduction of exam materials, or the attempt thereof
- Possessing unauthorized materials in the secure testing area
- Recording notes while in the secure testing area outside of any materials given in the secure testing area
- Disruptive or unprofessional behavior individually or directed toward USMLE or testing center staff during the registration, scheduling, or examination process
- Failure to fully cooperate in any USMLE investigation
- Altering or misrepresenting exam scores or outcomes
- Violating any USMLE policy, procedure, or rule, including instructions from the testing center staff
While irregular behavior may seem straightforward, some things can be considered violations of USMLE policy that someone may consider innocuous. For example, completing a USMLE application incorrectly, applying for an exam only five months following a failure, or applying after withdrawing from medical school can land one in trouble.
USMLE Investigation and Hearing Process
If any violation has occurred and any FSMB or NBME officials have knowledge of an infraction, an investigation will be conducted, according to the USMLE website. First, anyone alleged to have engaged in irregular behavior or other violations will be prohibited from registering for additional exams. Moreover, previously unreleased scores may be withheld, and scheduled exam appointments will be canceled.
Individuals who are the subject of an investigation must cooperate with the Committee for Individualized Review (CIR), providing all requested documentation and answering all questions posed during investigative interviews honestly. If requested, individuals must provide a signed release form authorizing the USMLE governing body to obtain records from educational institutions and other relevant third parties. Failing to cooperate with an investigation or providing false information will constitute irregular behavior and may be the basis of separate proceedings or further actions by the USMLE governing body.
Following the investigation, an individual alleged to have committed irregular behavior will be granted the opportunity for a hearing. All informal, private CIR hearings will occur at the NBME office in Philadelphia, Pennsylvania. The CIR will present the charges to the individual alleged to have committed irregular behavior. After this, there will be a questioning period where individuals may present their cases in front of the CIR. It will be essential to have all material from test preparation, documentation, letters regarding character assessments, and an attorney-advisor present at the hearing.
Consequences of Violating USMLE Policy
If the CIR determines that an individual is responsible for the irregular behavior, it will become a part of their permanent USMLE documentation. If an exam score was given, the USMLE transcript would have a notation detailing the CIR's findings of irregular behavior. The information will also be forwarded to third parties that will receive or have received USMLE transcript information in the past, as well as "legitimately interested entities."
At a minimum, special administrative procedures or conditions will be implemented for any future exams taken. Yet, individuals are commonly barred from sitting for the exam in the future.
What Action Should You Take?
Sitting for the three-part USMLE is one of the most important things a physician does during their career. Any misstep in the process could mean the end of the career before it even begins. Sometimes, individuals don't realize the seriousness of an irregular behavior notice and attempt to handle it alone.
There are several mistakes that medical students can make when trying to smooth things over with the CIR without proper representation, such as:
- Apologizing to the committee instead of defending their actions
- Contacting an attorney-advisor or education lawyer after the fact
- Failing to act out of fear
- Not preparing thoroughly before the CIR hearing
Furthermore, if an individual fails to submit a challenge to alleged irregular behavior, it will have the same implication as cheating or unethical conduct during the exam. The subsequent notation on an individual's transcript has a significant chance of impacting their ability to match with their ideal residency program or obtain one at all. Therefore, their future career as a physician will be affected drastically after years of schooling, costing tens and even hundreds of thousands of dollars.
Outside of irregular behavior investigations and hearings, it's also crucial to employ a professional attorney-advisor to assist in applying for disability accommodations. The guidelines surrounding their application are strict. You must have detailed and extensive documentation that goes back through years of doctor's visits, accommodations given in K-12 and post-secondary schooling, and evaluations from healthcare providers.
Contact Attorney-Advisor Joseph D. Lento for USMLE Concerns
With so much at risk, you must find the best education lawyer to assist you. Attorney-advisor Joseph D. Lento has helped countless medical students across the country fight disciplinary action involving exam violations, applying for legally-required disability accommodations, and safeguarding due process rights.
Instead of allowing the pressure of the situation to overwhelm you, Joseph D. Lento and the Lento Law Firm's Student Defense Team can secure your chance at a fair USMLE score. Remember how far you have come to achieve your professional aspirations in the healthcare industry and become a board-licensed physician. Call 888-535-3686 today, or visit the confidential online consultation form. Your career and reputation depend on it.
