How Student Discipline Issues Can Impact USMLE Eligibility

One of the biggest milestones in your medical school studies occurs when you take your Step exams, which are the three stages of the United States Medical Licensing Examination (or USMLE). The USMLE assesses your ability to apply your learning from medical school. Together, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB) administer these exams. They expect that you'll demonstrate patient-centered skills as well as apply key concepts, principles, and knowledge to show that you will practice safe and effective patient care. If you are an international student, you may have to get your ECFMG (Educational Commission for Foreign Medical Graduates) certification before being allowed to take your Step 3 exam.

With so much money and time invested in your medical career, running into student discipline issues when you attempt to take your licensure exams can have a huge impact on your future medical career.

Irregular Behavior 

Most often, the NBME, USMLE, or ECFMG notifies a student of reports of irregular behavior, and while this may seem insignificant, it's important to challenge these allegations, refute them, and request a hearing. If you don't submit a challenge and are found to have committed “irregular behavior,” this has the same implication as cheating. If the boards find you guilty of this, it will follow you on your transcript and has a significant chance of impacting your ability to match with your ideal residency program. The residency that you participate in can drastically impact your future career as a physician, and after so much effort to complete your medical school studies, you must challenge this charge if it is brought against you.

How Do the USMLE and ECFMG Define Irregular Behavior?

According to the USMLE website, “irregular behavior” is conduct that includes (but is not limited to) the following:

  1. Seeking, providing, or obtaining unauthorized access to examination materials, including online or in person, but not limited to those.
  2. Providing false information, making false statements, or similar conduct concerning application forms, scheduling permits, or any other documents linked to USMLE.
  3. Taking an examination when the examinee is not really eligible for it (or attempting to do so).
  4. Impersonating someone to take the exam on their behalf or finding someone to do this for you.
  5. Offering, acquiring, or looking for 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 written materials provided expressly for this purpose.
  7. Failing to follow any USMLE policy, procedure, or rule or the instructions of the test center staff.
  8. Verbal and physical abuse, harassment, or threats toward test center staff or any other disruptive or unprofessional behavior at the test center.
  9. Possessing any unauthorized materials, including photographic equipment, or communication or recording devices (cell phones, fitness trackers, etc), in the secure testing areas.
  10. Altering or misrepresenting your scores.
  11. Failure to cooperate with an investigation regarding a potential violation of the USMLE rules.

At the bottom of the page, they also state that there are severe consequences for anyone who attempts to acquire test materials, sell test materials, or communicate about test materials with anyone who has recently taken the exam. If found to have engaged in any of these (or hosting a site for others to do so), “your registration and/or testing may be canceled, your scores on the USMLE may be withheld or canceled, and you may be subject to further sanctions.”

What Are Examples of Irregular Behavior?

In actual practice, some instances of irregular behavior are what you would expect. Others are behaviors that you might consider harmless. Here are some examples:

  • Attending a USMLE prep course offered by a third-party where they use actual exam questions
  • Talking with another person during the exam
  • Using your phone during a break
  • Applying for the exam after withdrawing from your medical school
  • Completing your USMLE application incorrectly
  • Setting fire to the testing center so that your test is postponed

As you can see some of the examples above appear more serious than others. Often it turns out that the allegations of irregular behavior can be easily overcome by an attorney who has experience in student disciplinary action.

What Action Should You Take?

If the NBME, USMLE, or ECFMG has notified you of irregular behavior concerns, there are a few steps that you can take to protect your future.

  1. Do not delete any material from test prep, emails, text messages, etc. You won't know what is important and helpful for your hearing. Instead, keep it so that a student defense attorney can evaluate their usefulness in fighting on your behalf.
  2. Obtain copies of all material tied to your course prep. This will be paramount, again, for your student defense attorney to take stock of and see what can be helpful in your irregular behavior hearing.
  3. Find an experienced student defense attorney who can be present at the hearing, which usually occurs in Philadelphia. They will understand how to best approach this bump in your medical career so that it remains a bump and not a road closure.
  4. Gather evidence of your character: awards, achievements, honors, reference letters of character. All of these items can help in your defense. They may help demonstrate what type of person you are, in the hands of an experienced student defense attorney.
  5. Request an in-person hearing and be prepared to go a day early to review information with your attorney.

What Are Potential Mistakes to Avoid? 

There are also several mistakes that medical students sometimes make when they've received a letter from the NBME, USMLE, or ECFMG. It's best to try and avoid these if possible so that the investment of time and money is not poorly affected.

Inability to take action because of concern or fear

Sometimes medical students are paralyzed when they receive the notice of irregular behavior. Time can be lost as students try to figure out what it means or worry about the consequences.

Try to defend themselves before the committee

Trying to speak to the committee meeting alone doesn't make much sense. Sometimes students think they can go and apologize or clear their name, however with something so important at stake, it's critical to have a student defense attorney by your side.

Appear before the committee and contact an attorney after the fact

Sometimes families don't realize the seriousness of an irregular behavior notice, and so they attempt it alone. It's wiser to engage an attorney before the damage has been done by an undesired outcome.

How to Prepare for the Hearing Before the Committee Meeting? 

Medical professionals make up the hearing committee. Often there are doctors, professors, members of professional organizations, and so on. Most frequently, the hearings occur in a conference at the National Board of Medical Examiners Building in Philadelphia. A good attorney can assist you with preparing for the hearing, so you are ready to fight for your future when you enter the room. Here are some things you can do to prepare.

  • Request a complete copy of the USMLE file. Make sure that this includes anything that they've gathered, such as statements, video evidence, internet or social media postings, etc. Don't respond until you've received it. An attorney can assist you in understanding the ramifications based on the evidence that you are sent.
  • Document everything and request everything in writing. Request a hearing, and the ability to appear in person at the hearing. If you need an extension, do so in writing. Keep copies of everything. File everything early, including your initial statement. Tracking numbers are your friend and will help you ensure that what you send is received. Require signatures on items.
  • Tell the truth in your statement and everything that you provide. Don't submit false information. Everything that you submit will be investigated by their team and if you have failed to tell the truth, it most likely will lead to harsher penalties.
  • Take care with everything you write. Make sure it sounds professional and thoughtful. Your written communication is your first line of defense, as it's how the investigators will first engage with you. Organize your statements, documents, and communications clearly and succinctly.
  • Prepare a statement that directly responds to the allegations. A student defense attorney can advise you about the best way to do so.

With so much at risk and so many moving parts, if you've been notified of irregular behavior, you must find the best lawyer to assist you. Attorney Joseph D. Lento has helped students across the country fight disciplinary action. As a medical student, you want someone committed to protecting your rights and ensuring that due process occurs so that you are not penalized for the alleged irregular behavior or other disciplinary actions. You've worked too hard and put too much effort into your medical school studies for something like this to negatively impact your medical career. Contact us today at 888-535-3686.

Contact Us Today!


If you, or your student, are facing any kind of disciplinary action, or other negative academic sanction, and are having feelings of uncertainty and anxiety for what the future may hold, contact the Lento Law Firm today, and let us help secure your academic career.

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