Category Archives: NBME

The National Board of Medical Examiners (NBME) provides assessments of healthcare professionals. If a physician or other healthcare professional is accused of cheating or gets their license revoked, there can be major consequences.

Ready or Not, It’s Irregular Behavior Season…

LLA Headshot smBy Lenis L. Archer, J.D., M.P.H., The Health Law Firm

Every year at regular intervals, our firm receives calls from panicked medical students and residents about a recent letter they have received, alleging irregular behavior.

This letter may come from the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE), or the Educational Commission for Foreign Medical Graduates (ECFMG). No matter the organization, if you receive a letter alleging irregular behavior, it will typically say the following:

1. A bulletin or policy related to the exam stating that Irregular Behavior is not permitted.
2. The facts alleging irregular behavior in this case.
3. You have an opportunity to respond to the allegations, in person, with counsel.

Often there is a very short window of time to respond to such allegations. While this is important because it is urgent that you get your test results, it also gives a limited time to prepare to defend yourself.

What is Irregular Behavior?

Although irregular behavior is not the same thing as cheating, it is often thought of as the same by medical school officials and residency program directors. A notice of irregular behavior may hold up and delay your entry into a residency program, your graduation from medical school, and your job opportunities. Your examination scores will be held up while the matter is reviewed by a USMLE Committee on irregular behavior or until a hearing can be held.

What Should You Do?

Once you receive an irregular behavior letter, begin to compile documents to defend yourself. Write out your version of events in order to recall what happened. Collect character reference letters from professors and administrators that attest to your integrity.

Place the personal appearance date listed in your letter on your calendar. It is of utmost importance that you attend in person, preferably with representation. Hearings are usually held in Philadelphia, Pennsylvania, so plan accordingly.

Consequences of an Irregular Behavior Finding.

If a finding of irregular behavior is made against you, then this usually means that your best score is voided, and you must retake it. The USMLE Committee may require you to wait a year or more to retake the examination. This can prevent you from obtaining or entering a residency program or it may delay you from graduating. Furthermore, the notation that you were found to have committed irregular behavior will be placed on your Step exam transcript. This will be reported out when your test scores are reported.

As indicated above, many medical decision makers view this as similar to cheating. It may disqualify you for many jobs or residency programs that you would otherwise be considered for. If you are accused of irregular behavior, immediately consult with an attorney who has actual experience in dealing with this matter. You can find more information about irregular behavior by clicking here.

Comments?

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? Please leave any thoughtful comments below.

Contact Experienced Health Law Attorneys.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at. www.TheHealthLawFirm.com.

About the Author: Lenis L. Archer is as attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

 

“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 © 1996-2015 The Health Law Firm. All rights reserved.

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Use Caution in USMLE Step Exam Preparation

CTH Blog LabelBy Catherine T. Hollis, J.D., The Health Law Firm and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The United States Medical Licensing Examination (USMLE) Bulletin of Information outlines several examples of conduct that is deemed to be irregular behavior.  On February 27, 2014, the USMLE posted an Announcement listing the types of alleged irregular behavior recently reviewed by the Committee for Individualized Review (CIR).  Some of the cases reviewed involved individuals who were accused of soliciting unauthorized access to examination materials or communicating about specific test items, cases, or answers with other examinees.  This particular type of irregular behavior seems to be increasingly alleged against individuals who have participated in online forum discussions requesting assistance with examination preparation.

Click here to read the entire February 27, 2014, USMLE Announcement.

Do Not Seek Specific Examination Materials or Attempt to Communicate With Other Examinees.

The USMLE is taking a hard line stance on enforcing its irregular behavior policies concerning soliciting test materials and communicating about specific test items.  We have recently seen a number of individuals accused of engaging in irregular behavior because of posts on forum websites that appear to be solicitations for specific examination materials or cases.  Some examples of these posts include:

–    Joining in requests from others for information on recent test questions after another individual’s post requesting Step 2 Clinical Skills  (CS) cases;
–    Requesting that others provide information about some of the cases at a specific test center;
–    Suggesting approaching examinees as they leave the exam center to ask about the exam; and
–    Requesting a list of CS cases for a specific test center.

Know the Rules.

All USMLE applicants are required to be familiar with the USMLE’s Bulletin of Information.  By signing a Step Exam application, an applicant is certifying that he or she has read and is familiar with all information contained in the Bulletin. You will still be held responsible for this whether you read it or not.

According to the Bulletin, irregular behavior includes any action that subverts or attempts to subvert the examination process.  As noted above, the Bulletin contains a non-exhaustive list of examples of conduct that is deemed to be irregular behavior.

Click here to read our previous blog about irregular behavior.

Irregular Behavior Has Serious Potential Consequences.

If an examinee is found to have engaged in irregular behavior, the CIR will impose sanctions.  These sanctions can include an annotation on an individual’s USMLE transcript, invalidation of scores, a report to the Federation of State Medical Boards, and even a bar from taking future USMLE examinations.

Appropriate Test Preparation.

Examinees can adequately prepare for the USMLE Step exams without the need to seek further assistance that might cross the line into irregular behavior.  On April 4, 2014, the USMLE posted an Announcement on its website with information about materials available from the USMLE, the National Board of Medical Examiners (NBME) and third parties. From the USMLE website, examinees can access free orientation and practice materials, including:

–    Informational materials on the overall USMLE program and content descriptions for each of the USMLE examinations;
–    Tutorials that illustrate the USMLE Step 1, Step 2 Clinical Knowledge (CK), Step 3 multiple-choice software and the Step 3 computer-based case simulation (CCS) Primum® software;
–    Sample multiple-choice test questions with answer keys for each Step exam;
–    Sample Step 3 CCS cases with feedback; and
–    Orientation materials for Step 2 CS.

Examinees may also, for a fee, take advantage of the self-assessment services offered by the NBME.  These services are designed to familiarize examinees with USMLE questions and provide feedback on the examinee’s areas of strength and weakness.

There are also a variety of commercial test preparation materials and courses that claim to prepare examinees for USMLE Step exams.  These courses are not affiliated with or sanctioned by the USMLE program, but may be helpful to you.

Click here to read the entire April 4, 2014, USMLE Announcement.

Contact Health Law Attorneys Experienced in Representing Health Care Professionals.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you ever come across these online forums? Have you ever posted in these forums? Please leave any thoughtful comments below.

Sources:

“USMLE Takes Action Against Individuals Found to Have Engaged in Irregular Behavior.” USMLE. (February 27, 2014). From: http://www.usmle.org/announcements/?ContentId=130

“Use Caution in Selecting Review Courses.” USMLE. (April 4, 2014). From: http://www.usmle.org/announcements/?ContentId=67

“USMLE 2014 Bulletin of Information.” USMLE. (2013). From: http://www.usmle.org/pdfs/bulletin/2014bulletin.pdf

About the Authors:  Catherine T. Hollis is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

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. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“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 © 1996-2014 The Health Law Firm. All rights reserved.

Medical Students and Residents Must Fight Allegations of “Irregular Behavior” on the USMLE Step Exams

6 Indest-2008-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I am constantly taking calls from medical students and residents (or future residents) relating to allegations brought against them of “irregular behavior” in connection with the United States Medical Licensing Examination (USMLE) exams. Although the term “irregular behavior” is equated by many with the word “cheating,” it is actually defined by the USMLE to mean:

Irregular behavior includes any action by applicants, examinees, potential applicants, or others when solicited by an applicant and/or examinee that subverts or attempts to subvert the examination process.

The notice that a person has been accused of irregular behavior may come in a letter from the USMLE, National Board of Medical Examiners (NBME), or Examination Committee for Foreign Medical Graduates (ECFMG). In serious cases, one might be approached by a private investigator or law enforcement authority, for example in the case of an alleged theft of an examination or illegal use of examination questions.

Regardless, any notice that you are suspected or accused of irregular behavior should be treated as an extremely serious matter that can suspend your medical education or residency and place your medical career on hold. You should immediately contact an attorney familiar with health and medical law and, especially, one familiar with USMLE, NBME and ECFMG proceedings.

Examples of What Not To Do.

A few examples of irregular behavior we have consulted on include:

1.  A student soliciting information about the contents of a USMLE step examination in an online blog.

2.  Individuals blogging online regarding a certain step exam preparation course they took when the course instructor allegedly used actual examination questions to teach it.

3.  An individual allegedly using an iPhone during a step examination.

4.  Someone setting a fire in a bathroom in the testing center where the examination was given.

5.  An individual who allegedly had written notes on his arm to use during the exam.

6.  Someone who wrote down notes about the exam on a piece of tissue paper after the exam was over.

No matter how trivial the matter may initially seem, it can have devastating effects. The reporting of your test results will be held up until the matter is completely resolved, thereby delaying entry into or continuation of a residency program or, in some cases, medical school graduation. Choice residencies can be lost and a promising medical career can be placed on hold.

If irregular behavior is confirmed, test scores will be voided, your transcript of USMLE tests will be annotated with the fact that you were found to have committed irregular behavior and you may not be allowed to retake the exams for a period of time. This can really screw up your life.

Ask for a Hearing and Be Prepared.

If you are accused of irregular behavior, you will be given the right to have a hearing before a committee of the USMLE which will hear evidence on the matter. Ask for the hearing! Do not waive it.

You will have the right to submit documents on your own behalf. Do this. Use any favorable document that supports your side of the story, shows your good character, shows your academic and clinical performance and mitigates from the seriousness of the alleged conduct.

Attend the hearing in person and with your attorney. You have this right. Do not expect to win a hearing if you do not attend it yourself to answer any questions the committee may have. These committee hearings are all held at MBE headquarters in Philadelphia, Pennsylvania, so it may be a challenge to attend. But you must do so; this may be the most important hearing of your life.

Retain expert witnesses to support you if appropriate. In matters where a statistical extrapolation is used against you, a statistics expert can be a valuable asset.

Many times the facts of the situation turn out to be far different from what the USMLE secretarial has initially reported. But you must avail yourself to the procedures and opportunity to prove this.

Don’t delay. At your first notice, contact an experienced attorney to represent you. The stakes are too high to gamble on handling it yourself.

Contact Experienced Health Law Attorneys Today.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you faced the Committee? What was the experience like? Did you retain experienced legal counsel? Please leave any thoughtful comments below.

About the Author: 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.

“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 © 1996-2012 The Health Law Firm. All rights reserved.

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

Many 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 www.TheHealthLawFirm.com.

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 www.TheHealthLawFirm.com or read this article concerning USMLE and ECFMG challenges and representaion.