Recent Reports Indicate Cheating Rampant on Medical License Exams 

Sarasota, FL (WorkersCompensation.com) - The United States Medical Licensing Examination (USMLE)  program consists of two entities, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Together, these entities develop and administer medical licensing tests, and report the results of those tests to medical licensing authorities. 

The FSMB consists of representatives of 70 medical and osteopathic boards. A non-profit, the organization operates as a governing body in that it is not only responsible for licensing of physicians, but for disciplinary actions of physicians that break the law, and investigating patient complaints. Additionally, the FSMB directs credentialing documentation and protocols, maintains a database of physician disciplinary actions, and acts as a voice on issues impacting licensing and practice of medicine. 

The NBME collaborates with national medical professionals and experts in other fields such as test developers, scoring experts, and academic researchers to develop educational programs and assessments for those individuals working toward obtaining their medical license. The NBME is led by a twelve member board of directors. 

USMLE testing consists of three steps to determine not only medical knowledge, but also the ability to apply the knowledge in an ethical manner.

With an emphasis on principles and mechanisms related to health, disease, and modes of therapy, Step 1 is to assess whether applicants actually understand and can apply the sciences related to the basic practice of medicine. Step 1 is an eight hour session, in one hour blocks with a 45 minute break, and a 15 minute optional tutorial. The total number of questions in the tests do not exceed 280.

Step 2 takes nine hours to complete, with a maximum of 318 questions. The purpose of Step 2 is to determine if the applicant can apply medical knowledge in the course of patient care under supervision. 

Step 3 assesses if the applicant can apply medical knowledge and clinical sciences unsupervised in patient care. The test focuses on patient management in an ambulatory setting, and includes different situations that a physician might encounter. 

While the testing is extensive with the goal of producing physicians that are knowledgeable as well as ethical, the USMLE recently announced their investigation into potential cheating based on unusual score patterns that indicate prior unauthorized access to exams. Although details provided in the announcement were minimal, the announcement stated that the anomalous exam results were associated with Nepal, and the results changed the validity of test results for an entire group of examinees. USMLE is currently notifying the applicants of their invalidated exam scores and they will be required to take a validation exams. 

Memorizing test questions is not a new phenomenon. In 2012, a CNN report delved into physicians cheating on medical board exams via extensive accessible databases of “recalls”, or memorized test questions. 

According to a recent Medscape report, Recall websites are rampant and easily accessible to the point that the information is commercially advertised on multiple websites including Reddit and others. Critics of the USMLE testing limits state that allowing applicants to take the test multiple times makes applicants more likely to memorize a test and sell the questions. The USMLE previously allowed six attempts before 2021 but revised the limit to four attempts.   

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