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Medical licensing authorities and other entities utilize and rely on the United States Medical Licensing Examination (USMLE) as a standardized, valid and reliable tool to assess physicians’ knowledge and skills. As such, engaging in irregular behavior during the USMLE process can have a broad and damaging impact on an individual’s ability to complete the USMLE sequence and subsequently obtain a medical license in the United States. While there are also repercussions for the USMLE program and entities overseeing medical students and physicians, the risk to the public of being cared for by someone who did not pass a medical licensing examination by his or her own merit is of great concern. This study reviews data about individuals who engaged in irregular behavior, common sanctions taken against them and their ability to ultimately practice medicine in the United States. Using data from the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), individuals with findings of irregular behavior as part of the USMLE application and/or testing process between 2006 to 2015 were identified, along with their corresponding demographic, examination, sanction and licensure outcome data. A total of 165 individuals were found to have engaged in 170 incidents of irregular behavior. The majority of individuals were male (63%, n = 101), international medical graduates (69%, n = 112) and had a mean age of 33 years old (SD = 8 years, n = 161) at the first incident or finding of irregular behavior. The two most common types of irregular behavior were falsified information (31%, n = 53) and security violations (27%, n = 46). Most incidents (86%, n = 146) were reported to the FSMB Physician Data Center (PDC) and 68% (n = 116) involved a bar from taking the USMLE for a period of time. Only 26% (n = 43) of individuals ultimately passed the entire USMLE sequence and 16% (n = 27) obtained a full, unrestricted medical license in the U.S. by 2019. To help maintain the integrity of a key component for initial licensure in the United States, there is a continued need for rigorous enforcement and safeguarding of USMLE examination applications, content, testing conditions and score reports. Individuals who plan on taking the USMLE should become familiar with USMLE rules and penalties regarding irregular behavior, including the serious implications of such behavior that can severely diminish their ability to practice medicine in the United States. Entities using USMLE information for licensure or admission into medical-related programs need to diligently ensure authentication of USMLE documents and carefully consider if individuals who have engaged in irregular behavior are qualified to practice medicine.

Characteristics and Outcomes of Individuals Engaging in USMLE Irregular Behavior, 2006–2015