Ready or Not, It’s Irregular Behavior Season...

Wednesday, July 8, 2015
By Lenis L. Archer, J.D., M.P.H., and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

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 on standardized medical examinations.

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:

        A bulletin or policy related to the exam stating that Irregular Behavior is not permitted.

        The facts alleging irregular behavior in this case.

        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 results 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 upmost importance that you attend in person, preferably with representation.  Hearings are usually held in Philadelphia, Pennsylvania, so plan accordingly.  

Why Hiring an Attorney Matters.

An attorney can provide the following services to someone accused of irregular behavior:
Review documents, videos, photographs, and all other information that pertains to your case.
Recommend other documents that you should obtain in your defense.

Prepare you for a personal appearance before the respective board or committee making the allegations, and will also make a personal appearance with you at hearing.

Prepare you to answer questions under pressure and on the day of your hearing.

The takeaway message is that retaining an attorney to represent you against irregular behavior allegations could be the difference between a clear record and a mark that will follow you for the rest of your career.  Don’t risk jeopardizing your future as a healthcare practitioner.  Consult with an attorney as soon as you receive notice of allegations against you regarding irregular behavior.  
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.


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

About the Authors: 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. The Health Law Firm, 1101 Douglas Ave., 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.

"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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