What Is “Irregular Behavior” on the USMLE? How Do I Avoid It?

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What Is “Irregular Behavior?”

The USMLE examinations are tightly regulated and have a high level of security in place to maintain the integrity of their content and ensure their value in assessing candidates for medical licensing. As a result, there are certain actions of examinees that can be flagged as “irregular” and may be sent for review by the NBME’s Committee for Individualized Review (CIR). If the committee determines that the action in question compromises the examination’s integrity, a temporary ban from all USMLE testing will be placed upon the examinee. These bans are most commonly for 3 years, and while not explicitly labeled as cheating, the stigma of having “irregular behavior” listed on your score report or future applications can pose a serious threat to career advancement opportunities. After such a ban, only 16% of all students went on to obtain their full medical licensure.¹

Examples of Irregular Behavior on USMLE Exams

• Falsifying information on testing permit or application
• Sharing USMLE test questions
• Possessing unauthorized items, such as cell phone, recording device, or pre-written notes
• Not following procedures of testing center
• Disruptive behavior during the examination
• Unprofessional behavior at testing center
• Speaking with other examinees during the test

The most common categories of actions that are flagged as irregular behavior are falsifying information (31%) and examination content security violations (27%).²

Avoiding “Irregular Behavior” While Testing

All of these actions are easily avoidable! It is essential that when you are applying for a testing permit or scheduling your examination, you check all your information to ensure that it is correct. Ensure your name matches exactly what is listed on your identification.

Some issues arise for students simply because they are not familiar with the testing center and its protocols. A common solution for examinees is to take a practice test at the testing center, for a small fee, prior to the scheduled examination to become more comfortable on test day.

While online message boards can be helpful while preparing or even when debriefing after a USMLE examination, you should not discuss any specifics of the test on these forums. Additionally, sharing exam content with colleagues or friends is not advisable. Discussing specific content of the exam has and will continue to lead to serious consequences.

Possessing Unauthorized Items

It feels scary to not have any notes or other resources with you during the exam. This fear leads some desperate exam candidates to take the foolish step of bringing unauthorized items, such as smart phones or written notes into the exam room. This stress of not having any resources with you is mitigated with the following resources that the testing center makes available:

1. Something to write on, like a small white board and marker
2. Range of normal lab values
3. Cross-reference of brand/generic names of medications
4. Countdown timer available on every screen

Practice Makes Perfect

The best way to ensure things go smoothly on your scheduled examination day is by doing practice questions while following exam rules. With The Pass Machine for USMLE Step 2 CK and Step 3, you have access to over 4,200 multiple-choice questions for each exam. If you work through the questions, you will have hundreds of opportunities to practice important exam rules: working with a blank note sheet, disallowing access to a cell phone or watch, or answering question blocks without access to food or water.

The USMLE Step 1, Step 2 CK, and Step 3 can be daunting challenges, but if you follow these tips, you can be confident you will avoid any “irregular behavior.”

References

1. United States Medical Licensing Examination. 2019 Bulletin of Information. www.usmle.org/pdfs/bulletin/2019bulletin.pdf. Accessed March 7, 2023.
2. Frances E. Cain, Katie Arnhart, Aaron Young, David Johnson; Characteristics and Outcomes of Individuals Engaging in USMLE Irregular Behavior, 2006–2015. Journal of Medical Regulation 1 December 2020; 106 (4): 8–16.