EMERGENCY MAILBAG: The USMLE Cheating Scandal

This week, the USMLE announced that a number of test-takers from Nepal would have their Step scores invalidated due to “a pattern of anomalous test performance” suggesting “prior unauthorized access to secure exam content.”

This was big news that flooded my inbox and DMs… and necessitated an *emergency* mailbag. Here, I’ll cover ‘USMLE recalls’; Prometric center test security; how the cheaters got caught (and what will happen to them in the future); and where the USMLE should go from here to improve test security and maintain trust in their scores.

*** - Be sure to check out Part 2 and Part 3 here!

MORE Emergency Mailbag: The USMLE Cheating Scandal, Part II

Mailbag: Wrapping Up the USMLE Cheating Scandal

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NOTES:

1. Here are the official statements from the USMLE and the ECFMG…

2. I mentioned a few videos that explain in further detail certain other things about the USMLE…

Breaking the magic: how the USMLE three-digit score is calculated

Mailbag: Questions about the USMLE

A Brief Update on USMLE Score Creep

3. Here are the papers I mentioned…

Wood TJ, et al. Identifying the unauthorized use of examination material. Eval Health Prof 2010;33(1):96-108.

Smith R. Cheating at medical school. BMJ 2000;321:398.

4. Here’s the CNN story on the American Board of Radiology recalls scandal…

5. Here’s the Medscape article on USMLE recalls…
(n.b., the reporter was actually working on this for a couple of weeks BEFORE the USMLE’s announcement!)

6. Here’s a brief news article on AAMC v. Anyanwu… but if you want a really wild ride, look up the actual court filings.

_
MUSIC:
‘Clutch’ - Nicolas Major.

[moose]

You are the real Mitral Valve Prolapse

[henry.]

One of my old med school profs worked at USMLE and he said that it costs several thousand dollars to develop a single question because it has to be agreed upon by many physicians. Probably why the qbank is so small.

[inshapun]

When I clicked this video, I wanted to educate myself about the USMLE cheating scandal back home. At the end of the video, I felt I had a bird’s eyeview of the overall USMLE system. It helped me think, question and ruminate about so many things. Thank you for putting this together.

I scanned your other content too, looks well researched. You have earned a new subscriber.

[kindaabigdyl]

Thanks for a great video recap/summary.

I just wish NP tests and their boards took their testing and education as seriously.

[Monmon-]

Incredible, I enjoyed watching your video and I agree with your suggestions. I always wondered when you see someone with 260+ score are average when you have scientific discussion with them.

[noahthomas]

Hey I love your videos keep it up! I noticed you have a high pitched hum on your voiceovers. You could fix that by bouncing your voiceover then using a noise gate and eq then doing a high cut on that voiceover track. Then you can put it back in your editor with no buzz or extraneous noise, you’ll have to experiment with the threshold for the gate and the frequency for the eq but since it’s the same frequency, it shouldnt be too hard.

[ammyn]

Just to get to a certain point, how cruel steps some people take instead of working hard, that can hurt other innocent people really sickens me.
I had my exam the day before yesterday, I worked hard, skipped family events, cried sometimes due to anxiety and then told myself “everything is gonna be alright”.
Now I feel bad for every IMG including myself, that how our reputation could be affected without doing anything.
I pray that everyone who did nothing wrong stay safe and get the fruit of their hardwork. Amen.

[were]

The issue with the USMLE is that a simple pass is not enough. As long you have cut offs based on a candidate's centile rank, you will incentivise cheating. As someone who sat the USMLE, I was always mindful that someone could recall test questions and circulate them to cheat. However, given the complexity and duration of this exam, I thought that a reliable cheating mechanism created by a candidate's recall would be hard to implement. The fact that this was successfully achieved highlights just how sophisticated and deeply engrained the cheating culture is. This is not just the case in Nepal but inevitably other countries too, including the US.

[RussaalSinghMann]

Really appreciate you putting out a video like this, and shedding light on unfair means by candidates...it only hurts the people who goive their best and prepare fairly....and most of all the patients who woll be treated by these physicians.

[ifrqi]

You mentioned the story about the exam recalls for the American Board of Radiology exam several years prior. Have you heard from colleagues of similar recalls for any of the other specialty board examinations?I've heard how bad USMLE cheating is, but it was surprising for me to hear that it happens on specialty boards too.

You made your thoughts clear about the shortsightedness of folks who find it morally appropriate to cheat on an exam series that determines physician licensing. It makes me wonder if there is any legal recourse against individuals who get "caught" beyond board action.

[shinyumbreon]

There are at least two questions from Step 2 that I could probably write down word-for-word, because I looked at them for so long in the test. I didn’t post them on the internet because 1) that’s not ethical and 2) ethics aside, USMLE openly told me that they’d invalidate my score if I did. The number of people defending the cheaters—many of them grad students who know what academic dishonesty is!—is horrifying to me.

[sinaghnz]

Did this extensive cheating affect other examinees’ score?I mean by raising the average score, they caused inflation of the minimum passing score and led many applicants fail and retest.Any thoughts?

[samadhithabrewwijeratne]

how did this effect the exam average score and does it mean it could've skewed results for those with scores on the lower end/ borderline to fail due these high score outliers?

[kappa]

In this case Nepal prometric center was not involved. Students just used recalls which are done everywhere. Usmle only detected this on the basis of similar answers on questions and improbable high score

[isaacjamestea]

It's hard to find a competent resident. When I was in training not long ago there were those who were let's say not your best resident but they would always remediate and give second chances rather let them go. And this is someone who hasn't had any of this USMLE cheating issues. Losing a resident is huge for a program with all the schedule and rotation changes and coverage needed. If the resident is competent, I'm sure most will close one eye and move on rather than let the resident go. I'm not saying I condone cheating, but what I said above is just the reality of the situation at many places.

[usertrios]

Simply put, higher score corresponds to how good a cheater is at stealing exam questions.

[modelbashir]

I think alot of academic programs will flat out dismiss those residents. Community program PDs might want to keep them or give them a second chance. Some schools have a very low tolerance for that kind of thing specially being an academic institute. I think USMLE should not have analyzed past tests only for the current year and moving forward. Its hard not to "cheat' if everyone else around you is doing it. how do you compete as IMG when every other IMG in your country is using recalls and have been doing so for years. your 240 is not enough when the bottoms in your class can get a 260+ easily with recall. This is unfair. current year or make an announcement going forward. The fact that recalls even exsist or are viable lies soley with USMLE. Make more questions and do not reuse 60% of the pool of questions. Do it like the MCAT. Make less test dates avilable. Protect the integrity of your tests so students do not have to use recalls to compete with classmates

[ananyathakur]

How far back did usmle go to invalidate ! Is this only scores of 2023 ? Or back to to 2019 ?

[adamkatz]

One of the unfortunate casualties of this circumstance will be a precise preordained system of justice distribution.

+/- 10 of the original score…

If you were unlucky enough to be included as a result of these proceedings unjustly… you are a victim of the cheaters who received their just reward.

We don’t have a justice system to deliver justice, we have one to prevent future crimes.

[truthteller]

Wooh really looking forward to this video!