What Medical Students Need to Know About a Finding of “Irregular Behavior” on a USMLE Step Transcript – Part One

i4Perfection150429-1A6A0291-Edit-EditBy Ritisha K. Chhaganlal, J.D. and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health

The United States Medical Licensee Examination (USMLE) Step exams are a major component of students’ journey through medical school.  Most students focus on preparing a study plan and earning the ideal score to get into a residency program of their choice.  However, many medical students are not aware of the potentially career-damaging finding of “Irregular Behavior” on their USMLE Step transcript.

In this two-part series blog, we will discuss what constitutes irregular behavior and what the next course of action should be if there is a finding of irregular behavior.

What is Irregular Behavior?

In short, irregular behavior is typically regarded as cheating by medical school officials and residency program directors, even though it is not exactly the same thing.  Any such finding will be stamped on a USMLE transcript with a detailed letter of explanation attached to it.  This letter may come from the National Board of Medical Examiners (NBME), the USMLE, or the Educational Commission for Foreign Medical Graduates (ECFMG).  Regardless of the organization it came from, the letter alleging irregular behavior typically states 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.

-The opportunity to respond to the allegations, in person, with counsel.

What a Finding of Irregular Behavior Can Mean for Medical Students.

A finding of irregular behavior can be a career ending event.  At the very least, it may delay graduation from medical school.  It may also disqualify medical graduates from many jobs or residency positions.  Additionally, USMLE Step scores are withheld from the test-taker while the USMLE Committee reviews the matter, or until a hearing has been held.

If a finding of irregular behavior is made, then usually the test-taker’s best score is voided and he or she must retake the exam.  The USMLE committee may also require the test-taker to wait a year or more to retake the exam.  Further, the finding of irregular behavior will be stamped on the test-taker’s USMLE transcript and visible to anyone that views it.

Conduct Defined as “Irregular Behavior.”

The USMLE defines “irregular behavior” as conduct that includes (but is not limited to) the following:

(1)    Seeking, providing, or obtaining unauthorized access to examination materials;

(2)    Providing false information, making false statements, or similar conduct in relation to application forms, scheduling permits, or related documents;

(3)    Taking an examination when the examinee is not really eligible for it (or attempting to do so);

(4)    Impersonating another test-taker or engaging a different person to take the examination for the actual applicant;

(5)    Obtaining, giving, or receiving assistance during the examination or attempting to do so (except for certain authorized acts);

(6)    Making notes in the secure areas of the test center, except for notes on the writing materials provided at the test center for this purpose;

(7)    Failing to comply with or follow any USMLE policy, procedure, or rule;

(8)    Failing to follow instructions of the test center staff;

(9)    Abuse or harassment (verbal or physical) of test center staff or any other disruptive or unprofessional behavior at the test center;

(10)    Being in possession of any unauthorized materials, including photographic equipment, or communication or recording devices, including electronic paging devices and cellular telephones, in the secure testing areas;

(11)    Changing or misrepresenting your examination scores to others;

(12)    The unauthorized reproduction of any examination materials or dissemination of them by any means, including via the Internet (this includes, for example memorizing them and repeating them, restructuring them, discussing the actual questions and answers, etc.). Note: all test questions and testing materials are copyrighted. You could be prosecuted or sued for violation of the NBME’s copyrights, and this has actually happened; and

(13)    Communicating or attempting to communicate about specific test questions, answers, items, or cases with any other examinee, potential examinee, or preparation group at any time.

Other Negative Findings by USMLE That May Be Detrimental.

In addition to irregular behavior, USMLE has also accused a test-taker of “Anomalous Results.”  This means that a test-taker made answer selections that look suspect (i.e., putting down answer choice “C” for every question).  For more information about other negative findings by USMLE, contact our office.

Stay tuned for the second part of this two-part blog series on irregular behavior where we will discuss the steps that are recommended to combat a finding of irregular behavior.

Comments?

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?

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in the following areas: in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), discrimination due to race, sex, national origin, sexual orientation and any other matters, reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in state or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenants (covenants not to compete).

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at http://www.TheHealthLawFirm.com.

4 Indest-2009-3About the Authors: Ritisha K. Chhaganlal, J.D., is an attorney with The Health Law Firm.  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.  http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: United States Medical Licensee Examination (USMLE) Step exams, irregular behavior, graduate medical education (GME), medical graduate attorney, Association of American Medical Colleges (AAMC), Accreditation Council for Graduate Medical Education (ACGME), graduate medical education attorney, lawyer for medical students, medical resident attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, medical students legal counsel, National Board of Medical Examiners (NBME) lawyer, health law attorney, The Health Law Firm, Educational Commission for Foreign Medical Graduates (ECFMG), anomalous results, USMLE Step transcript

“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 © 1996-2016 The Health Law Firm. All rights reserved.

 

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Contracting 101: Tips for Medical Graduates Entering the Workforce: Part One

i4Perfection150429-1A6A0291-Edit-EditBy Ritisha K. Chhaganlal, J.D.

This blog is the first in a series intended to provide an introductory review of the basics of contracting for medical graduates entering the work force as residents and fellows, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice.

By the end of this series it is our hope that medical graduates will better understand the common language and terms found in employment contracts for professionals. These tips purpose to assist new professionals in recognizing common mistakes made by physicians and health professionals when negotiating contract terms. We hope to help make both employers and employees more knowledgeable about employment contracts so they can avoid potential problem areas and legal entanglements.

Our comments here are meant to provide general rules we have learned from our experience. However, please remember, every situation is different and there are exceptions to every rule. These tips are not intended to constitute legal advice. We recommend contacting an experienced health attorney for questions or concerns regarding specific employment contracts, or to thoroughly review all of the contract terms prior to acceptance.

Tip 1 -“Standard” or “Routine” Physician Employment Agreements Do Not Exist.

No two employment agreements are identical. Each must be reviewed on its own terms. It is important to consult with a healthcare lawyer experienced in negotiating employment contracts and evaluating health care business transactions.

Tip 2 – Negotiation is Always an Option.

Even though an employer may have what appears to be a “standard” employment contract for all physician employees, this can have changes, amendments, schedules, exhibits or terms that are varied from physician to physician or professional to professional. Generally, large employers are less likely to change their form to accommodate the physician than small organizations, but they can and often will. Small employers are often willing to make more changes to their written agreements.

If there are any changes, additions or clarifications you need to make to the contract, then put them in writing, sign them, incorporate them into the contract and attach them to the contract.

Tip 3 – All Oral Agreements Should be Accurately Reflected in the Wording of the Contract.

If it is different or not specified, the language in the contract will govern in any future dispute.

Keep Checking Back for Future Blogs on Employment Contracting.

In our future blogs, we will continue to provide tips on various issues to watch for in health care employment contracts.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in the following areas: in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), discrimination due to race, sex, national origin, sexual orientation and any other matters, reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete).

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: Ritisha K. Chhaganlal, J.D., is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone (407) 331-6620.

KeyWords: physician employment agreement, physician employment contract, health professional contracting, negotiating business transactions, physician contracts, contracting tips for medical graduates, contract attorney, business law attorney, business lawyer, contract lawyer, contract litigation, business litigation, employment contract terms, physician agreements, physicians entering the workforce, business transactions, restrictive covenants, noncompetition agreements, covenants not to compete, business ventures, residency and fellowship, medical graduate attorney, fellowship contract lawyer

“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 © 1996-2016 The Health Law Firm. All rights reserved.

Standardized Patient Program at UCF Offers Medical Students Advantages Not Encountered in Routine Hospital Rotations

i4Perfection150429-1A6A0291-Edit-EditBy Ritisha K. Chhaganlal, J.D.

Standardized patients (SPs) are an integral part of learning at the University of Central Florida (UCF) College of Medicine.  The “patients” are treated as if they are suffering from actual illnesses and ailments.  Medical students poke and prod and question such patients on symptoms and medical histories, and are even assigned the opportunity to break bad news in certain situations.

By doing so, the medical professionals in training are offered experience not always able to be acquired through routine hospital rotations.  SPs can also offer assessments of students’ performance, providing constructive criticism and further growth throughout their training.  Additionally, some medical students have actually assisted SPs in discovering unknown medical conditions that have gone previously undiagnosed.

The win-win of the long accepted and utilized concept in medical training has pushed UCF to expand on its current roster of more than 60 SPs.

The Role of a Standardized Patient.

It would seem that SPs are simply actors, however, Victor Changsan, a UCF student who doubles as an SP, said, “[…] it’s more than that.  I’m a facilitator or an assistant instructor.”

Neurologist and medical educator, and the creator of the first SP in the 1960’s, the late Dr. Howard S. Barrows, M.D., said, “The [SP] is a person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician.”

SPs are given scripts and act out (similar to an actor) different medical and social situations.  Also not unlike actors, most SPs are required to undergo an audition prior to selection.  As reported by the Orlando Sentinel, Rebecca Beiler, an SP educator at UCF College of Medicine, said, “We give them a simple case.  They review it and come in and portray it.”  This simple scenario is played out once in front of a top performing medical student and once again to a less organized medical student.  Beiler says the reasoning behind this “… allows us to see if they follow direction and don’t interject and how well they do in acting, because the students have to buy it.  They have to make it believable.”

However, according to the University of Pittsburgh School of Medicine, unlike acting, “[t]his work has nothing to do with finding dramatic moments, entertaining, or playing to an audience.  It can be very repetitive; the same patient must be presented for every student.”  For FAQ’s regarding SPs issued by the University of Pittsburgh Office of Medical Education, click here.  Furthermore, SPs must undergo training and practice scenarios with one another before being seen by medical students.  SPs have the opportunity to become more advanced in their role as well, even becoming SP educators such as Beiler.

Changsan said, “I don’t give them [medical students] the medical stuff, but I give them the human aspect.”

Benefits of the Utilization of Standardized Patients.

Dr. Barrows’ innovative teaching and assessment conceptualizations derived from a need for a more extensive methodology of evaluating the clinical skills of third-year medical students.  While his concepts were not widely accepted when initially developed, Dr. Barrows’ persistence gradually assisted in shaping present-day medical school curriculums across the United States.  To read more on the origin of SPs in the U.S., click here.

The utilization of SPs complements medical education by rounding out the following areas: demonstration and instruction, practice and experience, and evaluation and assessment.  Medical students are able to gain valuable skills in bedside manners, medical history documentation and critical thinking skills through the use of SPs in their training.

Dr. Barrows noted, “This examination simulates the entire encounter with a patient from beginning to end and allows us to assess students’ clinical skills in a valid, comprehensive, and powerful way.”  He further explained that SPs add significant value to medical students by: preparing them for actual clinical problems in a less threatening environment; allowing for interruption and immediate, consistent and corrective feedback; and making it possible for students to practice communication skills with sometimes difficult patients or emotionally-charged situations.  To read more on Dr. Barrows’ overview of the utilization of SPs, click here.

Comments?

Does/did your medical school utilize standardized patients?  Do you believe it was a helpful addition to the curriculum?  Please leave any thoughtful comments below.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Miller, Naseem S.  “Fake Patient Help Teach UCF Students.”  Orlando Sentinel: 6 Nov. 2015.  Web.  28 Dec. 2015

“Standardized Patient Frequently Asked Questions.”  School of Medicine Office of Medical Education.  University of Pittsburgh: 13 Jan. 2012.  Web.  21 Jan. 2016.

Stratton, Terry D., Ph.D.  “Origin of Standardized Patients in the United States.”  Office of Medical Education, UK HealthCare.  University of Kentucky College of Medicine: 2015.  Web.  21 Jan. 2016.

“Using Standardized Patients in Teaching & Assessment.”  School of Medicine Office of Medical Education.  University of Pittsburgh: 28 Oct. 2014.  Web.  21 Jan. 2016.

About the Author: Ritisha K. Chhaganlal, J.D., is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone (407) 331-6620.

KeyWords: Graduate medical education (GME), medical graduate attorney, Association of American Medical Colleges (AAMC), Accreditation Council for Graduate Medical Education (ACGME), graduate medical education attorney, lawyer for medical students, medical resident attorney, use of standardized patients (SPs) in medical school, standardized patients in medical training, medical graduate evaluations and assessments, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, medical students legal counsel, United States Medical Examiners (NBME) lawyer, health law attorney, The Health Law Firm, UCF College of Medicine applicants, UCF College of Medicine enrollees

“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 © 1996-2016 The Health Law Firm. All rights reserved.