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The U.S. Medical Licensing Examination (USMLE) has invalidated test scores for some examinees from Nepal after finding a pattern of suspicious results.

"As part of an ongoing investigation, the USMLE program has identified a pattern of anomalous exam performance associated with Nepal, which challenges the validity of test results for a group of examinees," USMLE said . "Highly irregular patterns can be indicative of prior unauthorized access to secure exam content."

A USMLE spokesperson told 乌鸦传媒 in an email that "multiple credible tips, review of exam performance data, and a thorough investigative process have confirmed anomalous performance for a group of examinees associated primarily, but not exclusively, with Nepal." The USMLE said the information and patterns emerged in 2023.

The Educational Commission for Foreign Medical Graduates (ECFMG) also detailing that applicants with invalidated scores "no longer meet the requirements for ECFMG Certification" which means they will also not be able to take part in the Match. In addition, previously certified individuals are no longer certified and those on J-1 visas sponsored by ECFMG are at risk.

USMLE said in its statement that they will contact directly anyone whose scores have been invalidated -- and thus will need to take a validation exam -- or who is otherwise impacted. One poster on Reddit of an email a Nepali applicant had received letting them know their results were invalidated.

The USMLE is a three-step exam required to become a physician in the U.S., and is co-owned by the Federation of State Medical Boards and the National Board of Medical Examiners. Step 1 focuses on basic sciences while Step 2 and 3 test increasing levels of clinical knowledge, skill, and decision-making about patient care. Back in 2020, USMLE announced that it would be making Step 1 pass/fail rather than having numerical scores. Last year, research found that ChatGPT could pass the USMLE.

The USMLE spokesperson told 乌鸦传媒 that the issue affected all three steps of the exam. They did not give a number of people affected, but said "impacted examinees to date represent less than 1% of all examinees who took USMLE in the relevant time period."

Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, of the situation on social media. He told 乌鸦传媒 that he's heard for years about USMLE "recalls" -- where people who take the test recall as much as they can in as much detail as possible immediately after taking it -- but most of the time, recalls weren't high quality. Some websites even for hundreds of dollars.

But last summer, he heard of verbatim test questions for sale in Nepal, although he never saw them himself. This situation would either indicate very-high-quality recall or imply that test centers are involved. He's also heard complaints about USMLE cheating in many countries, but especially Pakistan, Syria, and the Philippines.

People on Reddit's medical school and international medical graduate forums have been sharing fear and frustration that they'd be implicated in this scandal -- especially those who didn't cheat.

"I think it absolutely hurts [international medical graduates (IMGs)] from Nepal because if you're applying in this application cycle, programs are ranking applicants right now -- February is when you rank your applicants," Carmody said. This scandal may make program directors second-guess IMGs from Nepal -- especially since the scope of the scandal has yet to be revealed, he added.

At the same time, Carmody said that as a physician, "if your competency is called into question, it's your burden to prove it."

"USMLE is here to protect patients. They're not here to protect residency applicants," Carmody said.

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