There have been many comments and questions about why this situation was classified as cheating. 1. The issue is that the questions that were studied (memorized) by the students who cheated came directly from Step exams. It’s clear policy from USMLE that all test takers agree not to take or distribute test questions. This is because some test questions are going to be the same from one exam to the next. 2. This situation is different than studying practice questions from UWORLD, for example, since the questions from UWORLD are sample questions designed to help you learn the material, not direct copies of questions from the real exam. UWORLD designs these questions rather than taking them word for word from the exam. 3. There’s a big difference between memorizing something and actually understanding it. The entire purpose of USMLE Step exams is to ensure a certain level of competency in US doctors. Memorizing stolen questions and answers might result in scoring well, but it doesn't result in medical understanding. This is why USMLE is so strict on their rules about no one sharing the questions they encountered on the actual exam. Bottom line: Utilizing practice questions from reputable sources that aim to teach you the material is completely okay. No matter where your practice questions come from, aim to learn the actual material, not just the exact wording of the question. And don't buy practice questions from questionable sources.

Glad to have this vid, I’d seen various posts here and there about this but didn’t know what was going on, thanks for the explainer!

If you do this in the UK (where I am currently) it would be considered academic fraud - not a great trait for a doctor in medicine. This would be reviewed by appropriate medical associations resulting in them losing any ability to apply for licence to practice in the UK, it’s a complete professionalism concern

I love this kind of video. Thanks for the timely and in-depth breakdown of it all

Coming from a person who did schooling, high school, and bachelor's from Nepal, this is actually what we are encouraged to do by our teachers. For our 10th-grade examination, for instance, it is a norm to buy a book that has all the previous year's examination questions and, if one practices just from that book a score of 80% or above is pretty much guaranteed.

The nbme is way too lenient about this. Honestly should just ban these cheaters from ever taking the test again.

How do you feel about the judge's verdict? Do you agree, and what do you think should happen to students who cheat on medical exams?

this is infuriating and such a disservice to both patients and IMGs who, you know, actually work their butt off for their achievements

Wonderful Video Kev…..❤❤ Clarified all the gossips and speculations which was on air 👍🏻👍🏻

As someone studying for step 1, been struggling and have multiple people fail. This is heart breaking

I read that some folks paid up to 1-2K for these questions🧐 for this much, you can actually buy a course w/Q bank, maybe even some tutoring hours, actually study & pass. Especially Step 2 and 3. If you have gone through med school /early residency and you can’t pass the clinically oriented Steps🤔 … you really do need remediation.

Great breakdown. The reality of the situation is that if you take a test and share answers with a friend who hasn't taken it yet, it's cheating. What people also have to realize is that when you take STEP and leave the test center, you are required to sign a document stating "I will not share questions/answers with other people". Yes, people are going to talk about the questions they got that stumped them but no one is making a large booklet of questions and sharing that. What people also need to realize is that agreement analysis looks at the questions you get right in addition to the questions you get wrong. When a collective of people are getting the exact same questions right AND wrong, something fishy is going on. On questions: People need to realize that creating questions is harder than you think, that's why the USMLE will reuse some while implementing new ones every year. That's why in the USMLE exams, there are "experimental" questions that get tossed out. Fun fact, almost 1/4 of your exam questions are thrown out.

wait, I thought they had cheated, but if they just studied based on a large question bank made with recent USMLE tests, then how is that different from just studying? does the USMLE not change its questions every year? That sounds kinda lazy... sorry if I misunderstood something, I am not from the US or Nepal, I am just curious about the case, and that detail is something that left me a bit confused

The best combo of youtubers.

What is interesting is that we are discussing about medical knowledge gaps, perhaps boosting a score from a 220 to a 240, and the impact this has with treating patients, while we have NPs in the US establishing independent practices. I am not saying one is less concerning than the other, I am just laying out how messed up our system has turned itself into.

I feel that this video is a little biased. While I am definitely against all people who used recalls and cheated in other ways, I feel that that this video somehow targets all IMGs by saying that all of them will be affected. This doesn't make sense as there IMGs who took their exams in the U.S with U.S medical students. Therefore, it is not fair to include all of them in one bracket. Not to forget to mention that applications such as Telegram are also available in the U.S. It doesn't make sense that U.S medical students are not using them too. Investigation should also include U.S medical students and should affect them equally. Yes, cheating might be more rampant in Nepal, but that doesn't exclude other countries. Also, there are many top programs (not just community hospitals or family medicine programs) that rely on IMGs. In fact, many of the chairs at top institutions are IMGs. Instead of targeting specific countries and all IMGs, I believe that you have mentioned a very valuable solution, which is changing question pool regularly.

US med student here who recently took STEP 1 (hopefully passed lol) - I was also recently diagnosed with ADHD while in med school and now I'm wondering if there is negative stigma with me taking adderall. I know it is legally prescribed to me, but somehow it feels like people still think I'm taking a "shortcut" because I am medicated. When in reality I still had to sit there for 14 hours a day studying just like everyone else until I felt too tired to eat or sleep. Medication only helps me stay focused, but it does not solve all the other executive dysfunction issues that ADHD comes with. It was still a struggle and a challenge every day to stay organized and on track with studying. More and more people are getting diagnosed with ADHD every day (whether due to overdiagnosis or underdiagnosis), and I really hope there's less stigma and misinformation regarding stimulant usage moving forward. I'm glad Dr. Jubbal brought that up.

I still remember studying for 14-15 hours a day before a month of the Step 1 and Step2 CK exam, going through multiple revisions. After coming to know about this, this is really very heartbreaking. They should be banned from ever taking the Exams again.

13:40 exactly. To say that they are cheating just because they have high score is a bad mindset.

For the thousands of dollars I pay in order to take the step exams, they should more highly randomize the questions OR make more.

Injustice to all those students who do not cheat . Strict disciplinary action should be taken against the cheaters.

How long can someone with high passing score gotten from cheating pretend to be a knowledgeable student? They’re gonna be called out immediately I had one of these people in my rotations who we suspected was a cheater because they absolutely had zero understanding of the most basic concepts. Can someone with a 240+ step 1 not know a single side effect of ace inhibitors? It’s not possible!

I used to proctor for advanced Anatomy courses in college. My professor who made the exam warned me to make sure I had meticulous notes about what structures we highlighted because students would come into the lab and switch the flags so the other pre-meds would get the wrong answer and they would look better.

I thought the whole point of having to do these exams through rigid computer, software, and the reason why it takes so long for scores to come back, was because they were monitoring for these kinds of things. How the hell was this allowed to go on for so long?

Cheating shouldn’t be allowed but, I don’t think the Nepalese past students accumulated the past questions. Those questions were most likely accumulated in other countries then, made available for purchase which Nepalese students got their hands then, shared among friends since Nepal is close knit society. In order to prevent this NMBE needs to come up with other ways to conduct the test or, different set of questions every time and, the test centers should be strictly monitored.

It’s known for years in countries like India, Syria ,Iran , Russia that they have closed groups of many med students who study together then after taking exam they come out of exam and share the questions with non takers . Some doctors non are board certified doctors and they are practicing in the U.S. with successful business I have never agreed that move and never been part of those groups so I got stuck in the USMLE process for years .

Amazing, thanks

Hii, have you also paid attention to scores from lebanon, syria, egypt. I saw many students score more than 260 on step scores from there too on my linkedin. May be they too have these types of behaviour too of circulating old and recent past questions.

Just give different questions..😊😊

Honestly, it's very sad cheating and stimulants have become so prevalent. Most of my friends are pre-med and I can't name one that hasn't cheated. In the moment I didn't think much of it because of how prevalent it is but now that I am about to graduate and they are about to go to med school I understand the concern. Once you have a habit of cheating you don't just stop so we are going to have a generation of doctors that cut corners. That is a scary and very sobering thought so hopefully, this investigation grows and develops methods to curb cheating within med school boards.

Maybe i am wired that way cause I come from Nepal , but recall of recycled question in itself doesn't cross any boundary for me.

If these leaked exam questions are available online then that means anyone can access them even the students in the USA. Is there going to investigation for US students as well? Since the standard deviation of the test is based on the performance of US students, if their scores get invalidated, will the scores of other students change ?

In short, NBME repeats its past questions in its exams repeatedly, making it relatively easy to cheat. Therefore, NBME should modify their Qbank accordingly.

If WhatsApp or telegram groups discussion are cheating then even past doctors who matched this should be scrutinised ! This must be going on for years ! Why only cancel scores for this current match ? Then what about those students who already matched ?

Thank you Kevin I think taking all step exams for international physicians in the US exam centers would be a great idea

Who got hurt the most? Sadly patients. Personally worked with some of these IMGs and not going to lie, I’m genuinely concerned for some of their clinical knowledge, mannerism and ethics while taking care of the patients. That is not exclusive to only IMGs, US DOs and MDs too, but the percentage and likelihood with IMGs is scary.

The number of people actively admitting to cheating in this comment section is astonishing. YES, recalling active exam questions and sharing them with people who haven't taken the test IS CHEATING. Using those questions obtained from other students is cheating. It doesn't matter if you rationalize it as using your gigabrain memory to "beat" the test; you are giving/receiving an advantage over others based on inside knowledge. It also doesn't matter if YOU don't think it's cheating because before you sit the exam, there's a big freaking disclaimer at the beginning that you have to click "agree" on that saying NBME considers the reproduction and distribution of exact questions to be cheating and they will invalidate your score. These students were clearly told the consequences of what they did and did it anyway. If they didn't take those warnings seriously, that's on them. Many people here also don't seem to understand the amount of time, money, and effort it takes to generate NBME-style questions. Questions aren't just written and slapped onto the test, they're also edited by multiple people and focus-tested on examinees to make sure only good ones get through. You ever taken a test where questions have to be thrown out because they were confusing or one of the "wrong" answers choices could be reasonably argued as true? NBME isn't immune to that and bad questions can't be on board exams. If you take Step 2, dozens of those questions are testers that don't count towards your score, and they're only added to the question bank if they perform well enough. They can't write thousands of untested new questions every year to fill multiple versions of a 280-question test, and recycling questions isn't just "laziness" on the NBME's part. That's not how any of this works. I know I sound like an NBME shill, and I'm not. I'm a med student; I get frustrated with them too. Studying for Step exams sucks. The amount of power they have over your entire career sucks. But given what they did, and how clearly they were warned, I think NBME is responding appropriately to what happened.

Not surprised tbh, SAT exams used to get leaked every session. America seems to be popular with this stuff.

I am from Nepal. And knowing the culture here, cheating is not surprising

I heard that US students use some form of recalls as well?

this is a really disheartening situation imo. some bad apples should not be spoiling it for the bunch (the bunch being all FMGs). it reminds me of something I learned from Freakonomics where they discussed cheating and said how anyone can cheat if the stakes are high enough. this is esp true for FMGs who are desperate to be a doctor in a high income country like the US so they can build a better life. I think a good way to solve the problem is to make Step 1 pass/fail for them if it isn't already. also I think that investigation of the current STEP resources available to students at their home countries/med schools need to be done to ensure that they have equitable access. imo, in order to prevent future cheating, there has to be serious attempts taken to make admissions for FMGs to be more holistic vs so heavily dependent on test scores.

So i was looking for a support group online hoping to find people to ask about their USMLE journey because unfortunately I do not know a lot of people who are on the same journey.. and I was shocked to have been included to multiple group chats with people offering help in cheating.. providing latest questions etc.. its crazyyy. I was so scared of getting involved that i left the group chats.. and yes its not just Nepal. I saw people from multiple countries there

How come there isnt some sort of practical for IMGs? Im a foreign vet and the ECFVG requires the CPE which is a 3 day practical exam testing you in 5 things - small animal internal medicine, large animal internal medicine, surgery (spay), anesthesia (you are supposed to be the anesthesiologist) and pathology (necropsy). Wouldn't some sort of variation of that be reasonable for IMGs?

Not sure how to say this but memorizing the questions is a part of the process.(at least in our place, not in Nepal btw) Everyone knows it (even the administrators who make the questions) and the students recollect all the past questions then study around the same topic. In this method it is considered cheating if you are caught writing the question or actively noting it down anywhere near the premises. However, I think the difference in US exam and in our system is the questions never get repeated. Do 1000 past questions, chances are only 1 might be repeated. So, yes the Nepal students have cheated according to this but I guess more like they found a loophole and took the e advantage. Do NOt repeat the exact questions 🤷‍♀️ I’m not kidding we do so many past practice questions and we know we will get like questions around RS or CVS from valvular heart disease or COpd but each time the questions are testing on something different. It’s is rarely repeated. Also the cheating is with written papers so, how are they tested for clinical. In clinical even if you get the same patients there is no way you’ll be assessed the same as your colleagues. So, doesn’t USMLE have a way to eliminate those by equally assessing the clinical performance and written papers.

This is so weird. I completed my high school in Nepal and i am currently doing my BSN in US. There is no comparison of the education system of nepal and USA. You cannot compare them. I wonder how a US student would react to , if he gets put in one of the medical classes of nepal. It is tough and rigorous. Nothing like what you teach in US. Honestly what they are teaching in college, i already studied in my 8th grade. So coming and questioning the capabilities of a medical doctor from nepal is dumb. They have passed more tougher exams that USMLE itself. I doubt if you ever saw the cutoff of those entrance exams. And cheating part ,while i was giving my hesi i was recommended to use nurse hub by my own professor, which i did. Turns out all the questions I did in exam were mentioned in nurse hub somewhere. I made a perfect score. And nursehub is not some random illegal app. It is the most widely used app ,by nursing students in US. How did they got the questions word to word? It is not just in nursing school. I am 100% sure they might have similar big brand app to study for NCLEX and USMLE. Everything works like this in US. You either get quizlet with same question online or you purchase premiums and get through it. From driving license test to Starbucks interview , nursing to medical school.

Isn’t it already questionable when these graduates that barely speak English are passing an exam that is one of the hardest exams in the world and each question is paragraphs long with extensive vocabulary. How do program directors not question this? Most incredulous is that they will be practicing medicine and I heard many of these students have not even completed medical schools and going straight to taking the exams.

So is past paper practice illegal with these exams specifically?

How far back were the scores discredited? From 2023 back to 2020 ?

Wait, that's cheating? Memorizing the answers to reoccurring questions is so standard where I come from.

Nepal is nothing compared to what is happening in India. 🙄

Studied 12 hrs for 5 months in step 2 and still scored 230+ ..

A score does dictate the type of doctor one can be....it is just a score. Test questions are way more complex than what real patients are. This is crazy to do it by the nbme!

Something to consider with regards to similar answers, is that some schools train you to write and think the same way. There is a "regurgitate" culture in these countries and even where I'm from in the Caribbean. So you're practicing questions and you're writing what a teacher has trained you to write which would get all marks. If that makes sense.

I only feel bad for the ones who cleared it with genuine work.

I didn’t know Nbme repeat questions. In my life only 1 paper in med school had 3 questions repeated

I know many good, hardworking IMGs but sometimes I wonder about the ones who could barely speak/communicate in English but got very high scores on USMLE. Also, I recently had a conversation about USMLE, with an IMG from Nepal, who came to the US to apply for residency positions, and quickly realized that she had very limited knowledge of basic USMLE content but somehow passed both Step 1 and 2.

where can I find these screenshots from these whatssup group? Obv not about the answers

7:42 I don't think it is wrong or they were cheating. The collective and combined way of learning and taking references from past questions. All the students do that everywhere. Isn't it time for the test takers to make new and innovative questions every time, instead of repeating the same questions or patterns. These doctors, to reach there and take the test have spent studying more than 12 hrs/ day for nearly a decade, so they are the most smartest people around. I think blaming the students but ignoring their lack of creativity in setting questions is not fair. If the board can prove that their question papers were leaked, only then they can accuse? 😢. I have seen couple of such videos, It has blamed the students and that is quite sad and unfair. 😢

While this is obviously a massive breach, if the practicing physicians and residents are good doctors i dont find as much of an issue with this. The standardized exams are a really poor predictor of how good of a doctor someone will be, so im not as worried about whether patients are at risk here. Obviously its quite unfair to the rest of students who honestly take the exams but im not as hardlined on this as others may be. Giving them the chance to take it again and pass honestly is completely fair to me

Just commenting for the algorithm 💜💙

Ive come across 2 that cant even communicate in english with pts but are in these tough programs

This just causes distrust between the public and healthcare. This is disappointing and sad

On adderall, when I look at a piece of blank paper my mind is filled with ideas. Without adderall all I see is a blank piece of paper.

Cheating was incredibly prevalent when I finished up college in 2016. People were abusing Adderall all the time and cheating on exams and coursework. The outcome is more important than the process.....

Send the cheaters home, ban them from ever taking the test again

95% of cheater’s scores fall in the confidence interval. As long as p

This would be more like practicing and practicing rather than calling cheating. Maybe the fancy country accused them cheating because they were not being able to provide enough seats for their domestic students so they targeted specifically smart peoples majority in from group and accused them of cheating. If they are cheating they should provide the cctv video something. Some peoples are so hardworking I have seen they read under one candle whole night and day. I didnot saw this cheating at all. Looks like just a accusation.

Actually its normal to collect ,discuss and practice past questions in groups in sub continent .

Who has the link to the file

Im a third year nepali med student in the US. This is just sad to see and very disappointing. I'm honestly scared to apply to residency even as a US citizen after these cheaters have tainted Nepal's name and reputation

They need to do investigations thoroughly, the US included. This process is simply too gruesome for the cheaters to get away with it at the expense of the honest students and at the expense of patient safety.

great another problem for us IMGs...

Imagine the scores display instantly after the exam, so the proctors/any officials can gather the data talked about (time taken for answering questions, similarities in rights and wrongs, etc) with AI, and detect suspicious activity on the testing day itself. If the data suggests a more than 50% likelihood of cheating amongst all test takers, then all scores in that center would be invalidated then and there. It's easier to isolate testing centers and ban them this way too. It also alleviates anxiety around waiting for 2 weeks or so for the results. The falsely accused can then appeal to NBME (time waiting on the appeal > time waiting for the score), re-take the test in another center, or do nothing. The craziest thing would be to only have all the step exams available exclusively in the United States or Canada if they can't analyze data every year for each country where the test is available. But given that we have the efficiency of AI, it wouldn't take long to have a global analysis either.

So what about all the test prep centers making money selling previous questions for the SAT and other American exams. Kaplan

Prometric and their affiliates should be sued. Workers in prometric were bribed and allowed students to bring in phones to record on video their exam and use their phones during the exam to either search or make calls. Students were answering questions in 10 to 12 seconds per questions with 98% accuracy

What? When I was 18 taking exam for University we were sold so many questions saying those questions were asked in the past and made it practice, very few or almost none came in my exam but same things happens in every competitive exam When the entire system does it, every other person does it you don't even think you were cheating. This scandal has shown me the other side of the argument.

But still a lot of them matched this year.

The exam has gotten harder!!

In my opinion why is usmle recycling the questions…it’s almost as if students will recycle questions. Nepal and India I think the entirety of South Asia students use past question material to estimate the pattern of questions that can come in the future. It’s smart study. Usmle hates students who outsmart them apparently. And I understand that the exam is trying to test the understanding at the level that the exam is rather than the memory ability..but memory and knowledge is almost proportional imo…

You must have acquired sufficient knowledge by memorizing 1000 pages of material which is equivalent to reading and solving Uworld material. Why is called cheating? If these students answers are correct it means they know the subject by reading that full clinical material from recalled knowledge. Recollection of vast material is also talent and not cheating.

Kevin I definitely agree with you that the NBME went way too easy on these people

These people should be fucking monitored if they need to take the exam again. Like seriously. There is a doctor shortage. Also, test taking skills do not mean much in the long run if they want to become a physician. Reality is that I felt like I was cheating when my hair was undone, did not shower, and barely ate on time just to do well... it is all some memorize and regurgitation shit and not real learning. It is doable but not sustainable long term, in that short test taking period, it just all becomes an act.

Well, cheating is too harsh a word. It seems the USMLE questions were repetitive and not innovative. People around the world refer past questions to prepare for the exam. Telegraph group or not, but the USMLE questions lacked innovative approach and relied on past questions to conduct the exams. Let me tell you, these doctors, mostly from Institute of Medicine (IoM) prepare almost a decade of their time, from high school till they graduate, studying and praticing almost 17-18 hours a day.

I worked my butt off in 3 phlebotomy school and passed and got certificates I didn’t get a chance to take my national exam but I was allowed to practice through supervision and now I am doing emt and working very hard and I was looking up study guides and materials to study for whatever chapter I am doing and I come across a bunch of here is the answeres to this quiz or when I had to get my ICS 100 NIMS from fema and Is. 700.b getting ready for the exam I did what I usually do find study material and there was here is the answers to the fema exam I was upset. Why would I do that cheating gets you no where! And people who cheat on medical exams will not know how to treat their patients! And other things known basic medical terminology and the equipment you will need to use to save lives and they cheated oh God help us please!!!

My man, I know why they wondered about Adderall; your speaking speed is like 3x. I had a patient who was accused of cheating on a nursing exam. For a variety of reasons, I don't believe she cheated, and the program was known for being very harsh on students. As a result, she got a 0 on the exam; as a result, she failed the course. As a result of that, she was suspended for a year; as a result of that, she was unable to transfer to another school. And as a result of all that? She was required to pay-back her loans for that year, and was unable to secure loans to continue even when re-admitted. She lived alone & her first-generation immigrant family never knew she'd had to leave school. Her life literally fell to pieces. I stopped hearing from her. I made efforts to contact her, but never did hear back, and to this day, I don't know what happened to her.

Why not just ban all international testing at these shady test centers? If you want to practice medicine in America then you should test in America

I'm not saying that what these students did is okay - a judge obviously ruled on this for a reason. But I'm not sure I understand the difference between this, and going through practice exam papers? Those are often also just old exam questions, so why is that not considered cheating, if you remember the answers to those practice exams?

Is really practicing past question cheating i mean we study past year questions before every exams that is our studying strategy and now you consider that as cheating

Why the fuck they repeat the same questions? Of course, they created this whole mess by not being too innovative with their questions, but cheating is wrong!

Ngl AI questions are easy as f 😂

Using stimulants really isn’t cheating on these exams. Ultimately, if you don’t have the knowledge or reasoning skills, you’re not gonna do well on them

How can recalling past questions amount to cheating? You have to take mock exams and some questions do seem very similar to actual exam questions.

they should forever be banned from taking the exams again.

the bigger concern is the fact that these tests were originally designed for "passing" not identifying people for program eligibility and ranking. in an arms race, cheating will be more common.

In Jordan I think we are just good

What about the people who studied really hard and used this practice questions? ❓

Get their license, sue them and send them home. These cheaters are harming patients. After wining in court, give that money to U.S students or make USMLE free to take in U.S.

I am sure they would have done good in exams even if the questions of exams were flipped.

If you're not cheating you're not not trying hard enough. 😂😂. I feel sorry for Nepal med students who played it straight. Also the question of doping is pretty much done. Back in med school only 10% of my class was on PEDs aka ritalin. Now it's 90% of most classes. You literally need it to be competitive. When you consider kids are taking drugs just to get into med school outright cheating is simply the next step

I can speak for pakistan, here the USMLE is strict as hell! Noone can cheat even if they dream about it