ECFMG Irregular Behavior Policy: What It Covers

Irregular behavior is conduct by applicants, examinees or others that could compromise the validity, integrity or security of the USMLE process. The USMLE program and ECFMG each have policies, and the overall message is simple: give accurate information, follow test rules, and never share or seek real exam content.

Two overlapping policies #

We could not open every ECFMG page directly, so confirm ECFMG-specific wording and procedures in the current ECFMG Information Booklet. The USMLE material below is from usmle.org.

What USMLE lists as examples #

USMLE groups examples of irregular behavior in four areas:

• Eligibility and identity: registering for or taking an exam when ineligible, providing false information, or having someone else take an exam for you.
• Exam materials: unauthorized access to or reproduction of materials, discussing test content before, during or after an exam, or bringing unauthorized devices into secure areas.
• Exam conduct: giving or getting unauthorized help, taking notes in secure areas, breaking test center rules, or harassing or threatening staff.
• After the exam: altering or misrepresenting scores, or failing to cooperate with an investigation.

USMLE also warns that using prep services that distribute actual USMLE questions or answers can lead to canceled registration or scores and further sanctions.

What ECFMG's policy adds #

ECFMG's published guidance includes falsifying information on applications, submissions or other materials sent to ECFMG, as well as failing to follow USMLE or ECFMG rules and taking an exam when not eligible. ECFMG has described forwarding some matters to the USMLE Secretariat for independent review, and has said it may report determinations to organizations with a legitimate interest.

The sanctions ECFMG can apply are set out in its booklet and can be serious, including affecting an ECFMG certificate. We do not summarize specific cases here, and nothing on this page suggests that any person has engaged in irregular behavior.

How an inquiry generally works #

According to USMLE, it investigates when it receives information about possible irregular behavior. During an inquiry:

• registration for further exams may be blocked and pending appointments canceled;
• unreleased scores may be withheld, and the validity of a score may be reviewed;
• you are expected to cooperate fully, answer truthfully and, if asked, sign releases allowing USMLE to get records from schools or other third parties.

Failing to cooperate or giving misleading information can itself be treated as irregular behavior. The USMLE page we read does not describe an appeal process, so look for any process in the notice you receive and in the current Bulletin.

Possible consequences #

USMLE says a finding becomes part of your permanent USMLE history and appears on score reports and transcripts. A January 2026 USMLE notice covering cases reviewed in 2025 lists actions including annotating records and transcripts, barring access to USMLE for up to five years, reporting to the FSMB Physician Data Center (which state boards routinely query), and canceling scores.

How to avoid problems #

1. Submit honest, genuine documents. Never alter, backdate or "tidy" a diploma, transcript or translation. If something is wrong, ask the issuing school or ECFMG how to correct it. See name and document issues.
2. Answer every application question truthfully, including about prior exam attempts, schools and name history.
3. Only register when you are eligible. Confirm eligibility rules in the IMG eligibility guide before applying.
4. Protect exam content. Do not describe, post, trade or recall real questions in forums, chats or study groups, and decline any service that offers them.
5. Follow test center rules. Leave phones, notes and unauthorized items outside secure areas, and read the exam day checklist.
6. Never take or give help during an exam.
7. Cooperate if contacted. Respond by the stated deadline, accurately and completely.
8. Report concerns properly. USMLE has a reporting channel for suspected violations, listed on its page.

What this means for IMGs #

IMGs submit many documents across countries and languages, so most problems arise from mismatches or confusion, not wrongdoing. The safest approach is consistency and transparency: if documents differ for a legitimate reason, such as a name change, explain it and supply proof rather than hoping nobody notices.

See also common ECFMG delays for ordinary, non-disciplinary reasons applications stall.