Really appreciate not only this series but also your insights and wisdom on preserving one's unflinching integrity in the face of such fraudulent activities. You, sir have my respect
@@sheriffofsodium Last year I came across a video by a Nepali guy, he is not a UA-camr and posted only one video and was a test taker. I was looking at videos of test takers for suggestions on preparation and came across that video. I couldn't find it now. That dude posted the video after he joined residency and he scored 287 or something in Step2 ck. A lot of the video is useless as he didn't provide any valuable insights into the preparation. He replied to someone in the comment section asking about USCE and said he joined residency and didn't do any observership or other USCE. He took the exam before the applications for residency and applied and got in. At that time I was in awe about the score but thinking about it now, seems he may have been one of those that cheated. He mentioned he took both step 1 and step 2 within a span of months. I remember, reading one comment in the comment section by some Nepali person who wrote that more than 95% of his classmates and his seniors who took the exam scored above 260 in step2CK. At that time as I said, I wished that I was in their study group because I thought they must have studied together and had rigorous consistency and did questions and explained to each other. Now I think that is too much of a coincidence and that many students from the same college score above 260 seems sketchy. In my opinion, it seems a lot of them got these PQ's like you said in the video available to them. As for step 2 CS, I agree with your point of view. Also with step 2 CS, each student spends about 5000 dollars in just exam fees. For IMG's going to the US including the airfare and accommodation and everything else will bring the amount to 8k to 10k just to complete all 4 exams (that is if all are done in the first attempt). Also, I have seen many physicians who are a bit silent, introverted, and talk slowly but are very good at their work and they will definitely score less in new settings, especially under exam pressure. Also, I heard from some that residents don't have to go into the residency knowing everything or have clinical skills completely. Residency is where they learn and know a lot of skills over time.
As a Nepali.... I feel so disappointed... I was rooting for Nepali doctors...but Statistics and Probability don't lie... what's more disheartening is that they memorized the wrong answers 🤦🏻♂️, portraying they have no knowledge or critical analysis skills... C'mon man!!! This will hurt so many good and honest doctors in future
As an IMG who scored 270 by spending 8-10 hours a day studying, I hate hate those cheaters. The programs who were initially impressed by my score and invited me to interview might now be questioning my credibility. I don't know what's wrong with people who support those cheaters. The honest exam takers will be cleared when cheaters are caught and named.
Lol yeah we know how you got that 270 if you are genuine stop commenting here it will show up in your work. There is no place to run life will test you you no need to show you worked hard by commenting here this proves even more that you cheated. If you were hardworking you wouldn’t be commenting here you would be working on something
I've been on Reddit a lot lately following this saga and I've seen you attacked from all sides on Twitter. I applaud you for all you've been doing 👏 This whole thing is super juicy, sometimes hysterical, and definitely monumental. Thanks Dr. Carmody!
Great video Dr.Carmody , To add to your point at 37:46 USMLE showed that test takers from Nepal cheated on their step 3 exam most likely by recall thus achieving mean step 3 score about 20 points more than the US test takers so this would mean that unless proper measures are taken to tackle the problem of recalls it won’t matter where the usmle steps are being conducted.
One crazy fact that deserves more attention is that if 862 people had their step 2 score invalidated (and I’m not sure if that’s correct or it was 832 scores across all USMLE exams and and undisclosed number of total examinees), that would represent a very substantial fraction of the total number of students who took step 2 in Nepal, based on the data shown at the 16:10 mark
From the court filings - it was 832 examinees, which was approximately 40% of the group initially investigated by the NBME (consisting of self-reported citizens of Nepal; graduates of Nepali medical schools; and those who tested at the Nepal test center).
@@sheriffofsodium WOW. That's not a good look at all. Forty percent is an absurdly high fraction of future doctors willing to sell their integrity to get ahead at the expense of their future colleagues. Yikes
Don't usually post a lot but sherrif you really outdid yourself with this video. Thank you for your tireless dedication to medical education and your well thought out and comprehensive videos
I’m seeing your videos being suggested more and more on all different topics of posts on Reddit in particular. I hope your content continues to reach new listeners.
The fact that you have to keep repeating "Not all Nepali medical students cheated" 1000 times, just to be attacked is beyond me. You'd also think people in the medical field would also understand agreement analysis and statistical significance. Saddened by this whole situation but I am optimistic about cheaters getting their scores invalidated and can't wait for the other shoe to drop. Thank you Dr. Carmody for all the work you do. Your advocacy for medical education is admirable and I look up to you.
Thank you for the kind words. I’ve certainly been getting some ‘fan mail’ from people who assert that they haven’t heard me say that, and that I’m defaming Nepal by branding all of their doctors as cheaters.
An imminent test-taker from Nigeria here, and all I can think of is how this ordeal isn't a good face for any IMG. I mean, why will any PD want to go through the stress of recruiting an IMG when these issues may arise, and indeed are arising...
I think they were quite smart to crack the usmle. It proves intelligence to organise such a thing to memorize so many questions from first time takers all of them. I find it a great feat of human intelligence no other nation could pull this off in such a scale. While all other nations are trying to crack usmle in similar way but what nepalis did was quite extraordinary and that is quite high iq work.
@@kappa633 What do Nepalis doctors really want to prove? OpenEnhanced AI can score 90% on the USMLE exam. Note AI do not even have brains. Violating the USMLE rules, and suing the US board, proves their smartness? Then, there's nothing much to say.
This video was excellent. One concern I have with the clear bruise to the integrity of the exam involves cheaters who purposely tried to be conspicuous. While some of the invalidated test takers were finishing exams very early and were always getting stolen questions correct. I’m concerned cheaters who were actually good criminals are passing under the radar. A good criminal would know finishing the exam early and getting stolen questions correct every time would be suspicious. I’m worried there are good criminals who passed the exam with slightly above average scores who aren’t meeting the NBME’s high threshold for score invalidation. I would hope some state medical boards will push the NBME to lower the statistical threshold to invalidate scores. Certainly a probability of 1 in 500,000 to at least flag a test taker for more detailed analysis would be more than fair given only maybe 50,000 step 2 exams are administered each year. Another victim in this cheating scandal are residency applicants who lost out on interviews because these invalidated test takers took their interview slots during this cycle and the previous cycles. You would think invalidated applicants with 260-280 scores received interviews this application cycle.
Wow, this is such a thorough video, thanks for putting it together. I’m so shocked that they’re asking for U$80,000,000!! I didn’t know that and I’m just baffled by the audacity. And I also agree with what you said that the honest doctors who didn’t cheat should be the most outraged ones against the ones who did cheat. If it was my country, I would be beyond embarrassed to even be associated with these people. I truly do feel sorry for the innocent ones. Hope they can find a way to distance themselves from the scandal.
I agree with you. The way to separate yourself from cheaters is to NOT protect them. Don’t rush to their aid. Let them fend for themselves and face the consequences of their own decisions.
Thank you for taking your time on this and sharing. Great video! I feel your passion in Medical Education. Love to see science/the evidence based approach wins over!!
I am an IMG who is not planning to take the USMLE exams, but I ENJOYED this. This was a great video You did. You nailed it, agree with every word of yours.
USMLE CS is like Examen Profesional (or Professional Exam to be translated to English from Spanish) here in Mexico. I am a recent medical graduate here in Mexico City, Mexico but with dual citizenship of the US and Mexico so I'm planning to do STEPS to revalidate my medical work in the US. Actually, had a quick look at STEP 2 Clinical Skills while studying for a week straight for my Professional Exam, which i had do before even entering Servico Social (or Social Service be translated to English from Spanish) actually had a case I had was on the list of questions for some common symptoms that and list of questions need to be asked for that symptom and really saved my butt during the exam in the portion with the patient and also had impressed in a good way one of the judges by asking a question that many usually forget to ask and is extremely important for the cause and possible treatment of the patient being did it have blood or mucus in the patient stool.
As an IMG, it was well known that it’s foul play to share usmle questions. People made sure they didn’t do that during the times I took the tests from years 2017-2019.
Thank you for saying this. I’ve gotten a disturbing number of messages from people claiming - with a straight face - that these examinees did nothing wrong.
It really hurts me to see what happened. I am an IMG and I scored a 270+ myself and I know what goes into getting that. I couldn’t finish the exam even until the last 20 min, let alone imagining finishing a couple hours early. I hope that in the future, all medical graduates realize that without this knowledge, we aren’t an asset to anyone. Thanks Dr Carmody for being so comprehensive!
Not really, it was a pretty last moment decision. I have freedom in my country too. This was so that I could experience the healthcare system in the US.
@@solslastcannula5665 Yes, I love learning from everywhere I can. I have also given MRCP and plan on experiencing the UK healthcare system as well soon!
I feel like if us vets have to do the CPE which is a 3 day 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), IMGs should also have to do that
It is strange that we’ve chosen to license physicians without a practical test of their skills. Like I said, I’m not opposed to resurrecting a USMLE Step 2 CS type of exam *IF* it the NBME avoids the problems with the original Step 2 CS. I actually helped write a paper on that topic a couple of years ago: pubmed.ncbi.nlm.nih.gov/34548971/
@@sheriffofsodium i have also seen the vernacular change around this recall business now. they have started using pq or pyqs which is mostly what indians use to "crack" exams
@@AmberHaq-h4eYou are correct my friend. For whatever it’s worth, I took 13 months between Step 1 and Step 2 CK, and 3 years between Step 2 CK and Step 3. (I should have added /s to my response above.)
When i asked my fellow IMG grads if they were ever involved in such ,the answer always was "everybody does" I doubt if there is anyone who didnt use recall, its culturally instilled.
This is well done. I suspect some form of cheating has been around for several years. Will current residents or attendings in the US have their USMLE scores investigated (especially if they took them from these flagged areas)? Will their license be revoked?
I thoroughly enjoyed listening to this. The level of narcissism and blowback from people who have cheated or their acolytes instead of cowering in shame. I loved the use of statistics in the beginning of the video and anecdotes. At the end of the day, you end up cheating yourself when you cheat on exams, and it finally catches up to you FAFO. Can't cheat all the people all of the time!
Alot of Cheating happened during CS exam. In Texas, many students booked Hotel x very close to the exam center. They did stay in the hotel for 1 month before the test day. They did review all the recalls case and practised very well and passed.
I’ve heard this from some other people recently, too. What’s interesting is that I’d always heard that the Houston test center was more ‘IMG friendly’ - but that was attributed to a more culturally diverse group of standardized patients there vs. the other USMLE test centers.
@@sheriffofsodium I strongley believe that # we need usmle test face to face with attending oral clinical exam. As attending you can easily tell in few minutes who has knoweldge and how is recalling qs. Currently there is alot of physician with high score that does not match their scores at all. On paper they look good but not in reality. Some physicians missing basic concepts !!! On daily encounters. # we need to offer pathway through for good people who willing to do 1 year unpaid internship to evaluate before signing contracts. # I did not imagine that people with invalidated score went to the court !!!. There are many immigrants with green cards looking for half chance to do residency and not cheating at all. I know one failed multiple times with 1 point. What is his feeling thst some others used recalls and affected the score curve. The problem getting bigger now that some american patients are frustrated from some IMG and do not trust their knowledge at all. Believe me lawyers will investigate what happended. Also immigration lawyers may investigate how immigration happened base on medical exams putting american patients at risk. Also how cheating affecting malpractise cost now !!. We should support IMG but without putting the american patients life at risk. Canada will never give visa based on medical exams even if you score 99%. Also, very painful to see some IMG canadians scored low on canadian exams and very very high on American exam. They could not match in cananda but came here easliy !!.
If anyone has studied biostats for step 1, can understand how it is significant for mentioning who cheated or not cheated. 1 in 100 million chance that is literally cheating
@@sheriffofsodium lol. In my opinion, 1 in 100 million is still a very large number. They should flag anyone with 1 in a million or less. It's people's lives we are talking about. I think they were still cautious to only flag a chance with 1 in 100 million otherwise I bet many more people would have gotten their result invalidated
While I can not speak of what I have not witnessed, I have heard that neighboring countries are guilty of this as well. Is there any recourse if someone failed the exam by a point or two during these times, and what effect does it have ? Is the NBME going to go back and re-calculate scores?
USMLE can also introduce different type of questions in the exam: for example: "multiple correct answer type questions" where different options are correct but your answer to the entire question is not correct unless you mark all the correct responses.. or can introduce "integer type questions" where whole numbers from 0 to 9 are the answers and one has to approximate to the closest integer to mark the correct response. or introduce "match the following' type questions, or introduce negative marking to the incorrect responses. These are the strategies that are used in one of the toughest exams in India- IIT JEE to get admission into the prestigious IITs.
Looks like COMLEX may be the new standard 😎 Dr. Still would be proud. In all seriousness - thank you for the insightful video. I think we all could use more level-headed and thoughtful takes.
Thank you for this video. It's really encouraging to know that staying true and honest in what you know of Medicine is better than cheating and bragging over great scores.
I am a faculty in US residency, I can tell based on my experience supervising them and based on my brothers preparation for USMLE this allegation is most likely true... These allegations are serious and the FRAUD should be investigated and patients in USA should be protected from Harm.
50:00 - 51:30 was 🔥🔥🔥 And i absolutely agree with you. There SHOULD be justice and cheaters DESERVE to be punished. Imagine an innocent, hardworking applicant that got his career ruined by going unmatched because that spot went to a cheater who outscored him. I'm always shocked to see people defending this, complaining about "negativity" and telling people to "mind their own business".. makes no sense to me. Because this stuff is everyone's business. If cheaters make it through, everyone suffers at the end - the programs, the faculty, the healthcare system and ofcourse, the patients. In my opinion, it's too little too late from the NBME. They only started working after people complained about it. Weeks before the announcement, i started seeing posts on reddit about Nepali recalls users and was happy to see that there was finally action being taken. But a lot of cheaters are yet to be caught, im sure of it. I hope they catch them all eventually.
All the cheaters have to be punished. This test is serious thing, not only for those who take it, but also for the future of medicine. People work too hard to pass and prove that they meet the requirements to practice in USA to let bunch of cheaters to devalue all of our (IMGs) hard work.
Pre-test probability matters. You check a lot of ANA’s on healthy people, you’re gonna get a lot of garbage. You check a lot of ANA’s in patients with leukopenia, a photosensitive rash, and glomerulonephritis, and you’ll make a lot of diagnoses.
@@sheriffofsodium I think there's a good statistical argument for use and knowledge of Bayesian method amongst clinicians (re pre-test and posterior probability) as opposed to reliance on p-values. There are many statistical papers arguing for the same move against tradition.
TBH in south asian and asian countires "Recall" is such a big part of preparations and you will get books with last 15 or 20 years of previous year questions. But in our scenario repeat is less than 10% so it doesnt matter. When I first read about the students being deemed as cheaters because of recalls I was really surprised.
So respectfully then, Dr Carmody, why is this situation so scandalous? A group of 800 Nepalese students stood in solidarity with one another for a chance at a better life, in a land far away from their homes & among some potentially very hostile unknown strangers. Thru true teamwork, they bested one of the most powerful & established agencies on the planet. Perhaps there really is another lesson to be learned here. It would be interesting to hear you argue this case from both sides instead of just hearing you repeatedly defend yourself & repeat the same tropes against cheating. It would also help your listeners understand how/why this series of events transpired in the first place. Just some food for thought.
@@beautifulbull I think you’re missing my point. The passing standard for the USMLE is set to evaluate whether a physician has the minimum competence to provide patient care - or not. The problem with cheating on the exam (especially to this extent) is that it renders the test useless in that regard. A high score, or even just a barely passing score, might represent that someone has mastered the content necessary to progress in medical training… or it might not. Teamwork, solidarity, besting the test, etc. - it all sounds good until you remember that the purpose of the test is to protect patients. One day, there will come a time when you knock on a door or pull back a curtain, and there won’t be a five-answer multiple choice question. There will be a real human being who needs your judgment and skill as a physician to help them.
@@sheriffofsodium I think the scores are just to filter people espeacilly to narrow down applicabts in competitive specialities. It's mostly the research and presentations, LORs and connections that get you through.
Respectfully, Dr Carmody, you are missing my point. US physicians/residents have one of the highest suicide rates of any profession in the US; we have malpractice suits too numerous to even mention here; & our healthcare system in this country is broken & built on inequality. We both know this, so please don't explain that away here. I am saying perhaps there are better ways to assess adequate skills & medical knowledge of physicians here than simply the scores on these standardized exams. Especially when these exams are designed by the very purveyors of the healthcare system that makes its own physicians burnt out, very sick, & even dead. These tests can't assess these skills. And they aren't the final say on what truly makes someone a good doctor, & they definitely don't accurately assess what makes someone a decent human being, especially when they bring out the very worst qualities in the people taking them. Like I said, please consider making another video that looks at this issue from the other side. Thanks so much for your response & your consideration.
Thank you for watching. And I’ve gotta be honest: for many of my videos, you are in my target demographic. Although some videos are related to current events, some things that I’ve made are (I hope) evergreen. If you hear things that resonate with you, please consider sharing with others.
The scores of many US students who didn't cheat are artificially lowered (and this cycle many won't pass) because of international cheating. The exam has been made much more difficult each year without any adjustments to the time allowed to study or teaching/resource quality on the side of the US. Furthermore, US residencies are taxpayer funded. I don't see why the US sees a need to have foreign medical graduates in the first place at all. These are high paying jobs that should be going to US citizens and the process to get there should be regulated within the US. Medical students in the US have an average of 200k at 7% interest to the US government. They become doctors with high incomes that are heavily taxed. Those taxes should be going towards helping US citizens not recruiting cheaters from abroad. Also this invalidates both IMG graduates and using USMLE scores as any sort of metric for residency applications. IF this cheating is allowed to continue, I don't see why anyone should be taking these exams in the first place.
Residency spots are not high paying jobs… Also, don’t residency programs have to find alternate funding for IMG positions? Also he mentions in the video that there is a need for IMG bc there are more residency spots than residents
1:01:48 should be the key message everyone takes home. It's a sobering responsibility to know people trust you to know what you need to know to provide them the highest quality of care and I think we need to remember that is ultimately what Medicine is supposed to be.
The reasoning is very convincing. Just an inquisition,I don't know much about this exam scandal but it seems interesting, is referring to past questions and memorizing cheating? For me people can have similar answers if they come from same source, I would not consider the likelihood of the number of other answers there can be. It's like saying you have a one in a billionth chance of hitting a jackpot but you still can. This is very sensitive issue to judge on random probabilities. Is there something in written given to the exam attendees about not sharing questions after you appear? Is sharing old questions illegal?
I covered this in the first video, but I’ll link below in case you (or anyone else) missed it. Basically, anyone who had a USMLE Step 1 or Step 2 CK score invalidated will lose their ECFMG certification. Without ECFMG certification, they are not eligible to train in an ACGME-accredited residency program. So until they pass a re-take, they will not be able to work. Anyone who is working under a J1 or H1B visa will be in danger of losing it. Anyone who has *only* their USMLE Step 3 score invalidated may be okay, because passing Step 3 is not a requirement for ECFMG certification or participation in an ACGME residency program. However, it *is* a requirement for state licensure - so anyone who had an unrestricted license will lose it, at least until they pass a re-take. (I don’t think this will occur… at least not yet. In the lawsuit, the NBME only acknowledges reviewing scores as far back as 2021 - so anyone who matched is likely still in residency training.) EMERGENCY MAILBAG: The USMLE Cheating Scandal ua-cam.com/video/A3_HG5uc47I/v-deo.html
@@ckrgksdkrak I don’t think the NBME’s investigation goes back far enough to get someone who is already in practice - like I said, they’ve only acknowledged going back as far as 2021 at this point. But if someone has a full license and is already in practice, the NBME will notify the state board and their license will be suspended and they will not be able to practice. In that event, the person’s best bet is to re-take the exam(s) ASAP and get their license reinstated. The score won’t matter - but they would need a passing score to get their license reinstated. If they do that, my guess is that they’ll be able to get back on track quickly. On the other hand, if they choose to fight, they put themselves at much greater risk, because many state licensing authorities require good moral character to receive a license. So if they force the NBME to come to court or some appeal hearing and put on display all of the evidence that they cheated on the exam, they may render themselves unlicensable even if they eventually re-pass the test.
@@sheriffofsodium I mean if there is anyone who is within the worldwide medical community and hears this, they'll instantly tell the judge that there is no way she didn't cheat. I wanted to ask you something. This arhamba thing that the nepalis did is very hard to track down or penalise and it's effectiveness is proven by it's results. Will this model be replicated by others and in other fields or for other exams? and will this be replicated on a smaller scale within some colleges and kept on the more down low or could this have only worked to this efficacy due to the internet?
The short version of the story is this: back when I was a resident, we had the opportunity to moonlight in our NICU, so to make extra money, I picked up a lot of extra weekend shifts. When I did, I’d take over some of my fellow residents’ patients - and get to adjust their TPN. I’d become a believer that excess salt/water contributed to the development of bronchopulmonary dysplasia, so I’d always try to cut back their sodium intake. One of the neonatologists noticed this policing and christened me the Sheriff of Sodium. I’d always loved salt and water physiology, so I took pride in the nickname… so when I needed a domain name for my website a couple of years ago, ‘Sheriff of Sodium’ was it. You’ll be shocked to learn that no one else had claimed the title.
Justice do happens sometimes, just wish not as infrequently as lightning on a summer day . Hope to see USMLE go after cheaters in other places we know it’s not just Nepal. 1. To restore the integrity of the exam 2) those people don’t deserve to be anywhere near a patient
If they know students in Jordan, India, and Pakistan also cheated, what haven't they invalidated their scores? They are still being allowed to match. And what about students from other countries?
Oh, I think more invalidations are coming. Like I pointed out, though - the NBME doesn’t move particularly quickly. They got their first tips in January 2023, and it took till January 2024 to make a move in this case.
@@sheriffofsodium So they will be allowed to match in like three weeks, and then midway through residency their scores will be invalidated. That is taking a spot from someone who deserves it, and is going to be a strain on the residencies because they will lose residents midway. USMLE can't be that incompetent.
If they skip the aforementioned countries and let them go into match then that is also going to have negative consequences to all FMGs around the globe. I hope NBME does not just stop it right here and continues expanding their investigation to all other places.
Actually there is use of past questions in every other continent of world. Not only asia even European students use the past questions to know how exam is and what are the contents being asked and they learn those concepts and sit for exam. But the questions are not repeated all over asia people read past questions even in India MD entrance exam all just read past questions and their concepts but obviously those are not repeated. Nepali students found that loophole in Usmle and not only nepali almost every country uses this loophole for usmle. Nepali were just too good in this game and scored high with consistency that is the only reason they were flagged. To call this cheating depends on which country you are in and i think this can only be called cheating for US and for this specific exam since they mention and make you sign to not share exam content.
I feel like there are so many attempts to deflect from this scandal with the race perspective. I am an IMG from England and of Nepali origin despite being born and raised in the UK. I feel that Dr has totally screwed her career as she had no leg to stand on. The math doesn’t lie. This is not about race or creed, simply math. I hope they catch far more people as this behaviour is fundamentally incompatible with being a physician. Would you want these Drs in the US?
Dr Carmody, the NBME gives data for candidates from other countries possibly cheating in 2021 and 2022. What do you think is the possibility of some of those "cheaters" having matched and currently in residency? Also do you think they can be removed from their training or if that isnt possible, will NBME inform PD's and have them face some sort of consequences?
And thank you for sharing the story about the Pediatric Jedi, gives hope to someone like me, an older IMG from Pakistan with average scores. The reason why we are in this game, to change and improve lives.
I know with certainty that some of the impacted examinees *are* current residents. The ACGME issued a guidance statement on how these situations should be handled. Basically, anyone who had their Step 1 or Step 2 CK score invalidated will lose their ECFMG certification, and will no longer be able to participate in the residency program (until/unless they pass a re-take). However, the ACGME has reminded programs that they are required to give residents due process if they are being moved toward dismissal.
Sir, i believe the usmle exams should be done once a year, and applicant should have a score compared to the performance of rest of the applicants of that year. This will definitely cut down cheating and make the exam more standard.
You mention that restricting the USMLE to US testing centers (shutting down test administration abroad) would worsen inequity among IMGs. Spot on. I feel like many domestic students don't appreciate how much it costs to be a foreign IMG trying to make it in the United States, and how many additional costs they have to absorb. Additional exams, exorbitant fees for away rotations, and being forced to do some "research experience" at cost or find a qualifying job to maintain their visa status while they wait for July 1st because of schedule mismatches compared to the US medical school schedule. I almost assume every IMG I encounter comes from a family with few money concerns. I don't think there is a robust of a student loan system for medical education for most of them. I don't know if there's anything we can do to improve the likelihood of equitable outcomes for foreign IMGs applying to residency here, since the institutions collecting the checks aren't about to change their mind. Maybe program directors who empathize with that struggle have some potential to make a difference in that space. Great video as always. Can't disagree with any of your points about cheating.
I just have one question, there were many questions in which I chose an answer after initially seeing the last couple of lines in the stem, and then took my time to read the question, and then if my answer turned out to be wrong I would change it but if it turned out to be right I would move on to the next question, so my question is, is response time considered the time I took to move to the next question? or is it the time I took to pick an answer regardless of whether I took some time to read the question after that or not? Also, there was a considerable amount of questions that required less than 30 seconds to solve, especially for those who practiced with all the CMS and NBME forms, so I don't think the response time alone is enough to consider someone to have cheated.
Good question - and I honestly don’t know. My impression from the court papers was that this examinee answered questions, moved on, and didn’t return. But I don’t know that for sure. I agree with your point that response time alone is not sufficient to identify a cheater. If that were the only data point evaluated, you’d have a lot of false positives (and any cheater who just took their time would escape). But here, it was just one data point among several - and together, they create such a highly unusual set of findings that they simply would not be observed under normal testing conditions.
Can you make a video on why US residency programs provides residency interview based on contact. As an IMG with none alumni in US its hard for some IMG to have this sort of privilege. And I know being one such IMG myself I took to the world went to the US and communicated with lots of people made new connections however, I also saw people who got matched from a home country without any such efforts. Its really heartbreaking and unfair! Seeing this Scandle unfold and the action taken by NBME is something I always wanted and I really appreciate and apploud this action. And Thank you so much Dr. Carmody
Most people whom you have labelled as cheaters don't fully realise the consequences of discussing PQs. It has been an established culture in Nepal, India, Pakistan and most other south Asian countries to share past questions and discuss them. Most of these people are surprised why USMLE is taking such a harsh action. Most didn't pay to get their hands on 'SECURE' exam content or took photos of exam materials from the exam centre. They just joined Telegrams groups (which aren't hard to find) and started hosting sessions and discuss PQs. The US condemns such act as CHEATING. These people think it is normal to join PQ discussion groups. They do realize that USMLE doesn't approve of PQ discussion but they don't realize they they take this thing sooo seriously. I'm sure that people discuss PQs in the US or other countries as well. But the magnitude of Nepalese doctors taking their shot at the USMLE made this scandal come to light. So my take is Nepalese unknowingly crossed a threshold of allowable PQ discussion and the USMLE took action. And all the 'authentic' preparation materials like Uworld and all, there must be a fair amount of reviewing from test takers, discussing PQs to make sure to update them so that these materials do adequately cover the types of questions that are being asked in USMLE exams
If there are no repeat questions then how would you compare applicants to each other. One will say the last year exam was easy so thats why their scores are better than this year
@@Alich79865similarly how can you compare applicants when some are studying 1,000 page documents with recalls. Need some in between what we have now to prevent recalls
FYI, There no USMLE Test Center in Nepal. Authorized USMLE test center was removed 2-3 years back. Nepalese students need to go to other countries for USMLE Exams. Maybe India, Singapore, Thailand etc.
This can’t be true. The plaintiff who sued the NBME took the USMLE Step 1 examination on February 9, 2023 - so the center must have been open at that point. And remember, the NBME began getting tips about cheating in Nepal in January 2023… so if the closed the test center after that, it’s highly suspicious that they had concerns about something that was occurring at the test center itself.
This is the juiciest part of this series. I’m on the edge of my seat watching the telegram group chats. “And it turns out, the people using these recalls WERE that much dumb” 😭😭😭 I’m out 👏🏼 😂 Thank you for taking the time to research and present this!! Not that I want to fan the flames of drama or anything, but I’m kinda hoping for a part IV 🫢🤞🏼
I’m gonna be honest… I know I said I was out, but I’ve gotten 2 good questions since this video was posted, and the idea that a fourth Mailbag could eventually become necessary entered my mind. Thank you for watching!
I just double-checked - I didn’t. “Dr. Jurich” is Daniel Jurich, an NBME vice president and psychometrician. I’ve chosen to black out the plaintiff’s name, because I don’t want to detract from the fact that this is bigger issue than one person. But her name has been in the news media, and the court documents are a matter of public record.
This has happened before too all over the world. This is just about combination study and referring to old question. Study material is the same question is the same so answer might be the same. How can you guarantee it has not happened before or happening else where or domestically
“Other people have cheated before!” is a poor excuse for cheating now. And describing this as “referring to old questions” - when those questions have been systematically pirated, compiled, and shared among a group whose discussions clearly indicate that they are aware that what they were doing was not allowed - is beyond euphemistic. As I said in the video (and elsewhere), if anyone has credible evidence of cheating that occurred in the past, or in other places (especially including the United States), they should report it to the NBME. I’ll be just as critical of cheaters, wherever they’re found.
I still don’t get it. If the USMLE was running a fair investigation, why it only included Nepali students while not including the Jordanians, and Indians as well? Does that mean they pass the filter? Or there test scores were not investigated yet? I don’t know, there is almost a 100K examinations conducted every year, are they planning to examine every single case?
I think people from Nepal are doing something in Kathmandu at Kamar-Taj, that’s the same place where Dr strange the neurosurgeon went to learn about the Mystic art, the magic
Should the USMLE only be offered in the United States? ..Even the exam which was occurred, step 3's score is also invalidated..Why?? the security of this exam taker usemele please describe your security system in the exam..i don't trust this explanation at all...they are not cheaters ,,,if You are in power you can say anything that i feel in this case.....
Great overall video, but the economic equity argument regarding only offering the test in the U.S. fell flat. Medicine in the U.S. is already a highly elitist and financially privileged profession, with as many medical school matriculants coming from the top 5% in family income as those who come from the bottom 60% in family income.
Right… but those figures are from the AAMC, and refer to US MD students - who already take the USMLE in the United States. What about IMGs? As I mentioned, ~25k IMGs took Step 1, most probably took it somewhere other than the US. How many would take it they had to travel to the US each time to take the test? How would the income distribution of those test-takers change vs. the situation now?
@@sheriffofsodium Does it matter? Medicine overall is incredibly elitist and financially privileged. A few thousands more IMGs from wealthy backgrounds isn’t going to change anything. Not to mention the fact that most IMGs are already privileged enough to afford to $8,000+ for a relatively low chance of matching. If we’re concerned about prospective physicians skewing too wealthy, this is neither the time nor the place to begin this discussion.
![Lp. Сердце Вселенной #60 РОЖДЕНИЕ ЛОЛОЛОШКИ [Финал] • Майнкрафт](http://i.ytimg.com/vi/YoR0pAV9FVQ/mqdefault.jpg)
Really appreciate not only this series but also your insights and wisdom on preserving one's unflinching integrity in the face of such fraudulent activities. You, sir have my respect
Thank you for that - and for taking the time to watch my stuff.
@@sheriffofsodium Last year I came across a video by a Nepali guy, he is not a UA-camr and posted only one video and was a test taker. I was looking at videos of test takers for suggestions on preparation and came across that video. I couldn't find it now. That dude posted the video after he joined residency and he scored 287 or something in Step2 ck. A lot of the video is useless as he didn't provide any valuable insights into the preparation. He replied to someone in the comment section asking about USCE and said he joined residency and didn't do any observership or other USCE. He took the exam before the applications for residency and applied and got in. At that time I was in awe about the score but thinking about it now, seems he may have been one of those that cheated. He mentioned he took both step 1 and step 2 within a span of months.
I remember, reading one comment in the comment section by some Nepali person who wrote that more than 95% of his classmates and his seniors who took the exam scored above 260 in step2CK. At that time as I said, I wished that I was in their study group because I thought they must have studied together and had rigorous consistency and did questions and explained to each other. Now I think that is too much of a coincidence and that many students from the same college score above 260 seems sketchy. In my opinion, it seems a lot of them got these PQ's like you said in the video available to them.
As for step 2 CS, I agree with your point of view. Also with step 2 CS, each student spends about 5000 dollars in just exam fees. For IMG's going to the US including the airfare and accommodation and everything else will bring the amount to 8k to 10k just to complete all 4 exams (that is if all are done in the first attempt). Also, I have seen many physicians who are a bit silent, introverted, and talk slowly but are very good at their work and they will definitely score less in new settings, especially under exam pressure. Also, I heard from some that residents don't have to go into the residency knowing everything or have clinical skills completely. Residency is where they learn and know a lot of skills over time.
Dr. Carmody, you do such a great job with these videos, the research is so impeccable and detailed. Thank you!
This should be made into a movie
Thank you for taking the time to watch.
Stand and deliver 2
bro how are you everywhere?
FBI, lawsuits, cheating, American dream, perfect for a Hollywood movie 😂, amazing video, thank you for the information
It is a good Friday indeed when Dr. Carmody uploads an hour-long video.
Trying to keep everyone occupied for the weekend.
As a Nepali.... I feel so disappointed... I was rooting for Nepali doctors...but Statistics and Probability don't lie... what's more disheartening is that they memorized the wrong answers 🤦🏻♂️, portraying they have no knowledge or critical analysis skills... C'mon man!!! This will hurt so many good and honest doctors in future
As an IMG who scored 270 by spending 8-10 hours a day studying, I hate hate those cheaters. The programs who were initially impressed by my score and invited me to interview might now be questioning my credibility. I don't know what's wrong with people who support those cheaters. The honest exam takers will be cleared when cheaters are caught and named.
Lol yeah we know how you got that 270 if you are genuine stop commenting here it will show up in your work. There is no place to run life will test you you no need to show you worked hard by commenting here this proves even more that you cheated. If you were hardworking you wouldn’t be commenting here you would be working on something
@@kappa633What the hell are you saying???
Bruh you lost your mind @@kappa633
@@rr.studioshe's right tho
I've been on Reddit a lot lately following this saga and I've seen you attacked from all sides on Twitter. I applaud you for all you've been doing 👏 This whole thing is super juicy, sometimes hysterical, and definitely monumental. Thanks Dr. Carmody!
Great video Dr.Carmody , To add to your point at 37:46 USMLE showed that test takers from Nepal cheated on their step 3 exam most likely by recall thus achieving mean step 3 score about 20 points more than the US test takers so this would mean that unless proper measures are taken to tackle the problem of recalls it won’t matter where the usmle steps are being conducted.
One crazy fact that deserves more attention is that if 862 people had their step 2 score invalidated (and I’m not sure if that’s correct or it was 832 scores across all USMLE exams and and undisclosed number of total examinees), that would represent a very substantial fraction of the total number of students who took step 2 in Nepal, based on the data shown at the 16:10 mark
From the court filings - it was 832 examinees, which was approximately 40% of the group initially investigated by the NBME (consisting of self-reported citizens of Nepal; graduates of Nepali medical schools; and those who tested at the Nepal test center).
@@sheriffofsodium WOW. That's not a good look at all. Forty percent is an absurdly high fraction of future doctors willing to sell their integrity to get ahead at the expense of their future colleagues. Yikes
Don't usually post a lot but sherrif you really outdid yourself with this video. Thank you for your tireless dedication to medical education and your well thought out and comprehensive videos
Thank you for taking the time to watch.
The one reason I have been on twitter.
Contagious passion for medical education. Thanks for sharing!
I appreciate your kind words.
Me too!
I’m seeing your videos being suggested more and more on all different topics of posts on Reddit in particular. I hope your content continues to reach new listeners.
The fact that you have to keep repeating "Not all Nepali medical students cheated" 1000 times, just to be attacked is beyond me. You'd also think people in the medical field would also understand agreement analysis and statistical significance. Saddened by this whole situation but I am optimistic about cheaters getting their scores invalidated and can't wait for the other shoe to drop.
Thank you Dr. Carmody for all the work you do. Your advocacy for medical education is admirable and I look up to you.
Thank you for the kind words. I’ve certainly been getting some ‘fan mail’ from people who assert that they haven’t heard me say that, and that I’m defaming Nepal by branding all of their doctors as cheaters.
An imminent test-taker from Nigeria here, and all I can think of is how this ordeal isn't a good face for any IMG. I mean, why will any PD want to go through the stress of recruiting an IMG when these issues may arise, and indeed are arising...
Intelligence has to win over frauds and cheaters. Appreciable efforts Dr. Carmody.
I think they were quite smart to crack the usmle. It proves intelligence to organise such a thing to memorize so many questions from first time takers all of them. I find it a great feat of human intelligence no other nation could pull this off in such a scale. While all other nations are trying to crack usmle in similar way but what nepalis did was quite extraordinary and that is quite high iq work.
@@kappa633 What do Nepalis doctors really want to prove? OpenEnhanced AI can score 90% on the USMLE exam. Note AI do not even have brains. Violating the USMLE rules, and suing the US board, proves their smartness? Then, there's nothing much to say.
@@kappa633 clearly not high iq enough to at least stay there for the duration of the test
This video was excellent. One concern I have with the clear bruise to the integrity of the exam involves cheaters who purposely tried to be conspicuous. While some of the invalidated test takers were finishing exams very early and were always getting stolen questions correct. I’m concerned cheaters who were actually good criminals are passing under the radar. A good criminal would know finishing the exam early and getting stolen questions correct every time would be suspicious. I’m worried there are good criminals who passed the exam with slightly above average scores who aren’t meeting the NBME’s high threshold for score invalidation.
I would hope some state medical boards will push the NBME to lower the statistical threshold to invalidate scores. Certainly a probability of 1 in 500,000 to at least flag a test taker for more detailed analysis would be more than fair given only maybe 50,000 step 2 exams are administered each year.
Another victim in this cheating scandal are residency applicants who lost out on interviews because these invalidated test takers took their interview slots during this cycle and the previous cycles. You would think invalidated applicants with 260-280 scores received interviews this application cycle.
Wow, this is such a thorough video, thanks for putting it together. I’m so shocked that they’re asking for U$80,000,000!! I didn’t know that and I’m just baffled by the audacity. And I also agree with what you said that the honest doctors who didn’t cheat should be the most outraged ones against the ones who did cheat. If it was my country, I would be beyond embarrassed to even be associated with these people. I truly do feel sorry for the innocent ones. Hope they can find a way to distance themselves from the scandal.
I agree with you. The way to separate yourself from cheaters is to NOT protect them. Don’t rush to their aid. Let them fend for themselves and face the consequences of their own decisions.
Honest work and Science wins every time . Fire work ! Hats off.
💯
Thank you for taking your time on this and sharing. Great video! I feel your passion in Medical Education. Love to see science/the evidence based approach wins over!!
Thank you for the kind words - and for taking the time to watch my stuff.
Thank you for the amazing series! Amazing break down and thanks for the great words at the end.
Thank you for taking the time to watch.
I am an IMG who is not planning to take the USMLE exams, but I ENJOYED this. This was a great video You did. You nailed it, agree with every word of yours.
This was a really good video. I almost teared up at the end there.
Thank you for taking the time to listen.
USMLE CS is like Examen Profesional (or Professional Exam to be translated to English from Spanish) here in Mexico. I am a recent medical graduate here in Mexico City, Mexico but with dual citizenship of the US and Mexico so I'm planning to do STEPS to revalidate my medical work in the US. Actually, had a quick look at STEP 2 Clinical Skills while studying for a week straight for my Professional Exam, which i had do before even entering Servico Social (or Social Service be translated to English from Spanish) actually had a case I had was on the list of questions for some common symptoms that and list of questions need to be asked for that symptom and really saved my butt during the exam in the portion with the patient and also had impressed in a good way one of the judges by asking a question that many usually forget to ask and is extremely important for the cause and possible treatment of the patient being did it have blood or mucus in the patient stool.
As an IMG, it was well known that it’s foul play to share usmle questions. People made sure they didn’t do that during the times I took the tests from years 2017-2019.
Thank you for saying this. I’ve gotten a disturbing number of messages from people claiming - with a straight face - that these examinees did nothing wrong.
Can't believe the cheater had the audacity to get a lawyer and sue the NBME. That's something else.
It really hurts me to see what happened. I am an IMG and I scored a 270+ myself and I know what goes into getting that. I couldn’t finish the exam even until the last 20 min, let alone imagining finishing a couple hours early. I hope that in the future, all medical graduates realize that without this knowledge, we aren’t an asset to anyone.
Thanks Dr Carmody for being so comprehensive!
Great another square IMG. I bet you devoted your whole life to go live in freedom of America. Right? Am I right?
Not really, it was a pretty last moment decision. I have freedom in my country too. This was so that I could experience the healthcare system in the US.
@@chiragbansal2918 you went through all
3 steps (technically 4) because you wanted to experience the US healthcare system?
@@solslastcannula5665 Yes, and I like giving exams, I have given MRCP too, and will go there at some point of my career to experience that as well
@@solslastcannula5665 Yes, I love learning from everywhere I can. I have also given MRCP and plan on experiencing the UK healthcare system as well soon!
I feel like if us vets have to do the CPE which is a 3 day 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), IMGs should also have to do that
It is strange that we’ve chosen to license physicians without a practical test of their skills. Like I said, I’m not opposed to resurrecting a USMLE Step 2 CS type of exam *IF* it the NBME avoids the problems with the original Step 2 CS. I actually helped write a paper on that topic a couple of years ago:
pubmed.ncbi.nlm.nih.gov/34548971/
Just finished watching all 3 videos in this series and your analysis and commentary on this topic are simply phenomenal. Thank you from an IMG 🙏
this is the best video that you have put out thus far
Thank you for watching.
@@sheriffofsodium i have also seen the vernacular change around this recall business now.
they have started using pq or pyqs which is mostly what indians use to "crack" exams
So they took all 3 exams in 6 month . While I took atleast 6-8 months maybe more for each exam
But she swore under oath, under penalty of PERJURY, that she didn’t cheat! Are you saying you don’t believe her???
@@sheriffofsodium just sharing my experience… it does take time to take these exams .
@@AmberHaq-h4eYou are correct my friend. For whatever it’s worth, I took 13 months between Step 1 and Step 2 CK, and 3 years between Step 2 CK and Step 3. (I should have added /s to my response above.)
Few bad apples always ruin it for everybody
When i asked my fellow IMG grads if they were ever involved in such ,the answer always was "everybody does"
I doubt if there is anyone who didnt use recall, its culturally instilled.
This is well done. I suspect some form of cheating has been around for several years. Will current residents or attendings in the US have their USMLE scores investigated (especially if they took them from these flagged areas)? Will their license be revoked?
I thoroughly enjoyed listening to this. The level of narcissism and blowback from people who have cheated or their acolytes instead of cowering in shame. I loved the use of statistics in the beginning of the video and anecdotes. At the end of the day, you end up cheating yourself when you cheat on exams, and it finally catches up to you FAFO. Can't cheat all the people all of the time!
Alot of Cheating happened during CS exam.
In Texas, many students booked Hotel x very close to the exam center.
They did stay in the hotel for 1 month before the test day.
They did review all the recalls case and practised very well and passed.
I’ve heard this from some other people recently, too. What’s interesting is that I’d always heard that the Houston test center was more ‘IMG friendly’ - but that was attributed to a more culturally diverse group of standardized patients there vs. the other USMLE test centers.
@@sheriffofsodium
I strongley believe that
# we need usmle test face to face with attending oral clinical exam. As attending you can easily tell in few minutes who has knoweldge and how is recalling qs. Currently there is alot of physician with high score that does not match their scores at all. On paper they look good but not in reality. Some physicians missing basic concepts !!! On daily encounters.
# we need to offer pathway through for good people who willing to do 1 year unpaid internship to evaluate before signing contracts.
# I did not imagine that people with invalidated score went to the court !!!.
There are many immigrants with green cards looking for half chance to do residency and not cheating at all. I know one failed multiple times with 1 point. What is his feeling thst some others used recalls and affected the score curve.
The problem getting bigger now that some american patients are frustrated from some IMG and do not trust their knowledge at all.
Believe me lawyers will investigate what happended.
Also immigration lawyers may investigate how immigration happened base on medical exams putting american patients at risk.
Also how cheating affecting malpractise cost now !!.
We should support IMG but without putting the american patients life at risk.
Canada will never give visa based on medical exams even if you score 99%.
Also, very painful to see some IMG canadians scored low on canadian exams and very very high on American exam. They could not match in cananda but came here easliy !!.
Dr. Carmody thank you for the good words, and for that doctor story who struggled.
Someone should file a lawsuit against the NBME itself for be so lackadaisical that people had to complain before they realize such a massive flaw
If anyone has studied biostats for step 1, can understand how it is significant for mentioning who cheated or not cheated. 1 in 100 million chance that is literally cheating
B-b-but… what about… okay, I can’t, I’m out of excuses at this point.
@@sheriffofsodium lol. In my opinion, 1 in 100 million is still a very large number. They should flag anyone with 1 in a million or less. It's people's lives we are talking about. I think they were still cautious to only flag a chance with 1 in 100 million otherwise I bet many more people would have gotten their result invalidated
Damn that CS narration was spot on. It opened memories that I had blocked off as an IMG =D
Sorry for that flashback.
(But thank you for watching!)
There’s always a high pitched ringing in the background of your videos :(
I'm curious how they managed to do this with Step 3 though?
Why isn't there a part 4?
There may be, eventually. I’m following a couple of things right now.
Excellent gathering of information and presentation! :)
Thank you for watching.
Thank you for watching.
While I can not speak of what I have not witnessed, I have heard that neighboring countries are guilty of this as well. Is there any recourse if someone failed the exam by a point or two during these times, and what effect does it have ? Is the NBME going to go back and re-calculate scores?
USMLE can also introduce different type of questions in the exam: for example: "multiple correct answer type questions" where different options are correct but your answer to the entire question is not correct unless you mark all the correct responses.. or can introduce "integer type questions" where whole numbers from 0 to 9 are the answers and one has to approximate to the closest integer to mark the correct response. or introduce "match the following' type questions, or introduce negative marking to the incorrect responses. These are the strategies that are used in one of the toughest exams in India- IIT JEE to get admission into the prestigious IITs.
Quote: “is this a study group or fight club.”
How did she cheated step 3? I thought its only test is in usa....plz correct me if i am wrong!!
Looks like COMLEX may be the new standard 😎 Dr. Still would be proud.
In all seriousness - thank you for the insightful video. I think we all could use more level-headed and thoughtful takes.
Thank you for this video. It's really encouraging to know that staying true and honest in what you know of Medicine is better than cheating and bragging over great scores.
I am a faculty in US residency, I can tell based on my experience supervising them and based on my brothers preparation for USMLE this allegation is most likely true... These allegations are serious and
the FRAUD should be investigated and patients in USA should be protected from Harm.
50:00 - 51:30 was 🔥🔥🔥
And i absolutely agree with you. There SHOULD be justice and cheaters DESERVE to be punished. Imagine an innocent, hardworking applicant that got his career ruined by going unmatched because that spot went to a cheater who outscored him. I'm always shocked to see people defending this, complaining about "negativity" and telling people to "mind their own business".. makes no sense to me. Because this stuff is everyone's business. If cheaters make it through, everyone suffers at the end - the programs, the faculty, the healthcare system and ofcourse, the patients.
In my opinion, it's too little too late from the NBME. They only started working after people complained about it. Weeks before the announcement, i started seeing posts on reddit about Nepali recalls users and was happy to see that there was finally action being taken. But a lot of cheaters are yet to be caught, im sure of it. I hope they catch them all eventually.
Thank you. I think I got my BP up with that segment… actually felt dizzy for a second there and had to pause before moving on to the next question.
All the cheaters have to be punished. This test is serious thing, not only for those who take it, but also for the future of medicine. People work too hard to pass and prove that they meet the requirements to practice in USA to let bunch of cheaters to devalue all of our (IMGs) hard work.
I love the term p-hacking. This is what I’m concerned most about when it comes to Machine Learning and Medicine, too.
Pre-test probability matters. You check a lot of ANA’s on healthy people, you’re gonna get a lot of garbage. You check a lot of ANA’s in patients with leukopenia, a photosensitive rash, and glomerulonephritis, and you’ll make a lot of diagnoses.
@@sheriffofsodium I think there's a good statistical argument for use and knowledge of Bayesian method amongst clinicians (re pre-test and posterior probability) as opposed to reliance on p-values. There are many statistical papers arguing for the same move against tradition.
TBH in south asian and asian countires "Recall" is such a big part of preparations and you will get books with last 15 or 20 years of previous year questions. But in our scenario repeat is less than 10% so it doesnt matter.
When I first read about the students being deemed as cheaters because of recalls I was really surprised.
My scores are avg, i am glad that they are today. I worked hard and got the score that i truly wanted.
There will come a time in your career when your scores really don’t matter.
So respectfully then, Dr Carmody, why is this situation so scandalous? A group of 800 Nepalese students stood in solidarity with one another for a chance at a better life, in a land far away from their homes & among some potentially very hostile unknown strangers. Thru true teamwork, they bested one of the most powerful & established agencies on the planet. Perhaps there really is another lesson to be learned here. It would be interesting to hear you argue this case from both sides instead of just hearing you repeatedly defend yourself & repeat the same tropes against cheating. It would also help your listeners understand how/why this series of events transpired in the first place. Just some food for thought.
@@beautifulbull I think you’re missing my point. The passing standard for the USMLE is set to evaluate whether a physician has the minimum competence to provide patient care - or not. The problem with cheating on the exam (especially to this extent) is that it renders the test useless in that regard. A high score, or even just a barely passing score, might represent that someone has mastered the content necessary to progress in medical training… or it might not.
Teamwork, solidarity, besting the test, etc. - it all sounds good until you remember that the purpose of the test is to protect patients. One day, there will come a time when you knock on a door or pull back a curtain, and there won’t be a five-answer multiple choice question. There will be a real human being who needs your judgment and skill as a physician to help them.
@@sheriffofsodium I think the scores are just to filter people espeacilly to narrow down applicabts in competitive specialities. It's mostly the research and presentations, LORs and connections that get you through.
Respectfully, Dr Carmody, you are missing my point. US physicians/residents have one of the highest suicide rates of any profession in the US; we have malpractice suits too numerous to even mention here; & our healthcare system in this country is broken & built on inequality. We both know this, so please don't explain that away here.
I am saying perhaps there are better ways to assess adequate skills & medical knowledge of physicians here than simply the scores on these standardized exams. Especially when these exams are designed by the very purveyors of the healthcare system that makes its own physicians burnt out, very sick, & even dead.
These tests can't assess these skills. And they aren't the final say on what truly makes someone a good doctor, & they definitely don't accurately assess what makes someone a decent human being, especially when they bring out the very worst qualities in the people taking them.
Like I said, please consider making another video that looks at this issue from the other side. Thanks so much for your response & your consideration.
Students lie. Proctors lie. But numbers NEVER LIE. Thank you for all this thorough work. You should add JD to your credentials. 😂
Just an awesome video, from a US MD student
Thank you for watching. And I’ve gotta be honest: for many of my videos, you are in my target demographic. Although some videos are related to current events, some things that I’ve made are (I hope) evergreen. If you hear things that resonate with you, please consider sharing with others.
The scores of many US students who didn't cheat are artificially lowered (and this cycle many won't pass) because of international cheating. The exam has been made much more difficult each year without any adjustments to the time allowed to study or teaching/resource quality on the side of the US.
Furthermore, US residencies are taxpayer funded.
I don't see why the US sees a need to have foreign medical graduates in the first place at all. These are high paying jobs that should be going to US citizens and the process to get there should be regulated within the US.
Medical students in the US have an average of 200k at 7% interest to the US government. They become doctors with high incomes that are heavily taxed. Those taxes should be going towards helping US citizens not recruiting cheaters from abroad.
Also this invalidates both IMG graduates and using USMLE scores as any sort of metric for residency applications. IF this cheating is allowed to continue, I don't see why anyone should be taking these exams in the first place.
Residency spots are not high paying jobs…
Also, don’t residency programs have to find alternate funding for IMG positions?
Also he mentions in the video that there is a need for IMG bc there are more residency spots than residents
Take Usmle thrice or four times a year . Give percentile scores instead of actual ones
Excellent program.
Thank you for watching.
1:01:48 should be the key message everyone takes home. It's a sobering responsibility to know people trust you to know what you need to know to provide them the highest quality of care and I think we need to remember that is ultimately what Medicine is supposed to be.
Praise math! The reason we are in medicine.
How will this affect the other exam test takers? are the percentiles curved based on their scores?
The reasoning is very convincing. Just an inquisition,I don't know much about this exam scandal but it seems interesting, is referring to past questions and memorizing cheating? For me people can have similar answers if they come from same source, I would not consider the likelihood of the number of other answers there can be.
It's like saying you have a one in a billionth chance of hitting a jackpot but you still can. This is very sensitive issue to judge on random probabilities.
Is there something in written given to the exam attendees about not sharing questions after you appear? Is sharing old questions illegal?
Hate for the cheater ... usmle ecfmg should ban them instead just cancelation of results .... they are spoiling world best exam ...
This is pretty damning
I agree. If you read the court’s order, it seems clear that the judge was convinced as well.
So what happens to their licenses and jobs?
I covered this in the first video, but I’ll link below in case you (or anyone else) missed it. Basically, anyone who had a USMLE Step 1 or Step 2 CK score invalidated will lose their ECFMG certification. Without ECFMG certification, they are not eligible to train in an ACGME-accredited residency program. So until they pass a re-take, they will not be able to work. Anyone who is working under a J1 or H1B visa will be in danger of losing it.
Anyone who has *only* their USMLE Step 3 score invalidated may be okay, because passing Step 3 is not a requirement for ECFMG certification or participation in an ACGME residency program. However, it *is* a requirement for state licensure - so anyone who had an unrestricted license will lose it, at least until they pass a re-take. (I don’t think this will occur… at least not yet. In the lawsuit, the NBME only acknowledges reviewing scores as far back as 2021 - so anyone who matched is likely still in residency training.)
EMERGENCY MAILBAG: The USMLE Cheating Scandal
ua-cam.com/video/A3_HG5uc47I/v-deo.html
@@sheriffofsodium what I’m asking is what will happen if you already finished residency and you’re practicing with a full license.
@@ckrgksdkrak I don’t think the NBME’s investigation goes back far enough to get someone who is already in practice - like I said, they’ve only acknowledged going back as far as 2021 at this point. But if someone has a full license and is already in practice, the NBME will notify the state board and their license will be suspended and they will not be able to practice.
In that event, the person’s best bet is to re-take the exam(s) ASAP and get their license reinstated. The score won’t matter - but they would need a passing score to get their license reinstated. If they do that, my guess is that they’ll be able to get back on track quickly. On the other hand, if they choose to fight, they put themselves at much greater risk, because many state licensing authorities require good moral character to receive a license. So if they force the NBME to come to court or some appeal hearing and put on display all of the evidence that they cheated on the exam, they may render themselves unlicensable even if they eventually re-pass the test.
As an IMG, i really hope all of them get caught. I take step 1 in few days, i studies for 8 months for it. This is a bad rep for all of us.
Snacking and listening 😂😂😂 this situation is a mess
Thanks so much for the video! May I ask why you said u don’t think step 2 CS is a good predictor of clinical competency? Thanks
@48:03 she took all 3 steps within 7 months?
wtf??????????
people study for 6 months-1 year just to pass 1 step.
wtf
But she swore - under oath, under penalty of perjury - that she didn’t cheat!
@@sheriffofsodium I mean if there is anyone who is within the worldwide medical community and hears this, they'll instantly tell the judge that there is no way she didn't cheat.
I wanted to ask you something. This arhamba thing that the nepalis did is very hard to track down or penalise and it's effectiveness is proven by it's results. Will this model be replicated by others and in other fields or for other exams?
and will this be replicated on a smaller scale within some colleges and kept on the more down low or could this have only worked to this efficacy due to the internet?
@@sheriffofsodium also I wanted to say, phenomenal video
Thanks Doc. I'm curious why you call yourself " Sheriff of Sodium" . Is it trademarked or it's avail for all nephros?
The short version of the story is this: back when I was a resident, we had the opportunity to moonlight in our NICU, so to make extra money, I picked up a lot of extra weekend shifts. When I did, I’d take over some of my fellow residents’ patients - and get to adjust their TPN. I’d become a believer that excess salt/water contributed to the development of bronchopulmonary dysplasia, so I’d always try to cut back their sodium intake. One of the neonatologists noticed this policing and christened me the Sheriff of Sodium. I’d always loved salt and water physiology, so I took pride in the nickname… so when I needed a domain name for my website a couple of years ago, ‘Sheriff of Sodium’ was it. You’ll be shocked to learn that no one else had claimed the title.
Justice do happens sometimes, just wish not as infrequently as lightning on a summer day . Hope to see USMLE go after cheaters in other places we know it’s not just Nepal. 1. To restore the integrity of the exam 2) those people don’t deserve to be anywhere near a patient
If they know students in Jordan, India, and Pakistan also cheated, what haven't they invalidated their scores? They are still being allowed to match. And what about students from other countries?
Oh, I think more invalidations are coming. Like I pointed out, though - the NBME doesn’t move particularly quickly. They got their first tips in January 2023, and it took till January 2024 to make a move in this case.
@@sheriffofsodium So they will be allowed to match in like three weeks, and then midway through residency their scores will be invalidated. That is taking a spot from someone who deserves it, and is going to be a strain on the residencies because they will lose residents midway. USMLE can't be that incompetent.
If they skip the aforementioned countries and let them go into match then that is also going to have negative consequences to all FMGs around the globe. I hope NBME does not just stop it right here and continues expanding their investigation to all other places.
Actually there is use of past questions in every other continent of world. Not only asia even European students use the past questions to know how exam is and what are the contents being asked and they learn those concepts and sit for exam. But the questions are not repeated all over asia people read past questions even in India MD entrance exam all just read past questions and their concepts but obviously those are not repeated. Nepali students found that loophole in Usmle and not only nepali almost every country uses this loophole for usmle. Nepali were just too good in this game and scored high with consistency that is the only reason they were flagged. To call this cheating depends on which country you are in and i think this can only be called cheating for US and for this specific exam since they mention and make you sign to not share exam content.
Honestly tho, how do people even remember those questions. In my actual test I was going like “Wtf are u even saying” in every other question
I feel like there are so many attempts to deflect from this scandal with the race perspective. I am an IMG from England and of Nepali origin despite being born and raised in the UK. I feel that Dr has totally screwed her career as she had no leg to stand on. The math doesn’t lie. This is not about race or creed, simply math. I hope they catch far more people as this behaviour is fundamentally incompatible with being a physician. Would you want these Drs in the US?
Dr Carmody, the NBME gives data for candidates from other countries possibly cheating in 2021 and 2022. What do you think is the possibility of some of those "cheaters" having matched and currently in residency? Also do you think they can be removed from their training or if that isnt possible, will NBME inform PD's and have them face some sort of consequences?
And thank you for sharing the story about the Pediatric Jedi, gives hope to someone like me, an older IMG from Pakistan with average scores. The reason why we are in this game, to change and improve lives.
I know with certainty that some of the impacted examinees *are* current residents. The ACGME issued a guidance statement on how these situations should be handled. Basically, anyone who had their Step 1 or Step 2 CK score invalidated will lose their ECFMG certification, and will no longer be able to participate in the residency program (until/unless they pass a re-take). However, the ACGME has reminded programs that they are required to give residents due process if they are being moved toward dismissal.
they were really that much dumb, gosh
Yes, they were.
Thank you for watching!
Sir, i believe the usmle exams should be done once a year, and applicant should have a score compared to the performance of rest of the applicants of that year. This will definitely cut down cheating and make the exam more standard.
Test center capacity. A space of 50 can hold 500 exam takers at once.
You mention that restricting the USMLE to US testing centers (shutting down test administration abroad) would worsen inequity among IMGs. Spot on. I feel like many domestic students don't appreciate how much it costs to be a foreign IMG trying to make it in the United States, and how many additional costs they have to absorb. Additional exams, exorbitant fees for away rotations, and being forced to do some "research experience" at cost or find a qualifying job to maintain their visa status while they wait for July 1st because of schedule mismatches compared to the US medical school schedule.
I almost assume every IMG I encounter comes from a family with few money concerns. I don't think there is a robust of a student loan system for medical education for most of them. I don't know if there's anything we can do to improve the likelihood of equitable outcomes for foreign IMGs applying to residency here, since the institutions collecting the checks aren't about to change their mind. Maybe program directors who empathize with that struggle have some potential to make a difference in that space.
Great video as always. Can't disagree with any of your points about cheating.
Great points. And thank you for watching.
I just have one question, there were many questions in which I chose an answer after initially seeing the last couple of lines in the stem, and then took my time to read the question, and then if my answer turned out to be wrong I would change it but if it turned out to be right I would move on to the next question, so my question is, is response time considered the time I took to move to the next question? or is it the time I took to pick an answer regardless of whether I took some time to read the question after that or not?
Also, there was a considerable amount of questions that required less than 30 seconds to solve, especially for those who practiced with all the CMS and NBME forms, so I don't think the response time alone is enough to consider someone to have cheated.
Good question - and I honestly don’t know. My impression from the court papers was that this examinee answered questions, moved on, and didn’t return. But I don’t know that for sure.
I agree with your point that response time alone is not sufficient to identify a cheater. If that were the only data point evaluated, you’d have a lot of false positives (and any cheater who just took their time would escape). But here, it was just one data point among several - and together, they create such a highly unusual set of findings that they simply would not be observed under normal testing conditions.
Can you make a video on why US residency programs provides residency interview based on contact.
As an IMG with none alumni in US its hard for some IMG to have this sort of privilege.
And I know being one such IMG myself I took to the world went to the US and communicated with lots of people made new connections however, I also saw people who got matched from a home country without any such efforts.
Its really heartbreaking and unfair!
Seeing this Scandle unfold and the action taken by NBME is something I always wanted and I really appreciate and apploud this action.
And Thank you so much Dr. Carmody
Most people whom you have labelled as cheaters don't fully realise the consequences of discussing PQs. It has been an established culture in Nepal, India, Pakistan and most other south Asian countries to share past questions and discuss them.
Most of these people are surprised why USMLE is taking such a harsh action.
Most didn't pay to get their hands on 'SECURE' exam content or took photos of exam materials from the exam centre. They just joined Telegrams groups (which aren't hard to find) and started hosting sessions and discuss PQs.
The US condemns such act as CHEATING.
These people think it is normal to join PQ discussion groups. They do realize that USMLE doesn't approve of PQ discussion but they don't realize they they take this thing sooo seriously.
I'm sure that people discuss PQs in the US or other countries as well. But the magnitude of Nepalese doctors taking their shot at the USMLE made this scandal come to light.
So my take is Nepalese unknowingly crossed a threshold of allowable PQ discussion and the USMLE took action.
And all the 'authentic' preparation materials like Uworld and all, there must be a fair amount of reviewing from test takers, discussing PQs to make sure to update them so that these materials do adequately cover the types of questions that are being asked in USMLE exams
Thts why I love math. Math never lies.
Its great podcast 👍
Thank you for listening.
and then those whose scores are invalidated are matched!
USMLE exams should be administered quarterly with zero repeated questions
You can’t really have ZERO repeated questions… because you need some crossover questions in order to equate performance from year to year.
If there are no repeat questions then how would you compare applicants to each other. One will say the last year exam was easy so thats why their scores are better than this year
@@Alich79865similarly how can you compare applicants when some are studying 1,000 page documents with recalls. Need some in between what we have now to prevent recalls
1 in 100,000,000 is almost as rare as winning Powerball or Mega Millions jackpots
Thank you for advocating a common sense!
Thank you for taking the time to watch.
FYI, There no USMLE Test Center in Nepal. Authorized USMLE test center was removed 2-3 years back. Nepalese students need to go to other countries for USMLE Exams. Maybe India, Singapore, Thailand etc.
This can’t be true. The plaintiff who sued the NBME took the USMLE Step 1 examination on February 9, 2023 - so the center must have been open at that point. And remember, the NBME began getting tips about cheating in Nepal in January 2023… so if the closed the test center after that, it’s highly suspicious that they had concerns about something that was occurring at the test center itself.
26:24 I chuckled real hard! LOL
The first rule of Arahmba is that THERE IS NO ARAHMBA.
This is the juiciest part of this series. I’m on the edge of my seat watching the telegram group chats. “And it turns out, the people using these recalls WERE that much dumb” 😭😭😭 I’m out 👏🏼 😂 Thank you for taking the time to research and present this!! Not that I want to fan the flames of drama or anything, but I’m kinda hoping for a part IV 🫢🤞🏼
I’m gonna be honest… I know I said I was out, but I’ve gotten 2 good questions since this video was posted, and the idea that a fourth Mailbag could eventually become necessary entered my mind.
Thank you for watching!
You missed blacking out persons name on one of the court documents 23:58
I just double-checked - I didn’t. “Dr. Jurich” is Daniel Jurich, an NBME vice president and psychometrician. I’ve chosen to black out the plaintiff’s name, because I don’t want to detract from the fact that this is bigger issue than one person. But her name has been in the news media, and the court documents are a matter of public record.
This has happened before too all over the world. This is just about combination study and referring to old question. Study material is the same question is the same so answer might be the same. How can you guarantee it has not happened before or happening else where or domestically
“Other people have cheated before!” is a poor excuse for cheating now. And describing this as “referring to old questions” - when those questions have been systematically pirated, compiled, and shared among a group whose discussions clearly indicate that they are aware that what they were doing was not allowed - is beyond euphemistic. As I said in the video (and elsewhere), if anyone has credible evidence of cheating that occurred in the past, or in other places (especially including the United States), they should report it to the NBME. I’ll be just as critical of cheaters, wherever they’re found.
I still don’t get it.
If the USMLE was running a fair investigation, why it only included Nepali students while not including the Jordanians, and Indians as well?
Does that mean they pass the filter? Or there test scores were not investigated yet? I don’t know, there is almost a 100K examinations conducted every year, are they planning to examine every single case?
Your question is answered by the Natrium Sheriff at 12:44
U said nothing about how the Nepalese students scored very high in the step 3 considering it is taken only in the USA.
I think people from Nepal are doing something in Kathmandu at Kamar-Taj, that’s the same place where Dr strange the neurosurgeon went to learn about the Mystic art, the magic
Hahaha cracked me up
Should the USMLE only be offered in the United States? ..Even the exam which was occurred, step 3's score is also invalidated..Why?? the security of this exam taker usemele please describe your security system in the exam..i don't trust this explanation at all...they are not cheaters ,,,if You are in power you can say anything that i feel in this case.....
Great overall video, but the economic equity argument regarding only offering the test in the U.S. fell flat. Medicine in the U.S. is already a highly elitist and financially privileged profession, with as many medical school matriculants coming from the top 5% in family income as those who come from the bottom 60% in family income.
Right… but those figures are from the AAMC, and refer to US MD students - who already take the USMLE in the United States. What about IMGs? As I mentioned, ~25k IMGs took Step 1, most probably took it somewhere other than the US. How many would take it they had to travel to the US each time to take the test? How would the income distribution of those test-takers change vs. the situation now?
@@sheriffofsodium Does it matter? Medicine overall is incredibly elitist and financially privileged. A few thousands more IMGs from wealthy backgrounds isn’t going to change anything. Not to mention the fact that most IMGs are already privileged enough to afford to $8,000+ for a relatively low chance of matching.
If we’re concerned about prospective physicians skewing too wealthy, this is neither the time nor the place to begin this discussion.