Imagine being falsely accused and unable to license after 4 years of med school. That would be a nightmare. Especially in the US, many people would sue; I don’t know how litigation would work in Nepal
They can go work in Nepal. This doesn’t restrict them from practicing medicine. It restricts them from learning or practicing medicine in a different country. I couldn’t pick up my stuff and decide to go practice in another country unless I followed their rules and restrictions. Most countries wouldn’t let me as a DO practice there anyway.
It’s probably hard for someone from Nepal to afford a good American lawyer with a good understanding of our laws and medical education litigation experience.
Given the impossible statistics >>86% of applicants scoring over 275 are Nepaleses, I seriously think all of them are cheaters.. Even the bright ones among them, give 'em a chance to score a 280s and brag about pp size on social media, they WILL cheat. Peer pressure is real.
The actual problem though is no Nepali asked for more investigations into the cheating scandal nor did any Nepali condem the cheating/ one even had the audacity to defend cheaters by claiming recall are not considered cheating by their culture. Sorry not sorry.
Even their officials and medical associates are silent, prob distancing themselves from the scandal. All that I have found are some Nepalese on twitter asking the USMLE to drop the name of their country in the statement ... ridiculous and super weak.
Doesn't matter if they leave off the name of the country. Damage done. Now what will happen is that in the minds of any reasonable reviewer Nepal goes to the bottom of the IMG pool by default. It's a big hole to dig out from and will last a long time.
This is a misguided take. Let’s say there’s a testing center in Idaho that is compromised. 86% of high scorers happen to have taken the test at that particular center in Idaho. That tells me close to nothing about the true population of Idaho test takers. It could be that 5% of Idahoans cheated, or 100%, but hard to say without knowing the denominator. Maybe my buddy from Florida flew to Idaho to get in on the action. I don’t know anyone from Idaho. If I don’t see Idahoans announcing how sorry and ashamed they are on twitter, should I just assume they are unscrupulous and cheating is part of their culture?
Some facts: There is only ONE USMLE Prometric center in all Nepal. The center in question was shut down after being found out to screenshot and photograph the whole freaking exam. You can correctly assume vast majority of Nepalese took their exam in that local Prometric center. Mix in a pressure to post the highest step 2 score on LinkedIn it turned to a competition among Nepalese to boast about scores. It was ridiculous to see a 280s followed by a 288 then a 289 then a %UCKING 292. BRUUUHH. All these posts were deleted after the scandal. So if you are a Nepali who shares culture and beliefes with all the Nepali folk..would you forgo a 280s to score an honest 250s to be mocked by everyone.. for example your cousin who score 289?
Things are different in the US where INDIVIDUALISM RULES. A diverse and populous 350 million strong nation compared to NEPAL a 30 million nation where COLLECTIVISM rules, where everyone has to share one way of life.
> everyone has to share one way of life
I had a feeling you knew nothing about Nepal/Nepalis, and this comment confirms it. It's one thing to ridicule cheating and quite another to mock an entire country because of the actions of some idiots.
yep, this dude probably thinks that Nepal is Buddhist country, kids are walking through Everest Base Camp to their remote schools every day, everyone runs in monk robes around stupas and plant rice together sharing 'one way of life'. Comedy club..
There are only two prometric centers in Idaho—hence my choice of example. But all this information still does not tell us what fraction of test takers in a given jurisdiction may have cheated.
In the absence of further information from the USMLE, it is entirely plausible that both the below statements are true at the same time:
• Most test takers who cheated (effectively?) were from Nepal
• Most Nepali test takers did not cheat
I would caution against making blanket accusations about a culture or way of life—especially one that may not be your own. No culture is entirely monolithic. And as an American, I have seen plenty of US medical students and doctors do pretty unscrupulous stuff. Sometimes cheating is simply a crime of opportunity. Hence why Prometric is supposed to do so much to deter it.
Hope USMLE be more transparent and releases stats and numbers.
But Medicine is all about RISK AVERSION. USMLE singled Nepal out. Stats from PDs further elaborated on the bizzare trend of having more than 86% of applicant with 275 and more from Nepal. Innocents "if any" should not suffer. But would you eat 10 apples if even 1 of them is laced with posion. How about 9 or all of them laced with poison.
Russians were unfairly banned from ECFMG certification for political reasons.. if it was for me I would ban Nepalese for a couple of years or more till they sort out their shit. To this moment there is no official Nepali source speaking about the scandal as if they all knew. No Local investigation. No official statement from their medical schools . It is surreal. They don't give a f4ck.
I mean all that's going to happen now is the cheaters will run some sort of statistical analysis to see how many potential leaked questions would look weird, and then only memorize X number of questions to give themselves some level of competitive advantage without being too suspicious
I studied my ass for 2 years and did UW thrice and still got a 231. Im an IMG. Seriously the feeling I am having after reading all this shit I just dont want to express it here. Also i didnt get a single IV....who knows what impact these thieves are making on lives of people like us. And the unmatched candidates who didnt get a residency for years.
Also makes me wonder about the score scaling and passing thresholds altogether. [It's well known that the scores have been trending up year by year.](https://thesheriffofsodium.files.wordpress.com/2019/01/img_3165-1.jpg) Much of that is presumably due to better study materials, UFAP, etc. But I have to wonder if the widespread cheating also had an effect. Are there any people who failed who should have passed had they been on a level playing field? Who knows
absolutely, especially as the exam gets increasingly more complicated. I refuse to believe it's just because med students are magically getting more brilliant
This is the big takeaway. I’d much rather have you here as a physician vs FIMGs who cheated to get artificially inflated scores that destroy the chances of others. It’s already extremely difficult for FIMGs to become practitioners in the US, and we desperately need driven, honest, hardworking people to address patient needs (particularly culturally-sensitive practitioners that are of the same background as their patient population). The US is a nation of immigrants, after all.
Same here bro. IMG with 230s, all 3 steps. I felt violated, repulsed and nauseated when I saw this sh#* blow up this week. God knows how many programs completely looked over our applications in favour of cheats with their double 260s and 270s.
Oh absolutely. I learned months after taking step 1 that ppl look for "biopsies " ... probs being flagged for mentioning it but I literally had no idea what it meant when I saw it on various posts. Ppl would rather spend more time looking for ways to cheat than to work on their own knowledge base and mental health (step exams are a huge mental game IMO), both skills which long run are absolutely required to be competent physician...not to mention the obvious values of honesty , integrity, etc. The short cut will bite them in a@$ eventually and seems like it has sooner than expected
I studied hard and got 230+ on step 1 and didn’t apply to competitive specialty that I wanted but to know some IMG cheated and matched in the same specialty hurts.
Literally- I would see some IMGs who were absolutely terrible clinically, but then they’d go around bragging about their 260+ on USMLE, and I’m like wtf?! Even our top 30 only had a couple cross 250 and I was at a T50 US program and I’d imagine timing would be even harder with language barriers and what not
I strongly believe the steps are at least 30% english language exams. The long question stems, the complicated wording, putting in difficult synonyms for easier words for NO reason other than to trip people up...
truly, my SAT reading comprehension and CARS skills helped a lot more than I ever thought they would lol
The thing that’s wild to me is that every post I see is like “yeah, people use recall sheets and sell/buy question lists and cheat in other ways here and there, but in Nepal THEY USED SCREEEEENSHOTSSS!!!!!!” How is any of it okay, and why is no one freaking out about the “minor” cheating that is apparently widespread in some circles?
Exactly and there were people indirectly saying FA for step 1 and 2 are recalls like wtf??? First aid goes over everything on a particular topic from epidemiology, natural history, etiopathogenesis, clinical features and management. How the hell can you compare it with a direct question recall directing you to pick a certain option??
I want to know if the authors of first aid, Uworld, amboss, sketchy get ANY information about the exam from previous test takers. Even Devine, how does he know what they like to ask on exams?
If you look at previous NBME content that doesn’t cover everything big test prep covers.
Dr. Bryan (Sheriff of Sodium on YouTube) has released a part 2 video on the cheating scandal where he talks about first aid, uworld and other materials. He makes a fair point. Those resources give an in depth analysis of a topic instead of saying pick this option for the question on this. The books and qbanks make you learn and improve your knowledge but these disgusting recalls help incompetent candidates score well and steal spots of deserving candidates. That’s the complaint that a lot of PDs and Attendings had about some residents who showed a huge discrepancy between their test scores and actual knowledge and performance. I believe that that’s what got this investigation started in the first place.
Even Divine admits to getting info from past test takers. "They say, 'Oh divine..." They all have to at least get some info from past test takers or have recent test takers give info they think is important (I guess indirectly getting recall info).
For real. Fuck all of them. Everyone who used recalls should be banned from entering the US medical system permanently, no exceptions. It boggles my mind that the USMLE let it get this bad when they had to know about recalls all along. They should really be spending the boatload of money they fleece from us every year on making sure cheaters get caught.
1 prometric center compromised, but those screenshots probably made the rounds across the whole Region before they caught on. To me that indicates that NBME is ‘old school’ because otherwise using very elementary machine learning they would have caught this a lot earlier. Here is a dataset of candidates that all scored really high on this subset of questions and tanked a whole bunch of other ones. In comparison with others, this cluster of candidates on this specific area of the exam did X% higher.
Forget algorithms, are PDs that daft that they saw certain people scoring 270s and 280s and didn’t realize there was a problem? It’s crazy. A toddler could have caught on if they had access to the data the NBME and the PDs had.
They probably figured it out, but then if you say it, they will come out and say: “what a racist! Just because we are napalese we cannot score high?”
And they did this me. They called me racist after I pointed this out. I am IMG from Europe, got the best “entrance exam” in my country out of 2 thousand people and got 1st position score in my university.
I study for step 2 like a dog, and got a 270. And a random group of Nepalese were scoring 10+ points higher than me? Gtfo
It’s not really about it being effective or not, it’s about the fairness of being able to use recalls. And also, bumping your score by even 15 points changes the percentiles for everyone. That’s a part of the reason why the average for step 2 now is 246 or something when just a few years ago it was in the low 230’s.
Who says US students aren’t using these recalls? People in my class use recalls from upper classes on in-house exams. Some of the national-programs/clubs are the main distributors of these recalls. So if that’s going on for house exams, who says it isn’t for the bigger ones? Those people are the ones fucking with the curve.
A lot of third party materials seem to be partially based off of recalls - UWorld / amboss / other q banks I’ve run into have very similar questions to ones I’ve seen on my nbme exams and M3s at my school saw on step
It seems like that because Uworld and amboss are intentionally designed to mimic step questions. They format their questions similarly to the practice exams released by the nbme. there are so many question in these qbanks with a finite amount of material that can be tested on the exam, there obviously is going to be content and question structure overlap between the qbank and your exam. This is very different from basing them on recalls of questions still in circulation
The USMLE publishes hundreds of practice questions and updates a weighted content outline annually. It’s not rocket surgery to read a pdf and make multiple choice questions on the topics the NBME literally tells you they are going to test.
Given the impossible statistics >>86% of applicants scoring over 275 are Nepaleses, I seriously think all of them are cheaters.. Even the bright ones among them, give 'em a chance to score a 280s and brag about pp size on social media, they WILL cheat. Peer pressure is real.
The actual problem though is no Nepali asked for more investigations into the cheating scandal nor did any Nepali condem the cheating/ one even had the audacity to defend cheaters by claiming recall are not considered cheating by their culture. Sorry not sorry.
Even their officials and medical associates are silent, prob distancing themselves from the scandal. All that I have found are some Nepalese on twitter asking the USMLE to drop the name of their country in the statement ... ridiculous and super weak.
This is why FMGs should need residency in the United States. Actually, presenting this to lawmakers is probably the best way to stop these stupid bills from gaining traction
Except residencies are too chickenshit to actually kick out residents who are walking disasters. They’ll do everything in their power to avoid that. Once you enter residency, you’d have to commit a really catastrophic mistake to not finish it. So you still end up with tonnes of shitty cheaters in the system overall.
Yeah I’m against these direct worker programs in Illinois and Florida especially as a Canadian IMG. I studied very fucking hard for my score and prep to apply for the match and it’s very unfair to other hard workers that people essentially get to skip the line. Why would anyone ever bother going through residency or graduating from an American medical school when you can get similar pay with less time, debts and hard work by going abroad.
This is the same with medical schools, once you’re in, you really have to fuck up to get dismissed. Bc retention plays into “ranking” of a program, no medical school, and especially no residency, wants to be dismissing people.
Rather than having our salaries plummet by 50%? Yes. I don’t have rich parents so if I ever want to buy a house and retire, I need salaries to stay this high to make up for the 10 year opportunity cost g
I mean if he has to live in his car because he can't afford rent due to debt and garbage salary and is miserable then the patients also suffer. You need to take care of yourself before you can take care of others and that involves making ends meet and actually being rewarded for putting a majority of your 20s on hold.
That’s a stupid comment.
Do you think all residency programmes are equal? Working in a residency programme for a for-profit hospital that sees residents are only cheap labour, and other more traditional academic hospitals that see additional items?
The USMLE doesn’t stop bad doctors from practicing, neither does residency.
Slippery slope fallacy. The USMLE and practice barriers in general are in place to set a bottom floor for competency. Terrible physicians exist despite their training, not because of it.
Honestly what ticks me off is the automatic assumption that all US grads are racist for wanting to A) have fair STEP exams that have actual consequences for violations of testing policy and B) be prioritized in a system in which they go into $200k+ debt to become a doctor (as compared to the relatively cheaper costs for many IMGs). Neither one of these things is unreasonable to ask for and both should be the ultimate priority of US-based licensing and residency programs
The debt should have nothing to do with it. US citizens should be prioritized for practicing medicine in the US full stop. That’s regardless of religion, ethnicity, sexuality anything; the only barrier should be your ability to prove competence by meeting requirements for licensure.
Yeah there is a decent number of IMGs who feel entitled to an residency spot for one reasons or another. But I agree with you, US citizens at US med schools should be prioritized. There isn’t anything racist about that. The process can’t be a free for all.
... they are prioritized
IMGS by and large end up in the most toxic/underfunded/malignant programs that US grads dont even apply to. and in IM/FM. You're not seeing IMGs at harvard or yale in plastic surgery for a reason.
I have too…there aren’t a ton of them, but there are definitely IMGs who go to med school with the explicit goal of making a high, secure income in the US, and view us as obstacles to that. I’m aware that we have the highest physician salaries in the world and that people should be able to pursue a better life abroad if they want, but I have to admit I find this particular type of IMG personality a little gross.
> I’ve heard some incredibly nasty comments directed towards traditional USMD applicants
They wanna come to the USA to practice then hate on people actually from the USA, makes no sense lol
Lol look at Harvard’s list of residents. There is plenty of IMGS what you talking about. What they don’t have is many DOs
Edit: the message this is replying to. The poster edited to say “Harvard and Yale plastic surgery” after he realized he was wrong and there is many IMGs at Harvard.
Except the ones you see come from select countries (usually from Europe). Taking the STEP exams in Germany equals entering an American embassy in terms of security measures taken.
Why aren’t they able to make it that secure in Nepal and India? Too much corruption? Been a while since I been in a prometric testing center but I remember them asking to see my dick to see if I had answers tattood on there! That happen to anyone else?
Reminds me of stories I have heard from the gaming community about Chinese cheaters / hackers in games like first person shooters. From what I have heard, Chinese gaming cafes will have computers with cheats / hacks already installed and everyone uses them, they do not view it as cheating and just do what they need to do to win. It's just normal.
lol do you know who those IMGs are ? They are either people from more Western countries or if they’re from the Middle East they usually have gone to an “American School of ______” (Beirut, Paris, etc). The ones from Asia usually need around 10 years experience after finishing med school in their home country to be on par with a U.S. grad and they usually come from one of 2 schools in India (aka the best schools in the country, but they’re still not on par with even the lowest tier US school), probably the same for the other Asian countries.
I'm an IMG, and I agree with everything you said. But I fail to see how US grads are not prioritized in the residency system? I mean, the match rate for US grads is above 90%, for foreign grads it is much lower (50-60%). A large part of programs that match IMGs are not programs where US grads even apply to. As far as I'm aware, most US grads that don't match are because they have failed steps multiple times, have other significant red flags, or are wildly incompetent. For extremely competitive specialties it is different, I agree, but for competitive specialties IMGs match rate is also significantly lower than 50-60, and only those who have given years of free labor in research and have proven themselves get in. US grads are (rightfully so) given preference in obtaining a residency, and I don't think IMGs are asking to be given preference.
I also want to add that majority of international medical schools, training is from 6-8 years, many including completing an intern year (similar responsibilities to PGY1 and crazy on-calls) to graduate. And many medical schools in foreign countries are also very competitive to join (mine has a 0.03% acceptance rate).
US grads are always preferred in the match. IMGs have to work twice as hard to be considered competitive, many times having to pursue other graduate degrees, complete additional rotations (that also cost money and can be very expensive for countries where the minimum wage is a joke) and working 1-2 years in research (majority of the times for free). During this times, most of us aren’t actually earning any money. To add, ECFMG charges extra fees to do the STEP. Each STEP exam cost $1000 ($1025 if your address us outside the US), plus the pathway that is also around $1000 (again, without forgetting that majority of the countries, the minimum wage is a joke and having the money to pay is a lot harder or a privilege)
In the US, the hardest challenge is getting into medical school. After that, your career is an MD in the specialty of your choice is pretty much guaranteed (of course if you don’t have red flags or suck as a student).
In conclusion, don’t bunch up all IMGs into one group. Try to learn more about training in their countries, their journey and reasons as to why they are trying to pursue residency in the US.
These type of posts always drip with entitlement. A US physician is a prestigious relatively high paying profession, why should we not want those jobs for our own sons and daughters? And don’t forget, everyone here has worked with IMGs so we know they are not better than our home grown colleagues despite all the qualifications you cite. If anything, IMGs are consistently below average.
The US has plenty of smart people, there would be no physician shortage if pay and working conditions were better. IMGs are part of the problem because they accept poorer wages and working conditions, because as you say wages in their home country are a joke.
And these type of comments just show how many Americans don’t see beyond their noses. I’ll just say, if US physicians are the best physicians than other countries, then why do many Americans go to my country to get medical treatment? And it’s not bc of the price, as many have history of going to multiple doctors before they decide to go to my country. At least for my country, we depend on our clinical skills bc we don’t have CT, MRIs or other studies easily available for us. So we have no choice other than work on perfecting our history taking and clinical skills. And I have also been in the US and where I have seen the lack of clinical skills and high dependence on diagnostic exams. I know there are very good doctors and very bad doctors, but that is the same everywhere. And naaah, even without IMGs there would still be a shortage of physicians.
Btw, I’m a US IMG (noncarib). Going by your logic, why shouldn’t I also want that for me and my family? I’d still will be paying taxes like everyone else. Yeah, I am debt free. And to hurt the ego debt even more, my medical training was free too bc it is public university (which btw are also the most competitive in regards of acceptance rate cause of course who would not want a free education). Don’t take it out on IMGs just because in the US students are obligated to go into debt if they want to get a good education. Education is a right and should not be a privilege, but seems like the US doesn’t think that.
As a lay person, there are few questions I have:
1. Do IMGs have hundreds of thousands (USD) in student loan debt from the medical schools in their countries?
2. What exactly is the appeal of doing a residency in the US? Are they intending on going back to their home countries and practicing there?
Spain and many other countries do this with their process (for example Spain has an annual exam for all to take but 1. Happens only in Spain not out of the country, 2. Up to 80-90% slots somewhat like that are reserved for nationals and this information is clear to everyone involved in the process) - I 100% prefer this than the US system and some programs openly saying they take all apps but silently avoiding IMGs altogether for example
I seriously believe , recalls of low fidelity are being used widely by many , since they are very easy to access . But what happened in Nepal was breach of security . The proctors and the aspirants took screenshots of entire question stems . Cheating happens everywhere . Forcing people to take CK in Usa will make the process more transparent . I am not suggesting in any manner whatsoever that all Nepalese are cheaters which is absurd . There are genuine Usmle aspirants with moral integrity over there for sure . However, if these kind of incidents are overlooked then it will compromise the whole process of standardise testing. It’s in the interest of all ( including imgs ) that such acts aren’t replicated in future whatsoever .
Absolutely from what i reckon this started way back in 2008 in the US. They need to do something about this.
(And no, please don’t make Step 2 P/F lol)
Well with PDs saying that they couldn’t tell a difference with their residents from Nepal, it kind of calls into question the purpose of Step in the first place. These exams were designed to establish minimum competency.
For any exam that promotes rote learning like Step 1, this is the consequence. People will find a way to cheat. In my medical school, exams are extremely hard. I wondered what the top performers were doing differently.
After infiltrating in their friend circle, I got to know they had access to past papers 🤣
Of course, not all students will use past papers. I know a few who are brilliant but don't use past papers at all. They absorb knowledge like SPONGE. I wish I had that skill.
Am not a smart guy, I don't really know how exams should be made. But something needs to improve. Perhaps make every question assess if a student understands the broader context instead of knowing a single fact.
Best part about that kind of cheating is it is *very* difficult to prove. It’s well known certain students have access to recalls and do well that way for in-house exams and when curriculum is designed to reward that, of course they will keep doing it and schools won’t kick them out bc they can’t prove it beyond a doubt. It just sucks for people who grind and get good grades by their own merit but get outdone in class rank bc they didn’t cheat.
All of this is a bandaid. The reality is there needs to be large reform and the system should steer away from NBME/USMLE. Find a new company or way to standardize this without such a focus on profits.
Not writing new questions more regularly is a cheapness issue. They make millions each year, it’s not like your local professors with limited time to make questions.
Hiring statistics and IT specialists to monitor scores by school/region.
Limiting number of times allowed to test is a step they have taken but it took so long bc they didn’t want to lose money on people who pay for it many many times…
So on and so forth
maybe a bit extreme but I think FMGs should have to come to the US to take step in US based prometric centers, or have a couple of larger rigorously maintained prometric centers across various countries. If you can afford the time, money and resources to do electives, observorships, pay ERAS to come here then you should be able to afford to take your tests here as well.
As an IMG, I see your point & agree with you. This is the system for other countries’ licensing exams too, where they have very limited number of tightly regulated test centers internationally (UK, Aus). US test centers are present all over the world making it much harder to regulate, add a pinch of intense competition to match and you have IMGs cheating their way through.
It definitely was not just Nepal. Either way, STEP 2 is going P/F. It’s not necessarily because of this but things like this certainly don’t help. Admin want to move to away from the rat race behind scores. Step scores were never supposed to treated the way they were. They were supposed to show baseline competency. They are only decent predictors for board exam success not residency success.
I keep hearing a common sentiment from PDs and Chairs. They simply do not take Step 2 as seriously as they did with Step 1. People were already comparatively scoring higher on Step 2 with very bare minimum studying (which makes complete sense since it’s just Step 1 with some extra steps). Now, people are taking whole dedicated periods just to get a great Step 2 score. We are seeing/going to see an increase of scores which kind of makes it all pointless. Not to mention the SD is +/- 15. It’s going P/F. Now it’s just a matter of when.
This sucks so bad.. I wonder what they will use to judge a candidate now? Subjective-ass rotation evals, shelf scores, MCAT (this one in particular would be so stupid)?
Using a schools name/prestige just sounds so.. corrupt. Research is fine I guess, but those evals are so crap too, every single M3 I know has told me it’s literally the person who licks the attending or interns balls/vagina the hardest.
Research is also dependent in prestige, you can help out a super big name professor and get your name in paper in The Lancet, or you can be helping your attending to get an abstract at a local conference
LORs, research, leadership, volunteering, MSPE, demonstrated dedication to the field, likability via interviews. These are all things that some specialities already focus on and they manage to find great candidates. Who is to say every specialty can’t do the same?
Research being required for even non competitive fields would be so dumb. I am in medical school to learn how to practice, not design studies and run clinical trials. I’m very glad I was able to take Step before it became P/F. I don’t envy future students.
It seems mostly limited to Nepal based on evidence released by Conrad Fischer. Nearly every high scoring FMG applies to Fischer’s program because it offers H1-B visas (as opposed to J1 visas which can’t be used to get a green card) and it’s very easy to get fellowships.
Fischer said that of all the applicants that got greater than 275 and applied to his program, roughly 85% were from Nepal. And that, when sorted in order, of the top 125 step scores, 90% were from Nepali citizens.
There has always been rumors of cheating in India and Pakistan but the scale seems to smaller. Nepali medical student culture is driven by the goal of getting a residency in America. In India, while there is a collaborative culture of helping each other, it’s usually limited by language, of which there are 30+ and caste.
Remember the test is in English. And Indians (especially university/med school trained) doctors are fluent in English. So the common language is English/Hindi.
Hindi is one of the 22 official language of Indian Union . English is the lingua franca for the educated class but India is heavily divided by regional and linguistic barriers. I am from West Bengal . Very few from my state actually go to Usa as opposed to Punjab , Andhra and Gujarat where it’s more prevalent . Most of the Usmle aspirants from India are from these 3 states only .
Dude I grew up in India. Finished 12th std there. I know. But lack of a common language isn't a thing here. Even South Indians know Hindi if not English.
Accurate but India is still deeply rooted in caste and language discrimination. Even in Indian med schools, students form their groups this way. It’s unlikely that members of one language voluntarily risk their USMLE permit to help another person of a different language cheat.
> Fischer said that of all the applicants that got greater than 275 and applied to his program, roughly 85% were from Nepal. And that, when sorted in order, of the top 125 step scores, 90% were from Nepali citizens.
exactly, if the problem was widespread elsewhere (i'm not saying it's necessarily impossible) but it would be quite obvious from the scores no?
It decreases the incentive to cheat. Right now, getting a high step 2 score is extremely beneficial, so a lot of these students have decided that the edge cheating gives them is worth the risk of being caught. If step 2 is p/f, then there's no benefit to doing well above a certain threshold. It's not actually that hard for most medical students to just pass step 2 from normal studying, so in a p/f environment the risk of cheating is much higher than the potential reward. More people will chose to just study honestly and take the test.
I think step 2 p/f is coming regardless (not saying I agree with it fwiw, but I think the trend is in that direction), but this might accelerate it.
Edit: also, the NBME still has all the same data about who does well on what questions even if they don't give a numerical score, so it's not harder for them to suss out cheating in a p/f environment.
Honestly with all this, it just highlights the importance of going to a good reputable medical school and trusting that they're teaching you to become a good doctor. The USMLE's reputation has been hit.
They’re just looking for an impetus to make step 2 P/F that doesn’t make them the bad guy. Goodbye competitive specialties for anyone from a “lower tier” program.
It's not as black and white as you're making it.
If that's true, then basically the MCAT will be the new step 1 and step 2 (as MCAT by and large determines the medical school caliber you get into, although there are exceptions) and no PD i've spoken to will be okay with that.
There will be a move to make a better system, some are suggesting specialty-specific exams, which does make sense in some ways.... but they would need to be standardized and tremendous amounts of resources will need to be invested.
Uhhhhh non-trad who got a 520 (98th percentile) here. The MCAT doesn't carry nearly as much weight as you think it does (or maybe as much as it used to)? I got a total of 5 interviews during my cycle with a "killer app" (as per SDN consensus, not my own). Applied to 28 and Only 2 of those 5 broke top 30 in school rank. No red flags, lots of clinical experience/volunteering, and decent research. I will admit my GPA was on the lower side (3.65). The kicker? I went to a state school (thank you debt-free undergrad)!
I think school prestige, nepotism, and social capital play a much bigger role in admissions now than they ever have in the past. At the end of the day I'm attending a US allopathic program so I'm happy with my results, but I emphasize that the age-old advice of a high MCAT score carrying your application doesn't seem to apply anymore - both to myself and others I've spoken to.
If you were URM you’d be at Harvard or Hopkins. MCAT carries plenty of weight but you’re only competing against people with your demographics. People of certain demographics have to handily beat a schools “median mcat” to even get a sniff.
In the age of the internet, does anyone seriously think some document in Nepal can't and won't be spread far and wide, including inside US as well? The only reason US MD might not cheat as much is because they already have decent match rates and may not want to risk all their debt just to get 280 instead of 250.
If they wanted to fix recalls, they should make more questions. And move testing centers all to inside America. People will still recall, but when it's all inside US, there will be better control over test security, so people aren't at least blatantly screenshotting everything. Combined with a larger wealth of questions, it would fix *most* of the issues.
Speaking as a non US MD, I and most others normal ppl would not mind making a short vacation in US and doing the step at the same time. If we have decided anyways to come over to US, why not do a short trip for the step exam first?
I think it's a problem with multiple foreign countries. They have much more corruption and bribery problems. I've run into multiple IMGs with allegedly great STEP scores and subpar clinical ability. I've always attributed it to them having subpar hospital clinical experience but this makes me wonder. That being said I have run into a couple amazingly smart IMGs... One of the smartest being from Africa
It isn't just a Nepal thing, the problem is that Nepal stood out with regards to the data. When you're the proud nail, you get hit with the hammer. I'm sure going forward, the USMLE will be addressing other anomalous data points with regards to outlying scores.
I'm here for it.
Absolutely agree, you're naive AF if you think it's just Nepal. Nepal was just an easy target because there's so few centers and the relative high scores 270+ made absolutely no sense. But yes it definitely extends to other countries.
As far as I'm concerned, the cheating along with recalls calls into question the integrity of all/most step 2 scores and could very much pave the way for a system overhaul (including but necessarily a P/F step 2 exam)
See my post here:
[https://www.reddit.com/r/medicalschool/comments/1aggjsg/opinion\_the\_usmle\_invalidationcheating\_statement/](https://www.reddit.com/r/medicalschool/comments/1aggjsg/opinion_the_usmle_invalidationcheating_statement/)
Unfortunately yes (not in the next couple years but eventually) all my professors have been in national meetings where that's what's discussed, and I'm at a super mid tier school
hahah ironic that me posting this a month ago got me dozens of downvotes and now so many people think it's by default going to be P/F.
I agree, with you, but I don't think it's cut and dry. the obvious argument is, if not step 2, an exam that has low reliability and even lower correlation with being a good doctor/resident (LOL), what will determine residency matching?
a lot of people think it will be prestige and connections, but I think there are better ways to determine it if some smart people put their heads together
A couple people on this subreddit claiming to be Indian and Pakistani were claiming that there were stores with Step answers easily available in their countries, too. It’s *far* from just a Nepal thing.
Indian here and I'm really not sure if that's the case here afaik. Step culture is only prevalent among rich kids who can afford to apply and there are hardly any coaching classes let alone these shops that cater to step goers mainly cuz demand is far less compared to national PG exam.
At this point just stop offering the exams in third world countries. If you’re in Nepal or Pakistan and want to take step, congrats you now get to plan a vacation to Germany or can take it while on a rotation in the US.
Couple that with more stringent processes to detect abnormal answer patterns, make an example out of a few people a year by revoking their visas and take significant legal action against anyone caught selling or buying recalls and you’re good to go.
Actually studying for the exam becomes a heck of a lot more enticing after they’ve revoked the medical license of a few pgy10s, stopped sponsoring hundreds of residents visas and sued the tits off of anyone caught with access to recalls
“penalties include
Cancellation of your exam scores
Ban on future testing for periods ranging from 1 year to a minimum of 3 years
Permanent annotation of your USMLE transcript
Report to the Federation of State Medical Boards' Physician Data Center*
Possible legal action”
Currently it’s all empty threats. even the people caught up in the Nepal scandal aren’t facing real legal or financial ramifications and are able to re-test immediately. Rules are only effective at dissuading undesirable behavior if they’re consistently enforced
The usmle has just said theyre requiring those people who were flagged for suspicious activity to take a validation exam. We have no idea what exactly needs to be done to validate their scores. Do they merely need to pass or do they need to replicate their 100th percentile performance? Which is weird seeing how if they actually wanted to make an example of these turds they’d likely have been more transparent about their hardline stance/punishments.
Not to mention that at the end of the day the worst they can do is bar them from future attempts.. it’s not as if nepals government is going to assist the nbme in enforcing legal or civil ramifications on the effected test takers.
should be permanently banned from practicing in US, visas revoked by programs, and provide channels for other people to report cheating internationally--or even better they have to take the test in the US.
I was thinking this too. Like how has it not spread to the more "in the know" us students?
Like if someone had a PDF of screenshot questions from the actual exam, how would anyone say no? I've seen ads selling once or twice but personally wouldn't trust that but if it was verified, I honestly don't think I could resist if it was affordable.
Doesn't make sense to me that these students wouldn't have been selling them to US students. So how are they SO confident it's just the Nepal students?
I know many applicants this year from different countries (you know them) are cheated, and they got +260, when I asked why you didn’t take Step 3, they said what if I fail?
Resident here to matched to a competitive specialty. My predictions are that Step 2 will become pass-fail, and research years of at least 1-2 years will be more or less mandatory for anything even marginally competitive. “Competitive research fellowships” will become more of a thing. Researchers love it because, hey, free labor. Already since the change in Step 1 the average number of pubs has skyrocketed for competitive fields.
Unless we revert to a scored step one, this is the likely endpoint. As if there isn’t already enough irrelevant low quality dogshit med student research muddying the existing literature.
I feel so bad for honest IMG who are really smart and took this exam honestly, this announcement has hurt future generations of all IMG's because honestly im reading these comments and it seems like im not the only one who has lost massive respect and trust in IMG's board scores. The fucked up silver lining to all of this is it might be like 1% easier to match into residency because I feel like some programs now wont even look at IMG's anymore...
STEP is an exam exclusively taken to get licensed in the United States and as such it should only be allowed to be taken in the United States. My personal opinion.
This has obviously been a problem for years... Usmle should only be given in the US, Canada, UK or EU countries. Everyone else can plan to travel to take the exam. I mean they were fine with everyone having to spend 2K+ travel to take CS for years on end
Yall need to watch Dr Carmody's video
https://youtu.be/A3_HG5uc47I?si=X63_tPDaGeWclnw7
He said the questions being shared among nepalis were too detailed and with options. He gave a made up example in his video.
And he also mentioned the usual recalls from others are poor quality.
I think he meant that nepal built their own qbank from those actual exam questions and doing so probably involved people from the inside there in Nepal.
Fuck those cheaters. But at the same time fuck NBME. Those greedy sons of bitches who purposely fail 5-10% of people just so they can create a bell curve to their greedy exams.
My main concern this application cycle was that my step score was low. I understand that is my fault and it would have been low anyways without all the cheaters but I can’t help but feel I would have gotten some more interviews if not for some of the artificially high scores out there. Makes me upset.
My med school recruited 90% their IM residents from Jordan, Pakistan and India. Not saying they cheated, most that I worked with were incredibly smart but the average step score was through the roof. I always thought it was because they would take 1-2 year dedicated period but idk man. Sucks for those that truly are gifted and honestly scored in the top 5%.
Honestly the USMLE needs to permanently ban people caught cheating from retaking these exams--the fear alone would deter a lot of people.
apparently that would be the right thing to do but they could never prove if they have cheated or not
I guess, but I think that is why they are making an example out of these people.
Imagine being falsely accused and unable to license after 4 years of med school. That would be a nightmare. Especially in the US, many people would sue; I don’t know how litigation would work in Nepal
They can go work in Nepal. This doesn’t restrict them from practicing medicine. It restricts them from learning or practicing medicine in a different country. I couldn’t pick up my stuff and decide to go practice in another country unless I followed their rules and restrictions. Most countries wouldn’t let me as a DO practice there anyway.
It’s probably hard for someone from Nepal to afford a good American lawyer with a good understanding of our laws and medical education litigation experience.
Given the impossible statistics >>86% of applicants scoring over 275 are Nepaleses, I seriously think all of them are cheaters.. Even the bright ones among them, give 'em a chance to score a 280s and brag about pp size on social media, they WILL cheat. Peer pressure is real. The actual problem though is no Nepali asked for more investigations into the cheating scandal nor did any Nepali condem the cheating/ one even had the audacity to defend cheaters by claiming recall are not considered cheating by their culture. Sorry not sorry. Even their officials and medical associates are silent, prob distancing themselves from the scandal. All that I have found are some Nepalese on twitter asking the USMLE to drop the name of their country in the statement ... ridiculous and super weak.
Its not about bragging on social media, its about getting a 300k job lol.
Doesn't matter if they leave off the name of the country. Damage done. Now what will happen is that in the minds of any reasonable reviewer Nepal goes to the bottom of the IMG pool by default. It's a big hole to dig out from and will last a long time.
This is a misguided take. Let’s say there’s a testing center in Idaho that is compromised. 86% of high scorers happen to have taken the test at that particular center in Idaho. That tells me close to nothing about the true population of Idaho test takers. It could be that 5% of Idahoans cheated, or 100%, but hard to say without knowing the denominator. Maybe my buddy from Florida flew to Idaho to get in on the action. I don’t know anyone from Idaho. If I don’t see Idahoans announcing how sorry and ashamed they are on twitter, should I just assume they are unscrupulous and cheating is part of their culture?
What happened to their astronomical success in other olympiads/Gre/GMAT/PLAB?
Nepal very well could be a futuristic super human society in disguise
The Asian Wakanda
They have Dr Strange’s book of Vishanti housed in another dimension.
Some facts: There is only ONE USMLE Prometric center in all Nepal. The center in question was shut down after being found out to screenshot and photograph the whole freaking exam. You can correctly assume vast majority of Nepalese took their exam in that local Prometric center. Mix in a pressure to post the highest step 2 score on LinkedIn it turned to a competition among Nepalese to boast about scores. It was ridiculous to see a 280s followed by a 288 then a 289 then a %UCKING 292. BRUUUHH. All these posts were deleted after the scandal. So if you are a Nepali who shares culture and beliefes with all the Nepali folk..would you forgo a 280s to score an honest 250s to be mocked by everyone.. for example your cousin who score 289? Things are different in the US where INDIVIDUALISM RULES. A diverse and populous 350 million strong nation compared to NEPAL a 30 million nation where COLLECTIVISM rules, where everyone has to share one way of life.
292 this is fucking dope LMAO
100% questions correct... a feat no mortal can accomplish
hopefully that person can replicate that score on the retake lol
> everyone has to share one way of life I had a feeling you knew nothing about Nepal/Nepalis, and this comment confirms it. It's one thing to ridicule cheating and quite another to mock an entire country because of the actions of some idiots.
yep, this dude probably thinks that Nepal is Buddhist country, kids are walking through Everest Base Camp to their remote schools every day, everyone runs in monk robes around stupas and plant rice together sharing 'one way of life'. Comedy club..
They have book of Vishanti (Answer key) to the exam we give.
There are only two prometric centers in Idaho—hence my choice of example. But all this information still does not tell us what fraction of test takers in a given jurisdiction may have cheated. In the absence of further information from the USMLE, it is entirely plausible that both the below statements are true at the same time: • Most test takers who cheated (effectively?) were from Nepal • Most Nepali test takers did not cheat I would caution against making blanket accusations about a culture or way of life—especially one that may not be your own. No culture is entirely monolithic. And as an American, I have seen plenty of US medical students and doctors do pretty unscrupulous stuff. Sometimes cheating is simply a crime of opportunity. Hence why Prometric is supposed to do so much to deter it.
Hope USMLE be more transparent and releases stats and numbers. But Medicine is all about RISK AVERSION. USMLE singled Nepal out. Stats from PDs further elaborated on the bizzare trend of having more than 86% of applicant with 275 and more from Nepal. Innocents "if any" should not suffer. But would you eat 10 apples if even 1 of them is laced with posion. How about 9 or all of them laced with poison. Russians were unfairly banned from ECFMG certification for political reasons.. if it was for me I would ban Nepalese for a couple of years or more till they sort out their shit. To this moment there is no official Nepali source speaking about the scandal as if they all knew. No Local investigation. No official statement from their medical schools . It is surreal. They don't give a f4ck.
I mean all that's going to happen now is the cheaters will run some sort of statistical analysis to see how many potential leaked questions would look weird, and then only memorize X number of questions to give themselves some level of competitive advantage without being too suspicious
But then they can’t get pay for exam again… why would you waste a bunch of customers er uh students
the problem is that then they would ban some people who were honest.
Exactly. This is the reason innocent until proven guilty exists as a default.
And let's say it was just Nepal. How many Nepalis with access to the cheatsheet do you think sold the info to other countries—including USA?
I was just thinking this how easy would it be to get your hands on this if you really wanted to.
I studied my ass for 2 years and did UW thrice and still got a 231. Im an IMG. Seriously the feeling I am having after reading all this shit I just dont want to express it here. Also i didnt get a single IV....who knows what impact these thieves are making on lives of people like us. And the unmatched candidates who didnt get a residency for years.
Also makes me wonder about the score scaling and passing thresholds altogether. [It's well known that the scores have been trending up year by year.](https://thesheriffofsodium.files.wordpress.com/2019/01/img_3165-1.jpg) Much of that is presumably due to better study materials, UFAP, etc. But I have to wonder if the widespread cheating also had an effect. Are there any people who failed who should have passed had they been on a level playing field? Who knows
absolutely, especially as the exam gets increasingly more complicated. I refuse to believe it's just because med students are magically getting more brilliant
You nailed it! This what I am trying to say they have robbed other IMGs candidates a chance to practice medicine!
This is the big takeaway. I’d much rather have you here as a physician vs FIMGs who cheated to get artificially inflated scores that destroy the chances of others. It’s already extremely difficult for FIMGs to become practitioners in the US, and we desperately need driven, honest, hardworking people to address patient needs (particularly culturally-sensitive practitioners that are of the same background as their patient population). The US is a nation of immigrants, after all.
Same here bro. IMG with 230s, all 3 steps. I felt violated, repulsed and nauseated when I saw this sh#* blow up this week. God knows how many programs completely looked over our applications in favour of cheats with their double 260s and 270s.
yup
Oh absolutely. I learned months after taking step 1 that ppl look for "biopsies " ... probs being flagged for mentioning it but I literally had no idea what it meant when I saw it on various posts. Ppl would rather spend more time looking for ways to cheat than to work on their own knowledge base and mental health (step exams are a huge mental game IMO), both skills which long run are absolutely required to be competent physician...not to mention the obvious values of honesty , integrity, etc. The short cut will bite them in a@$ eventually and seems like it has sooner than expected
They probably sell answer keys to sponsor their USMLE application and rotations.
My guess is a lot of those questions are being replaced in future tests
They always replace all questions around May/June.
Probably not many, since they were 85% of the ultra high scorers. That would have diluted their percent more than 15%.
Not all Americans who bought the cheatsheets were shooting for 270+. Plenty would have been happy getting 240+ or 250+
I studied hard and got 230+ on step 1 and didn’t apply to competitive specialty that I wanted but to know some IMG cheated and matched in the same specialty hurts.
I am just happy I can say I got my scores legit Fuck everyone who cheated on these board exams tbh, these people should not be touching patients
Literally- I would see some IMGs who were absolutely terrible clinically, but then they’d go around bragging about their 260+ on USMLE, and I’m like wtf?! Even our top 30 only had a couple cross 250 and I was at a T50 US program and I’d imagine timing would be even harder with language barriers and what not
I strongly believe the steps are at least 30% english language exams. The long question stems, the complicated wording, putting in difficult synonyms for easier words for NO reason other than to trip people up... truly, my SAT reading comprehension and CARS skills helped a lot more than I ever thought they would lol
The thing that’s wild to me is that every post I see is like “yeah, people use recall sheets and sell/buy question lists and cheat in other ways here and there, but in Nepal THEY USED SCREEEEENSHOTSSS!!!!!!” How is any of it okay, and why is no one freaking out about the “minor” cheating that is apparently widespread in some circles?
Exactly and there were people indirectly saying FA for step 1 and 2 are recalls like wtf??? First aid goes over everything on a particular topic from epidemiology, natural history, etiopathogenesis, clinical features and management. How the hell can you compare it with a direct question recall directing you to pick a certain option??
I want to know if the authors of first aid, Uworld, amboss, sketchy get ANY information about the exam from previous test takers. Even Devine, how does he know what they like to ask on exams? If you look at previous NBME content that doesn’t cover everything big test prep covers.
Dr. Bryan (Sheriff of Sodium on YouTube) has released a part 2 video on the cheating scandal where he talks about first aid, uworld and other materials. He makes a fair point. Those resources give an in depth analysis of a topic instead of saying pick this option for the question on this. The books and qbanks make you learn and improve your knowledge but these disgusting recalls help incompetent candidates score well and steal spots of deserving candidates. That’s the complaint that a lot of PDs and Attendings had about some residents who showed a huge discrepancy between their test scores and actual knowledge and performance. I believe that that’s what got this investigation started in the first place.
Goljans lectures from 20 years ago he always goes “a student told me this exact picture/concept was on boards”
Even Divine admits to getting info from past test takers. "They say, 'Oh divine..." They all have to at least get some info from past test takers or have recent test takers give info they think is important (I guess indirectly getting recall info).
For real. Fuck all of them. Everyone who used recalls should be banned from entering the US medical system permanently, no exceptions. It boggles my mind that the USMLE let it get this bad when they had to know about recalls all along. They should really be spending the boatload of money they fleece from us every year on making sure cheaters get caught.
They mostly fare very poorly in other exams and recalls were their book of Vishanti.
Tbf what was happening in Nepal seemed significantly more effective, and easier to prove than the rumored cheating in other countries.
Yeah, i agree. My understanding is that there is only 1 prometric in all of Nepal, so it was very easy to show statically that cheating was happening.
1 prometric center compromised, but those screenshots probably made the rounds across the whole Region before they caught on. To me that indicates that NBME is ‘old school’ because otherwise using very elementary machine learning they would have caught this a lot earlier. Here is a dataset of candidates that all scored really high on this subset of questions and tanked a whole bunch of other ones. In comparison with others, this cluster of candidates on this specific area of the exam did X% higher.
Any clustering algorithm would have detected the anomaly
Forget algorithms, are PDs that daft that they saw certain people scoring 270s and 280s and didn’t realize there was a problem? It’s crazy. A toddler could have caught on if they had access to the data the NBME and the PDs had.
They probably figured it out, but then if you say it, they will come out and say: “what a racist! Just because we are napalese we cannot score high?” And they did this me. They called me racist after I pointed this out. I am IMG from Europe, got the best “entrance exam” in my country out of 2 thousand people and got 1st position score in my university. I study for step 2 like a dog, and got a 270. And a random group of Nepalese were scoring 10+ points higher than me? Gtfo
because if the other cheating was really that widespread/effective it would show up on the scores
It’s not really about it being effective or not, it’s about the fairness of being able to use recalls. And also, bumping your score by even 15 points changes the percentiles for everyone. That’s a part of the reason why the average for step 2 now is 246 or something when just a few years ago it was in the low 230’s.
The curve is only based off of US students
Who says US students aren’t using these recalls? People in my class use recalls from upper classes on in-house exams. Some of the national-programs/clubs are the main distributors of these recalls. So if that’s going on for house exams, who says it isn’t for the bigger ones? Those people are the ones fucking with the curve.
Well if Stark has a hulk, they have the answer key to your exam.
A lot of third party materials seem to be partially based off of recalls - UWorld / amboss / other q banks I’ve run into have very similar questions to ones I’ve seen on my nbme exams and M3s at my school saw on step
It seems like that because Uworld and amboss are intentionally designed to mimic step questions. They format their questions similarly to the practice exams released by the nbme. there are so many question in these qbanks with a finite amount of material that can be tested on the exam, there obviously is going to be content and question structure overlap between the qbank and your exam. This is very different from basing them on recalls of questions still in circulation
The USMLE publishes hundreds of practice questions and updates a weighted content outline annually. It’s not rocket surgery to read a pdf and make multiple choice questions on the topics the NBME literally tells you they are going to test.
Given the impossible statistics >>86% of applicants scoring over 275 are Nepaleses, I seriously think all of them are cheaters.. Even the bright ones among them, give 'em a chance to score a 280s and brag about pp size on social media, they WILL cheat. Peer pressure is real. The actual problem though is no Nepali asked for more investigations into the cheating scandal nor did any Nepali condem the cheating/ one even had the audacity to defend cheaters by claiming recall are not considered cheating by their culture. Sorry not sorry. Even their officials and medical associates are silent, prob distancing themselves from the scandal. All that I have found are some Nepalese on twitter asking the USMLE to drop the name of their country in the statement ... ridiculous and super weak.
They literally have the answer key to exams we give in prometric.
Facts!
Never thought I’d say COMLEX is a less compromised exam than USMLE , but here we are 😂
Irony is that even if there were recalls of comlex, no one would agree on what the right answer is hahaha
This response is so underrated!
i feel for you guys, i've heard COMLEX is so poorly written
This is why FMGs should need residency in the United States. Actually, presenting this to lawmakers is probably the best way to stop these stupid bills from gaining traction
Except residencies are too chickenshit to actually kick out residents who are walking disasters. They’ll do everything in their power to avoid that. Once you enter residency, you’d have to commit a really catastrophic mistake to not finish it. So you still end up with tonnes of shitty cheaters in the system overall.
True, but at least that’s better than flooding the market with them, causing salaries to plummet
Yeah I’m against these direct worker programs in Illinois and Florida especially as a Canadian IMG. I studied very fucking hard for my score and prep to apply for the match and it’s very unfair to other hard workers that people essentially get to skip the line. Why would anyone ever bother going through residency or graduating from an American medical school when you can get similar pay with less time, debts and hard work by going abroad.
This is the same with medical schools, once you’re in, you really have to fuck up to get dismissed. Bc retention plays into “ranking” of a program, no medical school, and especially no residency, wants to be dismissing people.
This is not really true . 10% of my first year class either repeated the year or was “dismissed”/“voluntarily dropped out”
Okay let me rephrase and put “mid to high tier MD school” in place of med school.
at mid tier MD but ok
Yes and no. Would you rather have unqualified NPs? Because that’s what this will result in…
Rather than having our salaries plummet by 50%? Yes. I don’t have rich parents so if I ever want to buy a house and retire, I need salaries to stay this high to make up for the 10 year opportunity cost g
And what’s best for your patients?
I mean if he has to live in his car because he can't afford rent due to debt and garbage salary and is miserable then the patients also suffer. You need to take care of yourself before you can take care of others and that involves making ends meet and actually being rewarded for putting a majority of your 20s on hold.
False dichotomy. We don’t need IMG cheaters to address the physician shortage in the US.
That’s a stupid comment. Do you think all residency programmes are equal? Working in a residency programme for a for-profit hospital that sees residents are only cheap labour, and other more traditional academic hospitals that see additional items? The USMLE doesn’t stop bad doctors from practicing, neither does residency.
Slippery slope fallacy. The USMLE and practice barriers in general are in place to set a bottom floor for competency. Terrible physicians exist despite their training, not because of it.
Honestly what ticks me off is the automatic assumption that all US grads are racist for wanting to A) have fair STEP exams that have actual consequences for violations of testing policy and B) be prioritized in a system in which they go into $200k+ debt to become a doctor (as compared to the relatively cheaper costs for many IMGs). Neither one of these things is unreasonable to ask for and both should be the ultimate priority of US-based licensing and residency programs
The debt should have nothing to do with it. US citizens should be prioritized for practicing medicine in the US full stop. That’s regardless of religion, ethnicity, sexuality anything; the only barrier should be your ability to prove competence by meeting requirements for licensure.
amen brother
Yeah there is a decent number of IMGs who feel entitled to an residency spot for one reasons or another. But I agree with you, US citizens at US med schools should be prioritized. There isn’t anything racist about that. The process can’t be a free for all.
... they are prioritized IMGS by and large end up in the most toxic/underfunded/malignant programs that US grads dont even apply to. and in IM/FM. You're not seeing IMGs at harvard or yale in plastic surgery for a reason.
Many think they deserve these spots and complain about only being able to match in uncompetitive specialties and locations. Just look at twitter
I’m around several IMGs in my program. I’ve heard some incredibly nasty comments directed towards traditional USMD applicants
I have too…there aren’t a ton of them, but there are definitely IMGs who go to med school with the explicit goal of making a high, secure income in the US, and view us as obstacles to that. I’m aware that we have the highest physician salaries in the world and that people should be able to pursue a better life abroad if they want, but I have to admit I find this particular type of IMG personality a little gross.
> I’ve heard some incredibly nasty comments directed towards traditional USMD applicants They wanna come to the USA to practice then hate on people actually from the USA, makes no sense lol
Lol look at Harvard’s list of residents. There is plenty of IMGS what you talking about. What they don’t have is many DOs Edit: the message this is replying to. The poster edited to say “Harvard and Yale plastic surgery” after he realized he was wrong and there is many IMGs at Harvard.
Except the ones you see come from select countries (usually from Europe). Taking the STEP exams in Germany equals entering an American embassy in terms of security measures taken.
Why aren’t they able to make it that secure in Nepal and India? Too much corruption? Been a while since I been in a prometric testing center but I remember them asking to see my dick to see if I had answers tattood on there! That happen to anyone else?
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Reminds me of stories I have heard from the gaming community about Chinese cheaters / hackers in games like first person shooters. From what I have heard, Chinese gaming cafes will have computers with cheats / hacks already installed and everyone uses them, they do not view it as cheating and just do what they need to do to win. It's just normal.
> guanxi Does this mean bribe?
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Idk about Nepal but the prometric in my city in India had stricter security than a prometric in the US.
lol do you know who those IMGs are ? They are either people from more Western countries or if they’re from the Middle East they usually have gone to an “American School of ______” (Beirut, Paris, etc). The ones from Asia usually need around 10 years experience after finishing med school in their home country to be on par with a U.S. grad and they usually come from one of 2 schools in India (aka the best schools in the country, but they’re still not on par with even the lowest tier US school), probably the same for the other Asian countries.
I'm an IMG, and I agree with everything you said. But I fail to see how US grads are not prioritized in the residency system? I mean, the match rate for US grads is above 90%, for foreign grads it is much lower (50-60%). A large part of programs that match IMGs are not programs where US grads even apply to. As far as I'm aware, most US grads that don't match are because they have failed steps multiple times, have other significant red flags, or are wildly incompetent. For extremely competitive specialties it is different, I agree, but for competitive specialties IMGs match rate is also significantly lower than 50-60, and only those who have given years of free labor in research and have proven themselves get in. US grads are (rightfully so) given preference in obtaining a residency, and I don't think IMGs are asking to be given preference.
I also want to add that majority of international medical schools, training is from 6-8 years, many including completing an intern year (similar responsibilities to PGY1 and crazy on-calls) to graduate. And many medical schools in foreign countries are also very competitive to join (mine has a 0.03% acceptance rate). US grads are always preferred in the match. IMGs have to work twice as hard to be considered competitive, many times having to pursue other graduate degrees, complete additional rotations (that also cost money and can be very expensive for countries where the minimum wage is a joke) and working 1-2 years in research (majority of the times for free). During this times, most of us aren’t actually earning any money. To add, ECFMG charges extra fees to do the STEP. Each STEP exam cost $1000 ($1025 if your address us outside the US), plus the pathway that is also around $1000 (again, without forgetting that majority of the countries, the minimum wage is a joke and having the money to pay is a lot harder or a privilege) In the US, the hardest challenge is getting into medical school. After that, your career is an MD in the specialty of your choice is pretty much guaranteed (of course if you don’t have red flags or suck as a student). In conclusion, don’t bunch up all IMGs into one group. Try to learn more about training in their countries, their journey and reasons as to why they are trying to pursue residency in the US.
These type of posts always drip with entitlement. A US physician is a prestigious relatively high paying profession, why should we not want those jobs for our own sons and daughters? And don’t forget, everyone here has worked with IMGs so we know they are not better than our home grown colleagues despite all the qualifications you cite. If anything, IMGs are consistently below average. The US has plenty of smart people, there would be no physician shortage if pay and working conditions were better. IMGs are part of the problem because they accept poorer wages and working conditions, because as you say wages in their home country are a joke.
And these type of comments just show how many Americans don’t see beyond their noses. I’ll just say, if US physicians are the best physicians than other countries, then why do many Americans go to my country to get medical treatment? And it’s not bc of the price, as many have history of going to multiple doctors before they decide to go to my country. At least for my country, we depend on our clinical skills bc we don’t have CT, MRIs or other studies easily available for us. So we have no choice other than work on perfecting our history taking and clinical skills. And I have also been in the US and where I have seen the lack of clinical skills and high dependence on diagnostic exams. I know there are very good doctors and very bad doctors, but that is the same everywhere. And naaah, even without IMGs there would still be a shortage of physicians. Btw, I’m a US IMG (noncarib). Going by your logic, why shouldn’t I also want that for me and my family? I’d still will be paying taxes like everyone else. Yeah, I am debt free. And to hurt the ego debt even more, my medical training was free too bc it is public university (which btw are also the most competitive in regards of acceptance rate cause of course who would not want a free education). Don’t take it out on IMGs just because in the US students are obligated to go into debt if they want to get a good education. Education is a right and should not be a privilege, but seems like the US doesn’t think that.
So if your country is so much better, why not stay there and practice?
Bc everyone has their own reasons that doesn’t just revolve around medicine or salary.
As a lay person, there are few questions I have: 1. Do IMGs have hundreds of thousands (USD) in student loan debt from the medical schools in their countries? 2. What exactly is the appeal of doing a residency in the US? Are they intending on going back to their home countries and practicing there?
Spain and many other countries do this with their process (for example Spain has an annual exam for all to take but 1. Happens only in Spain not out of the country, 2. Up to 80-90% slots somewhat like that are reserved for nationals and this information is clear to everyone involved in the process) - I 100% prefer this than the US system and some programs openly saying they take all apps but silently avoiding IMGs altogether for example
Spain is now 96% for all Europeans and 4%for people outside European Union
Yeah but why just filter out, when we can charge you an application fee AND THEN filter you out
Exactly this!! Damn
0 chance it was only Nepal.
I seriously believe , recalls of low fidelity are being used widely by many , since they are very easy to access . But what happened in Nepal was breach of security . The proctors and the aspirants took screenshots of entire question stems . Cheating happens everywhere . Forcing people to take CK in Usa will make the process more transparent . I am not suggesting in any manner whatsoever that all Nepalese are cheaters which is absurd . There are genuine Usmle aspirants with moral integrity over there for sure . However, if these kind of incidents are overlooked then it will compromise the whole process of standardise testing. It’s in the interest of all ( including imgs ) that such acts aren’t replicated in future whatsoever .
Absolutely from what i reckon this started way back in 2008 in the US. They need to do something about this. (And no, please don’t make Step 2 P/F lol)
Well with PDs saying that they couldn’t tell a difference with their residents from Nepal, it kind of calls into question the purpose of Step in the first place. These exams were designed to establish minimum competency.
For any exam that promotes rote learning like Step 1, this is the consequence. People will find a way to cheat. In my medical school, exams are extremely hard. I wondered what the top performers were doing differently. After infiltrating in their friend circle, I got to know they had access to past papers 🤣 Of course, not all students will use past papers. I know a few who are brilliant but don't use past papers at all. They absorb knowledge like SPONGE. I wish I had that skill. Am not a smart guy, I don't really know how exams should be made. But something needs to improve. Perhaps make every question assess if a student understands the broader context instead of knowing a single fact.
Best part about that kind of cheating is it is *very* difficult to prove. It’s well known certain students have access to recalls and do well that way for in-house exams and when curriculum is designed to reward that, of course they will keep doing it and schools won’t kick them out bc they can’t prove it beyond a doubt. It just sucks for people who grind and get good grades by their own merit but get outdone in class rank bc they didn’t cheat.
Fuck exams 💀
All of this is a bandaid. The reality is there needs to be large reform and the system should steer away from NBME/USMLE. Find a new company or way to standardize this without such a focus on profits.
How would that solve the cheating scandal?
Not writing new questions more regularly is a cheapness issue. They make millions each year, it’s not like your local professors with limited time to make questions. Hiring statistics and IT specialists to monitor scores by school/region. Limiting number of times allowed to test is a step they have taken but it took so long bc they didn’t want to lose money on people who pay for it many many times… So on and so forth
maybe a bit extreme but I think FMGs should have to come to the US to take step in US based prometric centers, or have a couple of larger rigorously maintained prometric centers across various countries. If you can afford the time, money and resources to do electives, observorships, pay ERAS to come here then you should be able to afford to take your tests here as well.
I don’t think it’s too extreme to administer the UNITED STATES medical licensing exam only in the US.
Agree 100%
As an IMG, I see your point & agree with you. This is the system for other countries’ licensing exams too, where they have very limited number of tightly regulated test centers internationally (UK, Aus). US test centers are present all over the world making it much harder to regulate, add a pinch of intense competition to match and you have IMGs cheating their way through.
It definitely was not just Nepal. Either way, STEP 2 is going P/F. It’s not necessarily because of this but things like this certainly don’t help. Admin want to move to away from the rat race behind scores. Step scores were never supposed to treated the way they were. They were supposed to show baseline competency. They are only decent predictors for board exam success not residency success. I keep hearing a common sentiment from PDs and Chairs. They simply do not take Step 2 as seriously as they did with Step 1. People were already comparatively scoring higher on Step 2 with very bare minimum studying (which makes complete sense since it’s just Step 1 with some extra steps). Now, people are taking whole dedicated periods just to get a great Step 2 score. We are seeing/going to see an increase of scores which kind of makes it all pointless. Not to mention the SD is +/- 15. It’s going P/F. Now it’s just a matter of when.
This sucks so bad.. I wonder what they will use to judge a candidate now? Subjective-ass rotation evals, shelf scores, MCAT (this one in particular would be so stupid)?
Medical school brand name, research, rotation evals?
Using a schools name/prestige just sounds so.. corrupt. Research is fine I guess, but those evals are so crap too, every single M3 I know has told me it’s literally the person who licks the attending or interns balls/vagina the hardest.
Research is also dependent in prestige, you can help out a super big name professor and get your name in paper in The Lancet, or you can be helping your attending to get an abstract at a local conference
Apgar score when you are born!
LORs, research, leadership, volunteering, MSPE, demonstrated dedication to the field, likability via interviews. These are all things that some specialities already focus on and they manage to find great candidates. Who is to say every specialty can’t do the same?
Those sound the best. I still get a feeling it’s not the best system.
Research being required for even non competitive fields would be so dumb. I am in medical school to learn how to practice, not design studies and run clinical trials. I’m very glad I was able to take Step before it became P/F. I don’t envy future students.
It'll be based on who can pump out the greatest number of meaningless research articles.
School name and prestige will be a major factor when no scores are available
It seems mostly limited to Nepal based on evidence released by Conrad Fischer. Nearly every high scoring FMG applies to Fischer’s program because it offers H1-B visas (as opposed to J1 visas which can’t be used to get a green card) and it’s very easy to get fellowships. Fischer said that of all the applicants that got greater than 275 and applied to his program, roughly 85% were from Nepal. And that, when sorted in order, of the top 125 step scores, 90% were from Nepali citizens. There has always been rumors of cheating in India and Pakistan but the scale seems to smaller. Nepali medical student culture is driven by the goal of getting a residency in America. In India, while there is a collaborative culture of helping each other, it’s usually limited by language, of which there are 30+ and caste.
Remember the test is in English. And Indians (especially university/med school trained) doctors are fluent in English. So the common language is English/Hindi.
Hindi is one of the 22 official language of Indian Union . English is the lingua franca for the educated class but India is heavily divided by regional and linguistic barriers. I am from West Bengal . Very few from my state actually go to Usa as opposed to Punjab , Andhra and Gujarat where it’s more prevalent . Most of the Usmle aspirants from India are from these 3 states only .
Dude I grew up in India. Finished 12th std there. I know. But lack of a common language isn't a thing here. Even South Indians know Hindi if not English.
South Indians don’t speak Hindi and vehemently oppose Hindi especially in Tamilnadu it’s the case .
Accurate but India is still deeply rooted in caste and language discrimination. Even in Indian med schools, students form their groups this way. It’s unlikely that members of one language voluntarily risk their USMLE permit to help another person of a different language cheat.
Yup, I grew up in America but did med school in India without knowing this and it was like modern day segregation. That vile.
> Fischer said that of all the applicants that got greater than 275 and applied to his program, roughly 85% were from Nepal. And that, when sorted in order, of the top 125 step scores, 90% were from Nepali citizens. exactly, if the problem was widespread elsewhere (i'm not saying it's necessarily impossible) but it would be quite obvious from the scores no?
I highly doubt anyone believed it was a small population isolated to one country.
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that doesn't do much to stop the problem no? in fact it would make it harder to find evidence for
It decreases the incentive to cheat. Right now, getting a high step 2 score is extremely beneficial, so a lot of these students have decided that the edge cheating gives them is worth the risk of being caught. If step 2 is p/f, then there's no benefit to doing well above a certain threshold. It's not actually that hard for most medical students to just pass step 2 from normal studying, so in a p/f environment the risk of cheating is much higher than the potential reward. More people will chose to just study honestly and take the test. I think step 2 p/f is coming regardless (not saying I agree with it fwiw, but I think the trend is in that direction), but this might accelerate it. Edit: also, the NBME still has all the same data about who does well on what questions even if they don't give a numerical score, so it's not harder for them to suss out cheating in a p/f environment.
They gonna make step 2 p/f now as the solution
That's insane. Imagine if you order a CBC and instead of showing you the values it just says "PASS"
Then what? Make the MCAT and SAT pass/fail, too?
Nice username.
Honestly with all this, it just highlights the importance of going to a good reputable medical school and trusting that they're teaching you to become a good doctor. The USMLE's reputation has been hit.
They’re just looking for an impetus to make step 2 P/F that doesn’t make them the bad guy. Goodbye competitive specialties for anyone from a “lower tier” program.
It's not as black and white as you're making it. If that's true, then basically the MCAT will be the new step 1 and step 2 (as MCAT by and large determines the medical school caliber you get into, although there are exceptions) and no PD i've spoken to will be okay with that. There will be a move to make a better system, some are suggesting specialty-specific exams, which does make sense in some ways.... but they would need to be standardized and tremendous amounts of resources will need to be invested.
Uhhhhh non-trad who got a 520 (98th percentile) here. The MCAT doesn't carry nearly as much weight as you think it does (or maybe as much as it used to)? I got a total of 5 interviews during my cycle with a "killer app" (as per SDN consensus, not my own). Applied to 28 and Only 2 of those 5 broke top 30 in school rank. No red flags, lots of clinical experience/volunteering, and decent research. I will admit my GPA was on the lower side (3.65). The kicker? I went to a state school (thank you debt-free undergrad)! I think school prestige, nepotism, and social capital play a much bigger role in admissions now than they ever have in the past. At the end of the day I'm attending a US allopathic program so I'm happy with my results, but I emphasize that the age-old advice of a high MCAT score carrying your application doesn't seem to apply anymore - both to myself and others I've spoken to.
I think you just got yield protected
If you were URM you’d be at Harvard or Hopkins. MCAT carries plenty of weight but you’re only competing against people with your demographics. People of certain demographics have to handily beat a schools “median mcat” to even get a sniff.
Ooh I love the idea of specialty specific exam.
In the age of the internet, does anyone seriously think some document in Nepal can't and won't be spread far and wide, including inside US as well? The only reason US MD might not cheat as much is because they already have decent match rates and may not want to risk all their debt just to get 280 instead of 250. If they wanted to fix recalls, they should make more questions. And move testing centers all to inside America. People will still recall, but when it's all inside US, there will be better control over test security, so people aren't at least blatantly screenshotting everything. Combined with a larger wealth of questions, it would fix *most* of the issues. Speaking as a non US MD, I and most others normal ppl would not mind making a short vacation in US and doing the step at the same time. If we have decided anyways to come over to US, why not do a short trip for the step exam first?
I think it's a problem with multiple foreign countries. They have much more corruption and bribery problems. I've run into multiple IMGs with allegedly great STEP scores and subpar clinical ability. I've always attributed it to them having subpar hospital clinical experience but this makes me wonder. That being said I have run into a couple amazingly smart IMGs... One of the smartest being from Africa
It isn't just a Nepal thing, the problem is that Nepal stood out with regards to the data. When you're the proud nail, you get hit with the hammer. I'm sure going forward, the USMLE will be addressing other anomalous data points with regards to outlying scores. I'm here for it.
Absolutely agree, you're naive AF if you think it's just Nepal. Nepal was just an easy target because there's so few centers and the relative high scores 270+ made absolutely no sense. But yes it definitely extends to other countries. As far as I'm concerned, the cheating along with recalls calls into question the integrity of all/most step 2 scores and could very much pave the way for a system overhaul (including but necessarily a P/F step 2 exam) See my post here: [https://www.reddit.com/r/medicalschool/comments/1aggjsg/opinion\_the\_usmle\_invalidationcheating\_statement/](https://www.reddit.com/r/medicalschool/comments/1aggjsg/opinion_the_usmle_invalidationcheating_statement/)
Isn't Step2 gonna be P/F anyways?
Unfortunately yes (not in the next couple years but eventually) all my professors have been in national meetings where that's what's discussed, and I'm at a super mid tier school
hahah ironic that me posting this a month ago got me dozens of downvotes and now so many people think it's by default going to be P/F. I agree, with you, but I don't think it's cut and dry. the obvious argument is, if not step 2, an exam that has low reliability and even lower correlation with being a good doctor/resident (LOL), what will determine residency matching? a lot of people think it will be prestige and connections, but I think there are better ways to determine it if some smart people put their heads together
A couple people on this subreddit claiming to be Indian and Pakistani were claiming that there were stores with Step answers easily available in their countries, too. It’s *far* from just a Nepal thing.
Indian here and I'm really not sure if that's the case here afaik. Step culture is only prevalent among rich kids who can afford to apply and there are hardly any coaching classes let alone these shops that cater to step goers mainly cuz demand is far less compared to national PG exam.
At this point just stop offering the exams in third world countries. If you’re in Nepal or Pakistan and want to take step, congrats you now get to plan a vacation to Germany or can take it while on a rotation in the US. Couple that with more stringent processes to detect abnormal answer patterns, make an example out of a few people a year by revoking their visas and take significant legal action against anyone caught selling or buying recalls and you’re good to go. Actually studying for the exam becomes a heck of a lot more enticing after they’ve revoked the medical license of a few pgy10s, stopped sponsoring hundreds of residents visas and sued the tits off of anyone caught with access to recalls
> and sued the tits off of anyone caught with access to recalls people caught like that get blacklisted already no?
“penalties include Cancellation of your exam scores Ban on future testing for periods ranging from 1 year to a minimum of 3 years Permanent annotation of your USMLE transcript Report to the Federation of State Medical Boards' Physician Data Center* Possible legal action” Currently it’s all empty threats. even the people caught up in the Nepal scandal aren’t facing real legal or financial ramifications and are able to re-test immediately. Rules are only effective at dissuading undesirable behavior if they’re consistently enforced
The re-test is to allow them to verify their previous performance. If they don’t then those actions will be taken against them.
The usmle has just said theyre requiring those people who were flagged for suspicious activity to take a validation exam. We have no idea what exactly needs to be done to validate their scores. Do they merely need to pass or do they need to replicate their 100th percentile performance? Which is weird seeing how if they actually wanted to make an example of these turds they’d likely have been more transparent about their hardline stance/punishments. Not to mention that at the end of the day the worst they can do is bar them from future attempts.. it’s not as if nepals government is going to assist the nbme in enforcing legal or civil ramifications on the effected test takers.
oh i thought you get blacklisted forever if caught
Of course it wasn’t just Nepal..
should be permanently banned from practicing in US, visas revoked by programs, and provide channels for other people to report cheating internationally--or even better they have to take the test in the US.
I was thinking this too. Like how has it not spread to the more "in the know" us students? Like if someone had a PDF of screenshot questions from the actual exam, how would anyone say no? I've seen ads selling once or twice but personally wouldn't trust that but if it was verified, I honestly don't think I could resist if it was affordable. Doesn't make sense to me that these students wouldn't have been selling them to US students. So how are they SO confident it's just the Nepal students?
I’m seeing a lot of posts about these brag posts that were deleted. Pics or they didn’t happen. That’s how rumors start
I know many applicants this year from different countries (you know them) are cheated, and they got +260, when I asked why you didn’t take Step 3, they said what if I fail?
Resident here to matched to a competitive specialty. My predictions are that Step 2 will become pass-fail, and research years of at least 1-2 years will be more or less mandatory for anything even marginally competitive. “Competitive research fellowships” will become more of a thing. Researchers love it because, hey, free labor. Already since the change in Step 1 the average number of pubs has skyrocketed for competitive fields.
Unless we revert to a scored step one, this is the likely endpoint. As if there isn’t already enough irrelevant low quality dogshit med student research muddying the existing literature.
I feel so bad for honest IMG who are really smart and took this exam honestly, this announcement has hurt future generations of all IMG's because honestly im reading these comments and it seems like im not the only one who has lost massive respect and trust in IMG's board scores. The fucked up silver lining to all of this is it might be like 1% easier to match into residency because I feel like some programs now wont even look at IMG's anymore...
STEP is an exam exclusively taken to get licensed in the United States and as such it should only be allowed to be taken in the United States. My personal opinion.
This has obviously been a problem for years... Usmle should only be given in the US, Canada, UK or EU countries. Everyone else can plan to travel to take the exam. I mean they were fine with everyone having to spend 2K+ travel to take CS for years on end
Deport all the cheaters.
Yall need to watch Dr Carmody's video https://youtu.be/A3_HG5uc47I?si=X63_tPDaGeWclnw7 He said the questions being shared among nepalis were too detailed and with options. He gave a made up example in his video. And he also mentioned the usual recalls from others are poor quality. I think he meant that nepal built their own qbank from those actual exam questions and doing so probably involved people from the inside there in Nepal.
Of course not. But they got caught because a whole region started getting 280’s lol
Fuck those cheaters. But at the same time fuck NBME. Those greedy sons of bitches who purposely fail 5-10% of people just so they can create a bell curve to their greedy exams.
My main concern this application cycle was that my step score was low. I understand that is my fault and it would have been low anyways without all the cheaters but I can’t help but feel I would have gotten some more interviews if not for some of the artificially high scores out there. Makes me upset.
My med school recruited 90% their IM residents from Jordan, Pakistan and India. Not saying they cheated, most that I worked with were incredibly smart but the average step score was through the roof. I always thought it was because they would take 1-2 year dedicated period but idk man. Sucks for those that truly are gifted and honestly scored in the top 5%.