Educational commission for foreign medical graduates

ECFMG Programs and Irregular Behavior 

ECFMG Policies and Procedures Regarding Irregular Behavior 

A. Policies Regarding Irregular Behavior 

1. Irregular behavior includes all actions or attempted actions on the part of applicants, examinees, potential 

applicants, others when solicited by an applicant and/or examinee, or any other person that would or could 

subvert the examination, certification or other processes, programs, or services of ECFMG, including, but not 

limited to, the ECFMG Exchange Visitor Sponsorship Program, ECFMG International Credentials Services (EICS), 

the Electronic Portfolio of International Credentials (EPIC), and Electronic Residency Application Service (ERAS) 

Support Services at ECFMG. Such actions or attempted actions are considered irregular behavior, regardless of 

when the irregular behavior occurs, and regardless of whether the individual is certified by ECFMG. Examples of 

irregular behavior include, but are not limited to, submission of any falsified or altered document to ECFMG, 

whether submitted by the individual or by a third party, such as a medical school, on behalf of the individual; failing 

to comply with United States Medical Licensing Examination® (USMLE®) or ECFMG policies, procedures, and/or 

rules; falsification of information on applications, submissions, or other materials to ECFMG; taking an 

examination when not eligible to do so, or submission of any falsified or altered ECFMG document to other entities 

or individuals.  

2. The Medical Education Credentials Committee’s determination of irregular behavior is sufficient cause for 

ECFMG to bar an individual from future examinations, to bar an individual from other ECFMG programs and 

services, to withhold and/or invalidate the results of an examination, to withhold an ECFMG Certificate, to revoke 

an ECFMG Certificate, or to take other appropriate actions for a specified period of time or permanently. ECFMG 

may report the Medical Education Credentials Committee’s determination of irregular behavior to the USMLE 

Committee on Irregular Behavior and Score Validity, Federation of State Medical Boards of the United States, U.S. 

state and international medical licensing authorities, directors of graduate medical education programs, and to any 

other organization or individual who, in the judgment of ECFMG, has a legitimate interest in such information. 

3. If the Medical Education Credentials Committee determines that an individual engaged in irregular behavior, a 

permanent annotation to that effect will be included in the individual’s ECFMG record. This annotation will appear 

on the ECFMG Credentials Verification Service (CVS) and ECFMG Status Reports for the individual. If the 

individual has an EPIC Portfolio, a permanent annotation will be included on all EPIC Reports with respect to that 

individual. Additional information explaining the basis for the determination of irregular behavior and the resulting 

action(s) will accompany every ECFMG Status Report, CVS Report, and EPIC Report, and may also be provided 

to legitimately-interested entities; this additional information may be provided, regardless of the date of the 

conduct or activity that comprises the irregular behavior. Notice of the Medical Education Credentials Committee’s 

determination of irregular behavior is periodically reported to the ECFMG Board of Trustees. 

B. Procedures Regarding Irregular Behavior 

1. After receipt of a report or other information suggesting irregular behavior on the part of an individual, ECFMG 

staff will review the information and will assess whether there is sufficient evidence of irregular behavior. When 

indicated and feasible, staff will conduct a follow-up investigation to gather additional information. 

2. If the individual is an examinee and the review referenced above will not be concluded until after the typical 

period for the reporting of exam scores, the examinee will be notified that the reporting of the exam scores in 

question is being delayed. 

3. If ECFMG staff finds that there exists a reasonable basis to conclude that an individual may have engaged in 

irregular behavior, the matter will be referred to the Medical Education Credentials Committee. ECFMG may 

withhold services from the individual pending a determination from the Medical Education Credentials Committee. 

If the individual is an examinee, the examinee’s exam scores will be withheld, if not already released, and the 

examinee may not be permitted to sit for subsequent examinations, nor will applications for examination be 

processed. 

4. Using the individual’s last known address, the individual will be advised in writing of the nature of the alleged 

irregular behavior and will be provided with a copy of the ECFMG Policies and Procedures Regarding Irregular 

18

---

Behavior. The individual will be given an opportunity to provide written explanation and to present other relevant 

information. Any such written explanation or other relevant information must be received by ECFMG by the 

deadline set forth in ECFMG’s writing to the individual. Submissions received after the deadline will be considered 

by the Medical Education Credentials Committee at its discretion. The individual may also request the opportunity 

to appear personally before the Medical Education Credentials Committee, and may be represented by legal 

counsel, if the individual so wishes. In instances in which the individual appears personally before the Medical 

Education Credentials Committee, a stenographic or audio recording will be made of that portion of the 

proceedings during which the individual is in attendance. Any statements made by the individual during a personal 

appearance before the Medical Education Credentials Committee will be under oath. 

5. All pertinent information regarding the irregular behavior, including any explanation or other information that the 

individual may provide, will be provided to the Medical Education Credentials Committee. The Medical Education 

Credentials Committee, based on the information available to it, will determine whether the preponderance of the 

evidence indicates that the individual engaged in irregular behavior. If the Medical Education Credentials 

Committee determines that the individual engaged in irregular behavior, the Medical Education Credentials 

Committee will determine what action(s) will be taken as a result of the irregular behavior. ECFMG will notify the 

individual whether the Medical Education Credentials Committee determined the individual engaged in irregular 

behavior and of any action(s) taken pursuant thereto. 

6. The Medical Education Credentials Committee’s determination of irregular behavior and any action(s) taken 

pursuant thereto (a “decision” of the Medical Education Credentials Committee) may be appealed to the Review 

Committee for Appeals if the individual has a reasonable basis to believe the Medical Education Credentials 

Committee did not act in compliance with the Medical Education Credentials Committee Policies and Procedures 

or that the Medical Education Credentials Committee’s decision was clearly contrary to the weight of the evidence 

before it. The notice of appeal must be received by ECFMG within sixty (60) days of the date on which the 

notification advising the individual of the Medical Educational Credentials Committee’s decision was mailed to the 

individual. The appeal of a decision of the Medical Education Credentials Committee is governed by the Rules of 

Appellate Procedure.  

7. Petitions for reconsideration of a decision of the Medical Education Credentials Committee will be reviewed by 

the Medical Education Credentials Committee only in extraordinary cases. Any such petition must first be 

considered by ECFMG staff, who, after discussion with the Medical Education Credentials Committee Chair, may 

deny the request or place it on the agenda for consideration by the full Medical Education Credentials Committee 

at a regularly scheduled meeting. Absent the submission of newly discovered material evidence not previously 

available to the petitioner and, therefore, not available to the Medical Education Credentials Committee, petitions 

for reconsideration typically will be denied. 

C. Representative Examples of Irregular Behavior 

Representative examples of allegations of irregular behavior and actions taken by the ECFMG Medical Education 

Credentials Committee include, but are not limited to, the following: 



Submitting an altered or fabricated letter of recommendation  

The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in 

connection with an ECFMG-certified individual who submitted two fraudulent letters of recommendation to 

ERAS Support Services at ECFMG.  

Following review, the ECFMG Medical Education Credentials Committee determined the individual had 

engaged in irregular behavior and took action to revoke the individual’s Standard ECFMG Certificate 

and to bar the individual from admission to all ECFMG examinations.  



Providing false information on an application submitted to ECFMG  

The ECFMG Medical Education Credentials Committee reviewed an allegation of irregular behavior in 

connection with an individual who provided false information on an application for a USMLE examination 

submitted to ECFMG. In that application, the individual certified he was a student enrolled in medical school 

when, in fact, he previously had been dismissed from medical school and, therefore, was no longer a 

student.  

19

---