USMLE, score validity and irregular behavior
USMLE Step Score Invalidated, Withheld, or Under Review
A Step result sits underneath residency applications, ECFMG certification, and a licence. The USMLE program runs two different processes that can take that result away, and they have different decision-makers, different consequences, and different openings for you.
Find out which process you are in before you write anything
A score validity review asks whether your result is a valid measure of competence, and the programme reserves the right to cancel results at or above the passing level on a good faith basis for questioning them. An irregular behavior referral asks whether you did something, and a finding carries a permanent annotation. The first can end in a retake; the second follows you. A submission written for the wrong one of these does damage.
The deadlines, before anything else
Every process on this page can be lost on a date rather than on the evidence. Put these in a calendar before you start drafting anything.
Written response to an irregular behavior notice
The date in your notice
Submissions after the deadline are considered only at the committee's discretion. Treat it as firm.
Score recheck
90 days
From release of your result, submitted with the fee to the organisation that registered you. A recheck is not a validity review and will not address a cancellation.
Testing rules are revised regularly, and the version in force on your test date is the one that governs your case. The notice you received controls. Read it against the rules as they stood when you tested.
What triggers a review on the USMLE Step Examinations
- •Performance analysed for aberrancies or other information raising questions about validity
- •Improper access to exam questions
- •Proctor reports from testing centres
- •Reports from registration staff at NBME, FSMB or ECFMG
- •Online monitoring of disclosed content, tips, and administrator inquiries
- •Anomalous performance or an unusual testing history, which can restrict future access
How the process actually runs
Taken from USMLE program, NBME, FSMB and ECFMG’s own published rules. Stages shown in grey are past the point where we assist, and are included so you can see the whole route rather than only our part of it.
Notice in writing, from the Secretariat
Where your result is being investigated for validity concerns, the USMLE Office of the Secretariat notifies you in writing. If the result has not yet been reported, your official score report may be delayed or withheld pending completion of the review. Validity questions can be raised before or after a result has been released.
Score validity review, and classification
After review and analysis of all available information, results are classified as eligible for reporting, not eligible for reporting, or cancelled if previously reported. If your result is invalidated, an annotation reading score not available appears on your transcript next to that examination date, and you are notified and advised of the options for retaking the examination where retaking is permitted.
Irregular behavior: referral and your submission
Where the question is conduct, the matter goes to the Committee for Individualized Review. Once a case is referred, you are notified of the basis for the allegation and given an opportunity to submit relevant information for the committee to consider. You may secure legal counsel and make a personal appearance before the committee to give testimony under oath. Where ECFMG handles the matter first, its Medical Education Credentials Committee advises you in writing of the nature of the alleged irregular behavior and provides the policies, and written submissions received after the stated deadline are considered only at the committee's discretion.
Where the programme has direct evidence, the route narrows
In cases where the USMLE programme has direct evidence, programme staff have authority to make the final decision on a finding of irregular behavior and the sanctions imposed, and in those cases there is no right to submit a personal statement, no right to appear personally, and no appeal to the Composite Committee. Establishing early which situation you are in determines whether there is a submission to make at all.
Consequences, and what is permanent
A determination of irregular behavior is sufficient cause to bar an individual from future examinations, to withhold or invalidate examination results, and to withhold or revoke an ECFMG Certificate, and a permanent annotation is included in the individual's record. Separately, anomalous performance or an unusual testing history can prompt a review of your eligibility and restrictions or conditions on future access.
What we do, and where we stop
We assist with the written submission and the documentation: working out which process you are in, what it actually alleges, and putting your account and your records into a form a committee can follow. We do not appear before the Committee for Individualized Review as counsel, and we are not attorneys. Because a finding here reaches certification and licensure, and because the policies expressly contemplate legal counsel and sworn testimony, this is an area where we often tell people to retain a lawyer and are glad to work alongside one.
AdvocatED is an education advising practice, not a law firm. We do not provide legal representation or legal advice. When you need an attorney instead.
How AdvocatED Helps With a USMLE Step Examinations Score Review
These notices arrive in the middle of a match cycle or a certification timeline, written in the language of committees, and the first question is usually which committee is even involved.
Where guidance pays off most:A score validity review can end in a retake. An irregular behavior finding is permanently annotated. Write to the one you are actually facing.
- Establish which process you are in, validity or irregular behavior, and who holds the decision
- Find out whether the direct-evidence route applies, because it changes whether there is a submission to make
- Calendar the stated deadline and treat it as firm, since late submissions are discretionary
- Organise the documentary record: testing history, preparation, registration correspondence, anything bearing on the specific allegation
- Draft the written submission so it answers the basis of the allegation rather than describing your career
- Prepare you for a personal appearance, including that testimony is given under oath
- Say clearly when counsel should lead, and coordinate with your lawyer rather than duplicating them
Mistakes that cost people the case
- ×Requesting a score recheck in response to an invalidation. A recheck verifies scoring, not validity, and the 90-day window is a different thing entirely.
- ×Explaining your circumstances instead of answering the allegation. The committee is deciding a specific question.
- ×Missing the written-response deadline. Late submissions are considered only at the committee's discretion.
- ×Sitting a Step exam to see the format. The policies prohibit taking a Step for any purpose other than to pass, and it can restrict future access.
- ×Handling a licensure matter without a lawyer because the first letter looked administrative.
Questions we get about USMLE Step Examinations score reviews
Can the USMLE program cancel a passing Step score?
Yes. The published policy reserves the right to cancel exam results at or above the passing level, before or after release, where the programme has a good faith basis for questioning whether the result represents a valid measure of knowledge or competence for licensure. Examinee performance is monitored and may be analysed to detect aberrancies or other information that raises questions about validity.
What does 'score not available' on my transcript mean?
It is the annotation the USMLE program applies next to an examination date where the result has been invalidated. The policy provides that you are notified and advised of the options for retaking the examination, where retaking is permitted. It is a different thing from an irregular behavior finding, which carries a permanent annotation in your record and can bar future examinations.
Can I bring a lawyer to the Committee for Individualized Review?
Yes. The published policies state that individuals may secure legal counsel and make personal appearances before the committee to give testimony under oath. We are education advisors rather than attorneys and do not appear as counsel, and given that a finding affects certification and licensure, this is a process where we frequently recommend a lawyer and are happy to support the documentary work alongside one.
Is a score recheck the same as challenging an invalidated score?
No, and conflating them wastes the window that matters. A recheck is a verification of scoring, requested with a fee from the organisation that registered you and received no later than 90 days after your result was released. It does not address a validity determination or an irregular behavior finding, and requesting one does not preserve any other right.
What is 'anomalous performance' and why does it matter?
It is a separate concern from both validity and conduct. The policy provides that anomalous performance or an unusual testing history may prompt a review of your eligibility for the USMLE, and reserves the right to restrict future access or impose conditions on it based on performance suggesting a lack of readiness to test. It also states that taking a Step examination to familiarise yourself with the format, or for any reason other than to pass, is prohibited.
Where this comes from
Every stage, deadline and standard on this page was read against USMLE program, NBME, FSMB and ECFMG’s own published rules in October 2026. We link them so you can check us, and so you can compare them against the version in force on your test date.
- USMLE Bulletin of Information, Scores
Score validity, invalidation and notice, anomalous performance, and the 90-day recheck.
- ECFMG, Irregular Behavior
The Committee for Individualized Review, written submissions, personal appearances, and consequences.
Other exams we handle
Got a letter about your USMLE Step score?
Send us the notice. The case review is free, and the first thing we will tell you is which deadline you are working against.