USMLE Invalidates Step 3 Exam Scores – What to Do if You Received Notice of Invalidation
Posted September 6th, 2026 by Dennis Abramson.
Categories: ECFMG, Medical Licensing, NBME, USMLE.
On Friday, September 4, 2026, the United States Medical Licensing Examination (USMLE) Program began notifying another group of examinees that their passing examination scores had been invalidated based upon statistical and forensic analysis of their performance data. This time, the invalidated scores are from Step 3.
Based upon the information presently available to our office (USMLE has not yet made an official announcement), the affected examinees appear to be principally, although perhaps not exclusively, of Nepali, Pakistani, Indian, and/or Jordanian origin. USMLE has not publicly identified the number of affected examinees or the precise criteria used to determine which Step 3 performances were included.
This is not the first time USMLE has invalidated examination results based upon what it considers statistically improbable performance patterns. In 2024, USMLE invalidated scores associated with a large group of examinees from Nepal. I previously discussed the policies USMLE adopted for these cases in When USMLE Invalidates Exam Results Based Upon Data Patterns.
More recently, the American Board of Internal Medicine employed statistical analysis and data forensics to invalidate the Longitudinal Knowledge Assessment results of certain diplomates. I discussed that process in ABIM, the LKA, and AI: How Data Forensics Are Driving Exam Invalidation.
What USMLE is doing now, however, presents an especially difficult problem for residents who have already passed Step 3 and relied upon that result in progressing through residency.
What USMLE Says It Found
USMLE is sending affected examinees its Policies and Procedures Regarding the Validity of Passing Level Scores Achieved by a Subset of USMLE Examinees, together with a June 2026 “Common Questions” document.
According to USMLE, every examinee flagged in this investigation had performance data containing irregularities which would be expected in fewer than one in one hundred million cases under normal testing conditions. USMLE considers this sufficient to provide a “good faith basis” for questioning whether the passing result represents a valid measure of the examinee’s knowledge and competence.
That conclusion is based upon USMLE’s statistical and forensic analysis. It does not necessarily account for the many individual circumstances which may explain why a particular examinee performed as they did or why that examinee was swept into the broad algorithmic net cast by USMLE.
Invalidation Is Not an Irregular Behavior Finding
USMLE’s policy expressly recognizes that questioning the validity of a score does not necessarily imply that the examinee engaged in irregular behavior or even knew that anything improper may have occurred.
An affected examinee has not, merely by receiving one of these letters, been found to have cheated, used recalled examination content, possessed prior knowledge of examination questions, or engaged in any other wrongdoing. If USMLE elects to investigate an examinee for irregular behavior, it will issue a separate notice and initiate a different adjudicatory process.
The practical consequences of a score invalidation, however, are substantial. The Step 3 result becomes unavailable and is designated as invalidated on the examinee’s USMLE transcript. USMLE may also send revised transcripts to third parties which previously received the passing result. Those recipients may include residency programs, medical licensing authorities, hospitals and other legitimately interested organizations.
The 15-Day Response Period
An affected examinee has only 15 calendar days from the date of the notice to respond.
The examinee may accept the invalidation and elect to retake Step 3 after the expiration of the suspension period. Alternatively, the examinee may request reconsideration and submit an explanation, together with supporting documentation, addressing why the Step 3 result should be considered a valid representation of the examinee’s knowledge and competence.
The reconsideration request is reviewed by an Initial Review Committee comprised of staff from USMLE’s sponsoring organizations. If reconsideration is denied, the examinee may appeal to an ad hoc committee established by the USMLE Composite Committee. That appeal is also subject to a 15-day deadline. The decision will be upheld unless the Appeal Committee concludes that it was clearly contrary to the weight of the evidence before the Initial Review Committee.
Failure to respond timely has consequences well beyond losing the opportunity to seek reconsideration. Under the policy, an examinee who fails to respond also loses the opportunity for a free retest and may face an additional three-year suspension following the initial 18-month suspension.
The Immediate Problem for Residents
Every affected examinee is automatically suspended from taking or retaking any USMLE Step examination for 18 months. For a resident whose Step 3 score has been invalidated, the suspension creates a problem which extends well beyond USMLE.
Many residency programs require residents to pass Step 3 by a specific point in training, frequently before the beginning or completion of the PGY-2 year. An affected resident may now be unable to satisfy that requirement because USMLE has removed the prior passing result and will not permit the resident to register for another examination for 18 months.
Residents receiving these notices should carefully consider when and how to report the invalidation to their program director, the Designated Institutional Official, and any other person or entity entitled to receive the information. They should also determine whether their program has a written Step 3 policy and whether an exception, extension or other accommodation will be necessary.
Our office can provide advice, counsel and consultation concerning those reporting obligations. We can also assist residents in seeking an exception from a residency program policy which requires a passing Step 3 score by a date the resident cannot possibly satisfy because USMLE has suspended the resident’s access to the examination.
The Reconsideration Submission May Serve Two Purposes
A properly prepared reconsideration request is directed to USMLE and should address why the Step 3 result is a valid measure of the examinee’s knowledge and competence. Depending upon the circumstances, that submission may address the examinee’s preparation, prior examination history, medical education, testing circumstances and the particular features of the statistical analysis identified by USMLE.
The same submission may also be important to the examinee’s residency program.
A program director who receives a revised transcript or learns that a resident’s Step 3 score has been invalidated may understandably be unsure why it occurred and whether wrongdoing is implicated. Where appropriate, the reconsideration submission can be provided to the residency program as a contemporaneous and detailed explanation of why the examinee believes the statistical criteria used by USMLE captured a valid examination performance.
The submission can therefore help the resident explain that the invalidation resulted from USMLE’s broad statistical and algorithmic review and set forth why the data pattern identified by USMLE is not indicative of wrongdoing. That explanation may be significant to a program considering whether to grant an exception to its Step 3 policy, whether any internal action is warranted, and whether it remains confident in the resident’s knowledge, competence and integrity.
Assistance With a USMLE Step 3 Invalidation
The response period is short, and the consequences of an incomplete or untimely response can be severe. Examinees receiving one of these notices would be well served to obtain advice promptly and before selecting either reconsideration or a future retake.
Our office can assist affected examinees in evaluating the notice, preparing and submitting a request for reconsideration, communicating with residency programs, satisfying reporting obligations, and seeking exceptions from program policies which cannot be met because of the 18-month suspension.
Should you need advice or counsel concerning a Step 3 score invalidation, please contact Dennis Abramson at 610-664-5700 or dabramson@theabramsonfirm.com.
