For as long as there have been written exams, there has been a subset of test-takers that cheat. Despite what we might like to believe, physicians and medicine are no exception. Take this brief description of an incident recorded in the 1899 meeting minutes of the North Carolina Medical Board.

“A dastardly attempt was made at this meeting to secure a license by fraud. One C. E. Coppedge of Spring Hope, Nash Co., NC employed Osborne, M.D., intern at hospital in Baltimore, Md. to stand Ex[am] for him, forging his name, etc. Detected and exposed by Sec’y before accomplishing purpose intended.

This may be an extreme example, but it wasn’t the first instance of cheating on the North Carolina examination. The prior year the board rejected four candidates for “copying” during the exam. (I know—such an unimaginative grade school tactic!)

In fact, once the board abandoned its oral exam in favor of a written test in 1889, they were forced to take more elaborate measures guarding against exam cheating. The board created a set of “rules” for testing that included proctoring requirements and authority for the board to reject or expel candidates for “cheating.” Examinees were assigned to specific desks for testing with a corresponding number affixed to each; examinees and desk assignment were rearranged after each subject examination.

So what was up with those Tar Heel doctors, right? Well, if you think they cornered the market on duplicitous doctors—think again.

1895 – The Bulletin of the American Academy of Medicine related how a Dr. “G.S.” graduate of Jefferson Medical College successfully duped an unnamed medical board two years earlier by sitting the exam successfully on behalf of his brother-in-law.

1903 – The Washington State Supreme Court upheld a decision by that state’s medical board to deny licenses to a pair of physicians found to have conspired to obtain advance copies of the licensing exam questions.

1904 – The Pennsylvania Board of Medical Examiners expelled four candidates from their exam for cheating.

1906 – President of the Indiana Medical Board reported being approached by a candidate offering $5000 for a passing score on their exam.

1912 – the Illinois Board of Health denied licensure to Charles Bateman based upon evidence he sat the Missouri medical licensing exam as a ringer on behalf of another physician, George W. Carson.

My favorite example of exam cheaters is one described in the October 1905 issue of the State Board Journal of America.

“There is the case of the young man, who, gaining access to the examination room on the night previous to the examination, bored a three-fourths inch hole in the floor so as to communicate with the coal-cellar below, where he next day had a corps of assistants installed with an ample library of modern text and reference books. When he wanted an answer, during the examination, he had only to write the question on a strip of paper, ball it up and drop it into his bureau of information. The question soon reappeared answered, and in the meantime he kept…his foot so adjusted over the aperture as to hide it and yet allow the return of the answered question.”

Talk about an imaginative scheme!

State medical boards of that era were keenly aware of efforts like these and adopted counter measures to combat cheating. For example, some boards stopped using local printers to print their exam questions—opting instead for printers in distant cities. To combat pre-knowledge of exam questions, boards supplied examinees with assigned blue books or colored paper when they arrived on site for writing out their answers. To forestall old fashioned copying by looking at another examinee’s test, boards would mix the order of questions or employ multiple test forms that minimized duplication of test questions.

The use of substitutes or “ringers” (i.e., individuals taking the exam on behalf of someone else) presented a special challenge. Boards ultimately had to introduce practices that  included  photographs of applicants affixed to assigned seats with comparison of signatures onsite during the exam compared to the signature on the license application.  Even this wasn’t foolproof–check out my earlier blog post on Phillip Dyment   By the 1920’s, most state medical boards had become highly versed in exam security and able to provide numerous anecdotes of cheating irregularities they uncovered.

Some readers may be surprised to see such a litany of misconduct—though the reality is that I could easily offer many more historical examples like these.

In relating these episodes, my intent is to prepare readers for the unsavory reality—and to some, the shock—that cheating on the medical licensing exam is not something limited to a bygone era. I’m priming you for my next blog post offering examples of far more recent vintage.

The views expressed are those of the author and do not reflect those of the Federation of State Medical Boards.

Source: North Carolina Medical Board, Registry Book 1859-1908. pdf 73-74, 188-189 https://www.ncmedboard.org/about-the-board/historic-