A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and serious penalties.

ABIM is sanctioning 139 physicians for sharing, buying, or soliciting confidential, copyrighted questions that were part of the exam used to certify doctors in internal medicine and its subspecialties. We also initiated legal action against five physicians who were among the most egregious offenders.

I think all of us can agree that physicians are – and should be – held to an exceptionally high standard of clinical skill and ethical behavior – this higher standard is vital if we want to continue to have the privilege of voluntary self-regulation. Board certification, a process developed by physicians nearly 75 years ago, provides patients with assurance that the doctors they choose are competent and knowledgeable in their chosen field of practice. Through the actions we are taking, we are reassuring patients that they can continue to trust this process and, and physicians can continue to trust that it is a fair and rigorous assessment of their medical knowledge and judgment.

As reported in the Wall Street Journal – the physicians receiving sanctions participated in a New Jersey-based course that purported to help physicians get ready for board certification. Participants were encouraged to relay questions from memory to the company immediately after they took an ABIM examination. They were also provided with questions obtained by other physicians who had completed ABIM examinations.

Through an extensive investigation, we established that the physicians being sanctioned shared or solicited actual ABIM examination questions. [read some of the emails here]. This is a significant breach in the professional standards we require of all of our board-certified physicians and any candidate taking the exam. Hundreds of questions were compromised and immediately removed from our question pool.

As most physicians know, before sitting for an ABIM exam, every test taker agrees in writing to not discuss the contents with anyone. Certification candidates are clearly warned that ABIM will impose severe penalties on any physician involved in efforts to provide examination question content to others.

So this week we have announced the following actions:

· Physicians who disclosed, purchased, or solicited ABIM exam questions were notified that their board certification is being suspended for up to five years, based on the extent and egregiousness of their offense.

· Physicians who have not achieved certification and who disclosed ABIM exam questions or solicited them were notified that they will not be admitted to sit for a certification exam for a term of one year or more based on the extent and egregiousness of their offense.

· Certification is being revoked for any physician who systematically sought to undermine certification through the organization, collection, and distribution of ABIM exam questions.

Our investigation revealed that the course operator repeatedly told participants that they were receiving actual ABIM questions and requested participants to send questions to the course operators after their exam. Although we do not have evidence that most physicians complied with this request, none notified us that this was happening – and all should certainly have known it was “against the rules.” As a result, any physician who took the course will receive a letter expressing our very serious concern about their failure to notify us about the questionable activities in the course.

We are also increasing our sizeable security and investigations procedures, and adding staff to monitor activity and conversations on websites and in chat rooms.

Sharing test questions from memory is a serious problem that threatens the integrity of all standardized testing. It is grossly unethical, and ethics are critical to the practice of medicine and are the foundation of a successful doctor-patient relationship. The Board and leadership of the American Board of Internal Medicine took swift and decisive action in underscoring that unethical behavior from physicians seeking board certification will not be tolerated.

Christine Cassel is President and CEO of the American Board of Internal Medicine.