ECFMG Professionalism & Ethics 3 — Questions and Answers
Question 1: A patient requests that his HIV-positive status be withheld from his spouse, who is also a patient in your practice. Your primary ethical obligation is to:
- Always maintain strict confidentiality regardless of third-party risk
- Warn the spouse because the duty to protect identifiable third parties may override confidentiality (Correct answer)
- Immediately notify public health authorities and the spouse simultaneously
- Discharge both patients to avoid the conflict of interest
Correct answer: Warn the spouse because the duty to protect identifiable third parties may override confidentiality
When an identifiable third party faces serious, imminent harm, the duty to warn may override patient confidentiality under Tarasoff-type principles and state law.
Question 2: An ECFMG-certified physician working in the U.S. is asked by a pharmaceutical company to co-author a paper for a fee without having contributed to the research. This practice is called:
- Ghost authorship (Correct answer)
- Honorary authorship
- Contributory authorship
- Collaborative research
Correct answer: Ghost authorship
Ghost authorship—lending one's name to work one did not perform—is a form of research misconduct that violates integrity standards.
Question 3: During an outpatient visit, a physician develops romantic feelings for a patient. The most ethical course of action is to:
- Pursue the relationship after the treatment ends since the patient is an adult
- Transfer care to a colleague and then consider pursuing the relationship (Correct answer)
- Never pursue any relationship with a former patient under any circumstance
- Disclose feelings to the patient and allow them to decide
Correct answer: Transfer care to a colleague and then consider pursuing the relationship
Transferring care to remove the physician-patient relationship is the necessary first step; romantic relationships with current patients are always prohibited.
Question 4: A patient lacks decision-making capacity and has no advance directive. His family is divided on whether to pursue aggressive care. The most appropriate surrogate decision-making standard is:
- Best interest standard based on what the physician recommends
- Substituted judgment—what the patient would have chosen based on known values (Correct answer)
- Majority vote among family members
- Defer exclusively to the next of kin regardless of expressed patient values
Correct answer: Substituted judgment—what the patient would have chosen based on known values
Substituted judgment asks what the patient would have decided based on their known values and previously expressed wishes.
Question 5: A researcher falsifies data in a federally funded study. This constitutes:
- Scientific misconduct subject to federal investigation and sanctions (Correct answer)
- A minor ethical lapse correctable by retraction only
- A violation only if published in a peer-reviewed journal
- An internal institutional matter with no federal implications
Correct answer: Scientific misconduct subject to federal investigation and sanctions
Falsifying data in federally funded research is research misconduct under federal regulations, triggering ORI investigation and potential sanctions including debarment.
Question 6: An IMG physician practicing in the U.S. realizes mid-procedure that a consent form was signed by the patient under a misunderstanding about the risks. The physician should:
- Proceed since the consent form was legally signed
- Pause the procedure, re-explain the risks, and obtain valid informed consent (Correct answer)
- Complete the procedure and document corrected information post-operatively
- Have a nurse re-explain while the physician continues
Correct answer: Pause the procedure, re-explain the risks, and obtain valid informed consent
Informed consent requires comprehension; if the patient misunderstood material risks, consent is invalid and must be properly obtained before proceeding.
Question 7: Which of the following behaviors would most directly violate ECFMG's policies on irregular behavior?
- Requesting a testing accommodation for a documented disability
- Having another individual sit for the USMLE Step examination in your place (Correct answer)
- Appealing a failed examination score
- Requesting an extension on document submission deadlines
Correct answer: Having another individual sit for the USMLE Step examination in your place
Having a proxy take a licensing examination is impersonation—a serious form of irregular behavior that can result in permanent ECFMG ineligibility.
ECFMG Professionalism & Ethics 3
A patient requests that his HIV-positive status be withheld from his spouse, who is also a patient in your practice.
Your primary ethical obligation is to: