well, in the US we give patients a lot more of say in healthcare than those other nations, many of which are socialized medicine. There are patient bill of rights, patient advocates, and patients in the US will have the right to complain about you to the higher ups and impact your career, and even sue you. So in the US the patient is a lot more empowered, and so yes the SP is a decent proxy for what you may face. This is a problem a lot of IMGs don't get -- you aren't going to need to just be technically proficient and smart in the eyes of other physicians to be a good doctor in the US, you need to be well regarded by your patients or you will be sued out of existence. So yeah the CS is a decent test regarding patient interaction skills. You need to put on a show of washing your hands, telling them what you are doing, show empathy and all those other things that are expected of by US patients. In all these other countries patients are less empowered, and a doctor can focus on just getting to the answer. But in the US the answer of what is wrong with the patient is only part of the issue, and the patient interaction itself is also important. It's not really accidental that this is the one test that few US grads have issues with compared to IMGs. And these touchy feely skills are the ones PDs care most about because patient complaints are going to be things the hospital administration will call the PD about, whereas technical skills will be internally dealt with within the department. So no, not US terrorism, just a reflection of how medicine is not the same everywhere, and in the US, the views of non physicians will matter to your career a lot more. Hence the SPs serve an important and appropriate role.