This has been an interesting discussion about the topic. I will just add a few salient (and some anecdotal) points.
The first is that in my experience here at UQ, the basic science has been very lax. In terms of what specifics they put in the official learning objectives, it is very comprehensive. However, in terms of what is actually emphasized in the didactics and more importantly what is tested, there is not. You can easily get a 6 or 7 in the course and not know nearly enough basic science to perform strongly on the Step 1.
As for the differences in education - I forget who brought it up, but that is exactly the point. In Aus they get examined through their rotations and again in more depth during specialty training. My understanding is that the specialist exams here are indeed quite tough. However, in the States there is very little examination in comparison during 3rd and 4th year rotations and there is no intern year(s) prior to beginning specialist residency. Additionally, for Americans, the Step 1 is a requirement to pass before beginning year 3 rotations. For this reason (and for uniformity in licensing as the Steps replaced all other licensing for MD) the Step 1 is much more heavy on basic science. In reviewing some practice questions with strong Aussie 2nd years, I had many a jaw drop as to the depth asked (yes, I know, anecdotal).
In regards to the Aussies doing well - I agree, but would posit that is a skewed statistic because of sampling bias. In the States everyone must take it, all of second year curriculum is designed around it, and the pass rate is 92%. Here, anyone who takes it must by definition study for it specifically and extra-curricularly and thus are more likely to be motivated to do well and I would thus expect to do well. This is a reflection on the individual and their study, not the curriculum.
As for prep - while I agree that the onus of a University is never to prepare you for foreign exams this is a special case. The Uni QLD took on the Ochsner cohort with the specific intent to train American physicians and the expectation that we sit the Step exams. Since the general curriculum cannot be tailored to our needs, I feel it is incumbent upon the university (especially in light of the fact that we pay higher fees than ANY other student group in the SoM) to provide us with additional resources specifically for us and specifically to adequately prepare for the exam. This is made even more important by new legislation that will cut off loan disbursements should our cohort fall below 75% first pass. And since we are not a group of self motivated students opting to take the exam, but instead are here as part of the UQ curriculum but must all still sit it (and based on my experiences with members of my cohort), that is certainly a potential issue - one that the SoM would be wise to circumvent.
And before anyone asks, yes, there is currently some resources available to the second year cohort, but not nearly enough. I have been part of talks in this regard and we will be drafting proposals and finding the best way to proceed and progress.
I'm sure I missed some points, but it is very late, I am very tired, and I just got back from being a patient at RBWH ER. "Come back if your symptoms get worse, you begin to vomit, or you have bloody diarrhea" Don't worry, I will.