theoretical knowledge when it comes to US trained students and doctors. Last year, a group of interns at our hospital all failed the USMLE utterly, despite the fact that they could probably do C/Sections with their eyes closed...
And right there is the problem with US medical education. This has been discussed to death in other threads, but all the theoretical knowledge in the world doesn't make you a good doctor.
Judging us medical students and deciding our careers, our fates, and the fates of our families (if we have them) on the basis of a theoretical knowledge based exam is unfair and short-sighted. Getting a 270 doesn't make you a better doctor than someone who got a 210. There should be a minimum level of competence (which, btw, is all the board exams are designed to test, and that is 180), but to say that someone who crushed it is better than someone who didn't is both untrue and unfair. Yeah, yeah, life isn't fair.
Now, I don't really have a better idea. I would like more input from our patients. I think it should be standard to have PATIENTS write letters of recommendations, at least one or two. I think the CS exam should be more standardized, and broken into two sections: a live patient section that is more subjective and similar to what we do now, and a Robot/Simulated patient section that throws everything and the kitchen sink at you to see how you respond and if you can act appropriately and order the correct treatments in a variety of situations, from codes, to C sections, to allergic reaction to meds, to...you get the idea. But everyone would pretty much get the same scenario.
It's the Kobayashi Maru, basically:
http://en.wikipedia.org/wiki/Kobayashi_Maru
This subjective uber-test would replace Step 1 as the "make or break" test, relegating Step 1&2 to what they are supposed to be, minimum competency exams.
I would even be in favor of throwing a REAL Kobayashi Maru (lose-lose) situation at the students, and grading them on how well they handle it.
Just one option, but there are a million ways the system could be better than the travesty that exists now. Do you know how many programs' sites I've read where they say things like, "We prefer applicants who have USMLE scores above the 85 percentile."
Really? I'm sure they mean the two-digit score...which is NOT a percentile, but yet some/many programs remain ignorant of this fact despite constant attempts to reeducate them. Saw another program that accepts the COMPLEX exam (the DO exam is the COMLEX, no P.) And it wasn't a typo...they repeated themselves many, many times. They really wanted to drive the point home that they take the COMPLEX on their website.
Anyways, this issue runs deeper than who is better. The US taxpayers spend a lot of money training us (government student loans, government funded residency programs, government loan forgiveness, etc, etc) and US students (MD's and DO's) should get some level of priority because of this, whether we're better or not.
before we 
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