Honestly, the only people in my class I know who do anything close to cheating (study drugs, get competitive and cheat in small group stuff that actually have no grades) are very smart. They are type A, OCD people who can't comprehend the fact that grades don't matter (it's only important that you have the knowledge needed to serve your patients), so they feel pressured to cheat even though they get in the 90s on their own. It's probably a mixture of the just scraping by and top of the class who cheat.
I've got the bird's eye view on this.
Ha, and here we forget the great equalizer. Step 1 and Step 2.
So whatever cheating is happening, there's quality control on the licensing of physicians.
No one is passing both that doesn't know enough to *begin* training, assuming they have also passed all clinical rotations at an accredited school.
You can't cheat the whole system.
An attorney just said to me, "You passed one of the most rigorous educational experiences in this country, and one of the most difficult and comprehensive of licensing exams in the world."
Cheaters or not, eventually they will have to pay the pied piper and meet the standards, which are too complex and numerous to be cheated through.
Now, that's knowledge base. As far as ethical behavior and such, again, it's hard to be a total incompetent tool that shouldn't treat patients and make it through 2 years of clinicals AND 3-7 years of residency. The plug can be pulled on you at any time before board certification.
After that, it's tougher. We still catch bad docs. And we still have bad docs slip through the cracks, our profession's "Jeffrey Dahmers" if you will.
Still, the concern with test scores becomes more and more ridiculous the further into training you get. You find that aside from being a tool and measure for knowing what you need to know for your job, (and residency placement), they are meaningless and cheating on a test questions regarding reading an EKG is not going to save your ****ing ass in the ICU while a patient codes. Others will be able to tell that your inability to read that EKG prevented you from doing the right thing. If you have a soul and are the OCD cheater, this will weigh on you. If you're a **** up in other ways, this could end you. If you're otherwise a good employee, you can continue, perhaps watched more closely than ever.
If the cheating is this bad, I am more worried that the school will have a wake up call in the form of failed steps. Maybe they can just study to the Step and pass. Or, students go out for VSAS and word is spread the graduates don't know what 4th years should know. Or, assuming the luck holds and they match, the grads will give the school a bad name, which will spread like wildfire amongst risk-averse PDs. Carribbean, anyone??
More than likely, it will not get this bad for the entire school.
Wait, you guys can use the bathroom during exams? Our options are either go diarrhea in our seat or remediate. I wish that was a joke.
This is why I recommend with all seriousness sturdy absorbent incontinence pads or diapers. There's nothing like knowing you *can* **** yourself and continue test-taking with total dignity, to ease anxiety over pissing yourself affecting your exam score.
Believe me, a lot of people, a lot of very smart people, they're saying this. And I'm not saying--you know, it's like, the media, or as I like to call it the "fake" media--you know, they're always saying, "Oh, he's got a cell phone, he's going to the bathroom," I'm just saying--and I've said this for a very, very long time--maybe we should look into it. 
