I don't think people recognize the complexity of some of these operations. Groups are arranged to discuss the exams immediately post taking it and are able to corroborate questions that two people independently recalled. These are arranged into banks and the more people that have recalled an individual question, the higher it is rated in the bank. There are also people who have no intention to pursue US residency who go in with the sole intention of memorizing everything they can while also failing so they can maximize lifetime attempts. They are often paid for this. The question banks are either sold or kept internal, which is particularly common in certain international regions/schools. It's not hard to find out how to buy them through telegram, though I strongly recommend everyone NOT to do this as tying your name to this would make you dead in the water should there ever be an investigation into it.
I am very close with an individual involved in the residency app process, and they said they become skeptical of super high step scores (280+) from IMG because they know this practice is rampant in certain areas. Whether that's fair or not is up to you to decide but that's what they told me. They also didn't say they don't rank people because of this, just that they become skeptical, so interpret that as you will.
I am in no way implying every IMG cheats and it actually sucks that the honest ones (most) get screwed over by the cheaters. I'm also not saying this never happens in the US, I have just never heard of such an operation happening, especially anything sanctioned by a US school or admin.
