Exams

Most Americans have some experience with standardized tests. Throughout primary and secondary schooling, students take a variety of tests to determine if they're making the grade. Tests such as the Iowa Test of Basic Skills (ITBS) are pervasive and used all over the country. The results are more of a diagnostic tool than anything else though. It's not until high school that standardized tests in America are able to determine more about your future. A high score on the SAT will make your application to elite schools more likely to succeed, whereas an average score, not unlike mine, generally relegates students to state universities. Even then, though, the tests aren't the be all, end all in a student's future.

Graduate school exams are similar to the SAT, but narrower in their scope. On the MCAT, for example, it is not necessary to complete any analogies (thank God). I had a hard enough time getting a reasonable score in the physics section; if there'd been analogies I would've been totally screwed. Your score helps make your application more or less competitive; notice that I did not apply to Harvard or Yale. It does not necessarily exclude you from medical education, however.

Standardized tests in China, however, are quite a bit scarier, in my opinion. High school students take a single, two day marathon exam called the gaokao. This exam can and does channel students to specific tiers of colleges, not unlike America. The gaokao is the only factor that universities in China consider in selecting students, which makes it far more powerful than the SAT can ever be. A high score can send a student to MIT, whereas a low score can send the student to a community college. The disparity in the perceived status of these colleges can and will affect the student for the rest of their lives. There is only one analog that I can think of in America.

That exam is the medical licensing exam, either the USMLE or the COMLEX. A student's score can and does determine what specialties they are able to go into after they complete medical school. A student scoring about 240 on the USMLE is eligible for prestigious residencies like plastics and opthalmology, whereas a student scoring around the national average is eligible for residencies in pediatrics, family practice, and other primary care specialties. This can be quite upsetting for a student who is gearing for something like opthalmology. Imagine working through the first two years of medical school, only to get your Step 1 scores back and realize that you cannot get into that residency. That is really the only American analog to the gaokao in China. And maybe that's a good thing.