smooth

I'll elaborate on the "deserve" part. According to this example, I am assuming that in a competitive system we would both agree that the student who does best according to the accepted means deserves the highest grade. That is, we agree that cheating or special favors to those not willing to do the work do not deserve the highest marks (or rewards).

Your scenario, without knowing the specifics, is exempt from this since an injury is outside your personal control. Do you think you should have been granted a special circumstance as warranted to accomodate your needs or should you be allowed to resort to unacceptable means? If the latter, what prevents others form figuring their circumstances exempt them from the normal means of achievement? Kant argued that social actors should follow a categorical imperative--that is, we should analyze our actions in terms of its acceptance as a universal law. Thus, one should not cheat because the system would not operate correctly if everyone cheated.

Your last point is perhaps where we might differ, but maybe not. I'm proposing a scenario like this:

Say five students are in a classroom. If we offer all the students a slot in medical school based upon merit and desire but without material rewards then only the ones who are most capable and desirous would apply themselves to the work. This is not to say that all the students should get slots if none do the work; rather, even if one removes the material incentives then those most desirous would still engage themselves in the work.

The students in your example should study for the test because they want to learn and they would do well on the test because they understand the subject best--not for material gain. By placing a premium on the course (by awarding A's and B's, etc.) and an essential need to achieve high paying jobs (paying rent, buying food, reinforcing the idea that people who drive a Lexus are more important than those who drive a Hyndai) creates impetus for people who would otherwise be unsuited for a particular position to strive to achieve it by any means possible--even illegal ones. Also, this system punishes those who have been ill-prepared by their social environment but would have otherwise been perfect for the position (the outside personal control injury exemption should apply to these students).

For example, my A's are pretty much assured according to my professors. My work has not diminished as a result of their opinion, my desire to learn and produce quality work precludes that from occuring. This is a conversation that occurred between me and the chair of my department last term:

Smooth: I'm going to take your class pass/fail because I don't want to jeopardize my GPA.
Chair: You don't need to tell me, I turn in a letter grade and the registrar places the P or F on your transcript.
Smooth: Well, I wanted your opinion.
Chair: I think it's a stupid idea. You'll still do the same amount of work--it's not like you're going to turn in sub-standard work, that's not the type of student you are. Why not get the A?