Ok, I can give you a detailed breakdown of your statistics, in my opinion. Disclosure: I'm a current TY heading to start my Neurology residency at large academic hospital. So I'm not a program director, but recently matched, so I have some limited insight into the process after some thorough research (which I think that all applicants should take the initiative to perform - most things are found through intelligent googling, and some smart emailing).
This is what "top" academic programs tend to look for:
- Step Scores, Step 1 >>> Step 2: An average score keeps you in the game. A good score, like yours, I'd say 230-240+, makes you stand out. A low score, <200, will probably have you getting passed over by Top 10 programs. This could potentially be reversed by some other outstanding areas of your application.
- Letters of Recommendation: Awesome letters needed. Period. Just don't use lukewarm ones unless it's coming from a big name/chair. People who know you and your abilities well enough can potentially even let you write your own letter - which they will stamp with their seal of approval. Some will call directly on your behalf if you ask them.
- Research: Academic centers want academically oriented people. You would need to show some involvement, capability, and dedication to the research side of medicine. These programs are heavily research oriented. Don't get me wrong, they are also pretty amazing places to train regarding facilities, toys, subspecialty representation, etc.
- Clinicals/SubIs: This is probably as equally important as research. And your LORs will probably coincide with how well you do. Always work your hardest, and strive for honors. But try not to have too many red flags such as failures. I have extrapolated that programs can be forgiving to a lot of mistakes depending on what you took away from the experience. SubIs at the locations you really want to end up can go a long way if you excel and leave a good impression. Some have had this backfire on them, and they did not even get interviewed. Others have gotten a "courtesy" interview - if you've got some interview skills and charm, you can potentially woo a program that wouldn't have considered you otherwise.
- Demonstrated Level of Interest: These are all volunteer activities, extra SIGN stuff, volunteer work, displays of organizational skill, etc. They can be more valuable if you're doing sincere and significant things. For example, taking a keen interest in student education, participating on education quality committees, and participate in advertising activities for SIGN - this shows that you're interested in the advancement of the field from all perspectives: public relations, politics, etc.
- Some examples of how you're a normal, compassionate doctor and a little security that you're not a total weiner or psychopath.
- The whole D.O. thing... From my knowledge, it is somewhat uncommon for top programs to have DOs. They are definitely out there. This is mostly program dependent. You'll just have to make an effort and see where it gets you. I will tell you that among the general applicant population, sometimes programs can be rated based on the number of DOs of FMGs/IMGs they take. Sometimes, this gets back to the programs.
From what you stated, it seems like you've got all the criteria. The D.O. thing will probably hurt you more than help when shooting for "Top 10". With some luck and perseverance (call them!), hopefully you'll find what you're looking for.