this is a hard question to answer, but i agree with jjackis, nobody has mentioned step 1 yet (altho it is important in the screening process of whether or not you get an interview). for internal med, the only number i've seen published is Mayo, which says they consider 220 a competitive score for granting interviews (nobody else has anything in print that i've come across and to be honest, i haven't asked about it on the interview trail). like smackdaddy said, just do your best on it, but don't stress out trying to make a 250