I think people are being unreasonably harsh with limited information here. Yes, some candidates are good on paper and awkward in real life which can hurt people during interview season. (That's also why I tell my medical students to be strategic about aways, because they can definitely hurt some people).
But in a competitive field, some people fall through the cracks every year through no major fault of their own. Step 1 250s with AOA and a research year is a standard derm application. It checks all the boxes but doesn't stand out from the pack. When a program interviews 20 or 30 people for each residency slot and they're all similar on paper, it's often the ones with a hook that stand out (a unique hobby, interesting backstory, LoR from a well connected faculty member).
Every year I see people who are stellar on paper and fine (not great, but normal enough) during interviews who end up slipping on rank lists because in a sea of superstar applicants, they have nothing unique that makes them really stand out in people's minds. They may not be great extroverted interviewees, but a failure to match into certain fields doesn't always indicate a poor interviewee or a personality defect. Sometimes it's a little too easy to pile onto someone's misfortune when you're sitting miles away.
