I can't say I recall anyone talking much about actual medical school grades when previewing applicants for potential interview. That's not to say some people don't count it highly, but in my experience Step I is the big "number" that gets looked at. Medical school name does have some influence, for better or worse ("we had a great resident from X, but a bad resident from Y, therefore that is how I will always think of those med-schools"), but widely comparable measures (such as Step I) seem to carry more weight. You can always try to use the strength of one of them to counter the other if it is a weakness; not all medical school curricula teach to Step I, especially these days as more move towards earlier clinical involvement at the expense of highly detailed basic sciences. Of course, every residency program has slightly different ways they cull from the applicant herd, or pick people for interview.
Step I probably isn't all it's cracked up to be in terms of identifying a good potential doctor or pathologist, but it -is- a pretty fair indication of how hard a worker someone is. Whether it's any more useful than that I suppose is a debate for another place.
Otherwise I'd have to repeat what most people have already said -- do a path rotation, get to know what you really think of it, and develop some basic connections in the field.
Pathology is increasingly competitive, though in terms of numbers doesn't match some specialties. You don't necessarily need a 250+ Step I, top 2 of your class, multiple publications, a great personality, and contacts out the wazoo to get a solid match spot -- but it certainly helps your chances of getting the spot you want most. IMO any passing Step I plus a solid foundation in exposure to pathology and a good attitude/personality gives you at least a -chance-. You're much less likely to get a top 20 kind of spot, of course, but you shouldn't be told you're wasting your time either -- heresay on the numbers just doesn't seem to support that conclusion right now.
