You know, last year I used to wonder what happened behind the scenes and thought maybe there was some special calculation or algorithm programs used to rank people. Now being on the other side of the interview process you realize that just like you suspected it really IS about the whole package.
When you're done interviewing there will be some programs that are "I love this place" top picks, some "if I don't match anywhere else", and a good chunk in the middle where there are only some slight differences between them. It's also like that with the applicants. There comes a point when the applicants look a lot like each other. They're all nice and hardworking. Then to rank them you need to start differentiating them by small differences in their application, like scores, grades, publications, activities, "walk on water" LOR vs just good LOR and so on.
One thing to keep in mind, that kind of surprised me, is that people talk. By that I mean if you make a good impression on one of the people you interview with they'll tell the other faculty who will tell other people. Also, whenever there's any social function with the residents (I know this is obvious) be energetic and positive. People will notice. Just take advantage of your day there and try to make an impression. Like a very wise man once told me, "Be yourself...just be the best version of yourself." 😉
Basicly, programs are trying to get smart, nice, and hardworking residents that want to be there. It seems to be that simple. I think that one thing you can do is express an interest in the program with a resident or faculty member that you connected with at the interview. Just stay in contact with that person. As far as letters of intent, I don't think that works because everyone does it and I've heard from multiple faculty members that they completely disregard them.
Finally, I think there is a fair amount of luck involved. The person you interview with might be easy or difficult to talk to. Anyway, those are just some musings. I'm supposed to be studying for Step 3...it's just so hard to sit and study for hours like the old days. *sigh*
Does anyone have anything else to add? This IS early and I don't have much experience being on this end of the process....