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I think youre having a classic case of pre-applicant anxiety. totally normal. besides low step scores your application sounds excellent. however i wouldnt worry too much about it. it is looked at, but if the rest of your application is exemplary, i think most programs will not care. for example, if youre coming from Harvard residency, do you really think Duke GI is gonna care you scored 210? you're a Harvard resident! that's all they care about.My residency research is all in GI, my medical school research was not. My residency program is not in that region, but I do have significant ties to the area that draw me to it (versus staying at my home institution which I like overall or going back to my medical school where I was also very happy).
My medical school was a top 30 school and is well known for churning out clinically strong residents. Otherwise, I didn't have any awards as such to separate me specifically no AoA, Gold Humanism Award, or PhD.
My biggest concern is really just making sure I match GI first and foremost, as I have found that its where my passion truly lies (as much as I like medicine overall otherwise), and secondly being able to have some geographic preference in where I match. I know that my best shot is my home institution, and it has a good reputation for GI, biggest thing is its not my geographic preference long term (although I would happily make it work for an extra 3 years). My worry is, if I express to my home GI PD that I would be interested in going somewhere else, say as mentioned above to a Duke or UNC as an example, that I would then have lower chances at my home institution and therefore less chances overall at matching I would imagine. Versus, not mentioning that I have that preference, but then my PD wouldn't know to make a call on my behalf? Sounds like your suggestion is to just message the PD myself, which I was planning to do anyways when the time is right. I guess its not a zero sum game, like to think that people understand you can have multiple places you would be happy.
I just know that programs like to hear they are the apple of your eye, and I am not the type to tell multiple programs they are my number one (even if they are number 2 for example). If my step scores weren't where they were I wouldn't even be asking, but given that reality, I want to make sure I don't make any strategic errors that could cost me my career choice, perhaps I am overthinking the variables though.
to be honest, what I would do is this:Have 3 first author GI pubs, 4 first author pubs total, a GI first author book chapter. Additionally have 10 abstracts (many from med school) all first author of which 3 are GI (all GI abstracts were first author), others are med ed original work and a couple of case reports, otherwise have several QI projects too that were from medical school that are mainly first author, although one was second author.
And I appreciate the reassurance/kind words from both of you from whatever its worth.