Hey Hannah, I'm sorry to hear that you are unhappy with your score too. I've just started third year too, but I know that you will not have a problem matching into IM with your score (IM is still being filled with ~40% non-american medical school graduates, and all residency programs favor american medical school graduates); and I don't think that you will have a problem matching in EM if you do well third and fourth year. When it comes time to apply, just make sure that you sit down with someone (your dean of student affairs, EM residency director at your school) to get some advice about where some good places to apply would be. Unlike the MCAT, board scores aren't even supposed to be used as cutoffs or to measure a student's apptitude according to the nbme (even though they unfortunately are in some of the most competetive residency programs), and I'm sure that your honors in your pre-clinical work will show that you do have a strong grasp of the subject matter. You can also take step 2 early (right after 3rd yr, before you apply) and if you do well on that, that will help your application too. Most things that I've read about residency programs and heard from profs, upperclassmen etc indicate that the average residency program in most specialties is just looking for people that they will enjoy being around for the 3-4 yrs of your residency, not people with the highest board scores. Good luck.