I've spoken to a lot of clinicians, my mentors, and residents about class rank and GPA about how they impact your chance of matching. Truth is, rank and GPA play a less significant role on your application when being compared to your letters of rec. You can be in the top 25% of the class because you are an excellent multiple choice taker on exams, but when asked for three differentials for hypercalcemia, you throw a blank stare. There's a difference in the people who memorize for an exam and then toss the information out, and the ones who may not be in the top 50%, but learned and understood the information and know how to apply it. The clinicians who write those letters have seen you perform in clinics and if you can critically think about a case which they will put in your letters. Communication is another aspect that can be put in letters of rec because how you communicate effectively with clients and other clinicians is vital. Having a good rank helps, but it is just a piece of an application when it comes to matching.