The reality is that there are not enough spots for everyone's number 1 program. With that said, I know a couple of kids who match into their top program last year with scores of 230's- both were IMG from Caribbean's med schools and both match into good academic programs.
This year I was part of the interview committee. I can honestly tell you that once you are granted an interview, although important, numbers (step 1, 2 etc) are not what will get you ranked higher. What is really important is how you fit into the program. For example, during this season, we had a kid from a great med school with great scores and some pubs but was an ass. Not a single resident voted for him and was not even recommend to be ranked. Another kid did not get along with 2 current PG1's- this is important because these PG1's will be sharing call with the upcoming class- bottom line, he will not get ranked.
Every program has different ways of ranking people. In our program, once you are granted an interview, you are looked at equally, regardless if you are a US grad or an IMG. Although I wish to remain anonymous, I am currently in a top 25 program. The only thing you can do is do your best during your interviews and try to establish rapport with the residents- trust me, and I know other residents will agree with this- we know who is faking it and who is genuinely interested. Good luck with your top program. To some, it is better to go unmatched while others would prefer go anywhere….and thus, some people don't even rank programs where they are not willing to go.
