Northwestern and UChicago are obviously quite competitive, they'll look at board scores. Relax. You've got them and then some with a 245 on Step 1. Like everyone else on this message board says, IM, more than just about any other specialty, is more than just grades and board scores. AOA is a great honor but does not exclude you from a top program if you don't have it. It's all relative. I mean, if I were a PD and I saw a guy who was top 1/3 with good evals from a great school like Duke, surely I would consider this a better accomplishment than some guy or gal who was AOA at "Joe's School of Medicine." That's just me. That being said, if you are coming from an average med school with a decent rep then getting AOA may be a little more important. If you don't get it, it isn't the end of the world for NW or UChicago though, especially with your Step 1. What will help is your good LORs and your research. Sometimes what I think we all forget on these message boards is that so much of this process is really the type of person you are rather than your actual qualifications. It's true, there is a certain reality to the situation, get good grades and rock the boards and you have more options. But, often times your grades and boards simply open the door. The time to really shine starts now in the interview process. When you interview at your top programs, let them know what your all about. You've done some research, take a little time to see what similar research has taken place at UChicago or Northwestern. Do you want to subspecialize? Read up on the school's division of cardiology or nephrology or whatever and start talking about what they are doing. A school picks you not necessarily on what you've done but where you are going and how you'll fit in. Let them know you're going someplace good with your career! Sorry this post got so long, I'll get off the soap box now. Good luck!