I don't go to a research powerhouse either--I interviewed this year for CRTP, HHMI, and multiple doris duke programs (will find out tomorrow). And, I didn't have any official publications--I did have a poster presentation at a major meeting and a couple small school presentations, but I THINK it's your letters and personal statement that goes a long ways...I had good grades first two years, but I don't know how much that factors in--I also spent a summer at a top 5 med school where I did some research, and I feel that my letter from there (which was incredibly strong) went a long ways. I felt that all my letters were really strong, speaking of my ability and potential to become an academic physician (which is what they want to produce or enocourage out of these programs)--the interviews for HHMI were super intense though..it was like being drilled for 30-40 mins re: your research and anything you may have written in your app or personal statement--will find out tomorrow though. I think it is kind of random...I felt the NIH itnerviews were more like you were trying to impress them (esp HHMI), where as most of the doris dukes ones were mutual...like they wanted to make sure that they had a suitable mentor and that u had a "match" with one of them on the interviews...hope this helps, sorry it's really vague, but I really don't know much beyond that.