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Penn's not easy... you don't have to be AOA but I'm sure they can stock their class with AOA if they wanted. Good Step I helps, but it's not like in surgical fields where they obssess over it. If its your dream program, then set up an elective there- probably within the next couple months- as a 4th year, impress the hell out of them, meet the PD and cross your fingers... that'll go a long way.