For any underclass medical students,
I tell this to all the third years who ask me. You should approach, in my opinion, the process of getting a residency as two steps. One get the interview and two get ranked high on the list.
Number one is all about: boards, third year grades, and very important letters of recommendation. What combination is needed varies year to year and is not a set number. Do the best you can and live with the results. Anything else is wasted energy.
Number two: Throw pretty much everything from number one out the window. Realize that you are qualified since you got the interview, now sell yourself as a person to the program. Show them you have a personality, be able to explain how you think and why you think that way. Sounds stupid maybe, but I think it is that easy. Programs are looking for PEOPLE that they would enjoy working with everyday, will get through tough situations well, and can articulate a thought process beyond a test situation. If you aren't good at the art of conversation, practice. Then learn how to make yourself memorable without it being a negative. Also sell why you would want to be at that location. Focus on all the positives of the location and the program. It shows you have thought about them and gives them reassurance you are honestly interested. Not just "I am here because you have a good name."
Number three: Make sure programs know you are interested in them, but don't lie. You will be dealing with people from other programs the rest of your life. If you are dishonest you have got to deal with that. All the programs I ranked I would have been happy to be at. At some programs I think I developed rather friendly relationships with PD's or others in the program. I look forward to meeting these people in the future and discussing the art as well as the things I do outside of work with them.
Good luck to all of you, I hope you get your #1.