As an MD-PhD student at a very reputed, research-heavy school (top 25), let me comment on the value of research.
As someone who cares deeply about science and wants to do research professionally as a laboratory scientist, it pains me to see so many of my MD colleagues pursue research for the wrong reasons - namely for the purpose of advancing his/her residency applications. Sadly, I think that even many MD-PhD students view their PhD simply as a means to get into a competitive residency. In this process of resume building, we tend to forget that the true purpose of research is to make a discovery and benefit society. Any other motivation for pursuing research, in my mind, is just a waste of everyone's time.
I think that the so called "top" medical residency programs seek out people with research experience not because they think that this makes them "better" than people who don't do research. I think it is because they want to recruit people who will go on to become academic scholars in their chosen discipline - people who will advance the field. If you honestly don't want to do research, that is fine, but that also means that you should go to a residency program that better fits your goals. A program that is research intensive, such as UCSF or Brigham, is probably not the best place for someone not inclined to do scientific research. This doesn't mean that someone who doesn't want to do research, or has limited research experience, won't be as great a doctor, it just means that a so called "top" IM program may not be the best place for that person. In fact the idea of dubbing a program "top" makes me cringe. I think that these places are just different, and are looking for a specific kind of candidate. They aren't necessarily going to recruit the "best" candidates, although the people who do get into them tend to be among the best.
To corroborate these views, I have spoken to many faculty at my institution who graduated from places like MGH, BWH etc, and they unanimously say that a major factor that these programs use in recruiting is whether or not someone has the potential to be a thought leader in some academic discipline - be it biomedical research, clinical/translational research, public health or other fields. Clinical excellence and solid grades are expected at these places as well, but this is simply not enough to get you into places like BWH. There has to be some evidence that you are going to do something beyond just being a great doctor.
To answer the OP - here is what I will say. The question you should be asking shouldn't be "what can I do to get into a top residency program", I think the questions you need to ask are:
1. What can I do to become the best doctor possible and learn the most in my limited time in medical school?
2. What is it that I want to do in my medical career and what experiences can I pursue to gain the necessary skills to achieve this goal?
To me, it seems like you don't really like research. My suggestion to you is - DONT DO IT! Find something that you are interested in and pursue it! Do you want to learn a new language and spend a year working in some other country? Do it! I don't know what it is you like, but you need to figure it out and do it. Get a vision for your career and follow it with intensity.
Regarding Step 1 - I do think the score matters, but maybe not as much as you think. Do as well as you possibly can. Shoot for a 250 - that should keep you in the running for most residency programs in most specialties. Even if you fall a bit short, don't sweat it. The most important thing is to spend your time doing what you like and to do that thing well. If you can do that, it will show on your application and you will shine.
On the other hand, if you have the attitude of "I'll just do some BS research to put on my resume without really committing", that will certainly show - either on your application or your interviews. Nothing comes easy in life - you got to be willing to commit a significant amount of time and energy to it. But if it is something you like to do, that shouldn't be very difficult.
PS (not to be mean, but just to be realistic) - The people who may interview you at BWH will have experience talking to candidates who have published substantial work as first authors in journals like Cell or Science. They will also be interviewing people who were Rhodes scholars, or candidates who played a division I sport in college. Pretty sure a chart review completed by an uninspired medical student won't impress the Brigham lol. It will just end up being a waste of your time.
