Subpar Medical Student Looking for Urology Match Advice

[Hash Slinging Slasher]

To give some background first, I'm a MS3 US medical student. I recently just finished a surgical elective rotation in urology and absolutely loved the rotation. After going 2.5 years in medical school with absolutely nothing clicking for me, the eureka moment of finally finding a specialty I genuinely enjoy is almost cathartic to say the least.

The only catch is that my academics is definitely on the poorer side. MS1 was P/F, which proceeded uneventfully. I did research during M1 summer, but nothing ever came of the project unofficially. MS2 was graded A-F, and I got a D (69.6) on my first module (which I re-mediated to a B) and Cs on the all rest except the last one which I got a B on (improvement, kinda sorta?). Lastly, I did score a 224 on the Step 1.

The bright side is that since MS3 began, I've studying MUCH harder and so far have As in all my third-year rotations so far including the urology rotation. My urology attending has agreed to write me a good letter of recommendation too. Also, I have access to already collected urological cancer data from a lab at my medical school and have started writing a paper during my free time using those results.

My question is at this point, is there anyway at all to salvage any chance of matching into urology? Would it be worth it/feasible for me to try at all? If so what should my timeline from here on look like? I'm willing to do almost whatever it takes including taking a research year if necessary or do as many away rotations in urology as needed, so any advice would be highly appreciated.

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[831929]

Not sure how different the app would be since urology has its own timeline but typically people applying for competitive subspecialities duel-apply with a backup plan. If you don't mind not matching and have some ideas for the year off, then just apply urology and try your luck next time after a year of research maybe. best people to talk to would be students from your school that applied urology. Look at the match data and see how you stack up (what is the match rate for your score range).

I don't think anyone can tell you more than just the stats on people matching with your grades and research so far. The only way to really find out is to apply. It sounds like this is your top choice so maybe take the risk and hope for the best. If you have a home program, talk to them. They would be the best to give your good feedback. Plus increase your chance of matching if you say they liked you a lot.

Also, check out some other fields. Obgyn for example can overlap a lot with urology especially after some fellowship training.

 

[sovereign0]

A 224 on Step 1 is by far your biggest problem. Poor preclinical grades can be looked past. Research you can continue to work on. And your clinical grades are great so far.

I couldn't find any data other than this table which suggests a <10% chance of matching considering your Step 1 score alone, and I'm guessing that those who did match had some combination of exceptional research and personal relationships with faculty or program directors.

I'm a fellow MS3 going into a different competitive specialty, so I'm not speaking from much authority, but my advice would be to consider a different field. It will be much less headache and likely anguish for you if you find something else to be interested in. If not - get 250+ if not 260+ on Step 2 CK.Talk to your home program's PD and develop a relationship with your department chair. Crank out as much research as you can. You'll need to do away rotations on MS4 and absolutely kill them for good letters there. Your best chance at matching will be at a program you rotate at.

Urology is a highly, highly competitive specialty, and your academics put you at a major disadvantage.

 

[NotaCop]

Your biggest barrier is that most programs in uro use 230 as a cutoff, some even higher. Very few use lower cutoffs and it’s impossible to know which do unfortunately.

 

[Frogger27]

Since Urology is such a small field, the only thing that really matters is Step 1, clinical grades, research/LORs.

Agreed with above that with that Step 1 everything else in your application would need to be exceptional and you would need strong support in your department/kill away rotations

 

[Dr G Oogle]

I’m a fellow in a urology department and I know that this year the new PD is making a point to not limit spots only to the 250s+ club; there were people with scores of 220s offered interviews, and I even saw a 214; that being said these people had other things going for them, great letters, research, someone to vouch for them, great grades etc, also keep In mind that this program has 3 spots and is interviewing dozens of candidates (I may be misremembering but I think it’s something like 50 interviewes). Not sure if this is a trend but have heard there is a push to putting less emphasis on board scores alone. So not impossible, not even necessarily a long shot but you probably have your work cut out for you.

 

[Frogger27]

I’m a fellow in a urology department and I know that this year the new PD is making a point to not limit spots only to the 250s+ club; there were people with scores of 220s offered interviews, and I even saw a 214; that being said these people had other things going for them, great letters, research, someone to vouch for them, great grades etc, also keep In mind that this program has 3 spots and is interviewing dozens of candidates (I may be misremembering but I think it’s something like 50 interviewes). Not sure if this is a trend but have heard there is a push to putting less emphasis on board scores alone. So not impossible, not even necessarily a long shot but you probably have your work cut out for you.

May I ask what part of the country this is in?

 

[Treebeard]

What? That seems like a terrible strategy for a program. What benefit could there be in intentionally interviewing candidates with near bottom quartile step 1 scores. What does a 214 bring to the table that you can't get from other applicants that's worth giving them an interview over the hundreds of other super qualified candidates?

Is it just a safety in case your program had to SOAP? As in, let's interview a 214 so that if worst comes to worst we will have a body here at this program if our rank list doesn't work out. It blows my mind because there's always 1-5 outliers who match each competitive specialty with like a 190-220. Who's giving out interviews to these candidates?

I promise that I'm not being sarcastic, but I would honestly like to better understand the rationale of intentionally picking very low step 1 scores to interview when you're turning down so many amazing candidates who happen to have crazy high step 1 scores in addition to the full package?

There is more to life than a standarized test taken in the second year of medical school.

 

[Donald Juan]

Realize it will be an uphill battle, but I don't think that a 220 step, especially since you've been acing clinical's since then, means you're dead in the water. You need to kill step 2. I think you get sub 250 on step 2 then you should really consider other options or a back up. If you continue to ace your clinicals and make a 270 and work your butt off on sub-I rotations then you have a good chance to match somewhere assuming you are likable. Do you have a home urology program? You should get in contact with them immediately if you are gonna go forward with this. You need to be well liked and show how outgoing you are. Having academic urology faculty that will go to bat for you is important. If you don't have a home GU department (and I mean academic GU department, not a private group that you rotate with) then you should reach out to the nearest school around you that does and get in touch with their program director. Urology programs often will take students from nearby schools under their wing when they don't have a home program. Keep the research going, but not at the detriment of your grades. Get research on your application, and keep working on it throughout M4 in case you don't match and want to reapply. Are you an MD or DO? I hate to say it, but if you're a DO, you should probably forget about it. Even DO students with above average scores have difficult times matching.

 

[Dr G Oogle]

May I ask what part of the country this is in?

Midwest

 

[Dr G Oogle]

What? That seems like a terrible strategy for a program. What benefit could there be in intentionally interviewing candidates with near bottom quartile step 1 scores. What does a 214 bring to the table that you can't get from other applicants that's worth giving them an interview over the hundreds of other super qualified candidates?

Is it just a safety in case your program had to SOAP? As in, let's interview a 214 so that if worst comes to worst we will have a body here at this program if our rank list doesn't work out. It blows my mind because there's always 1-5 outliers who match each competitive specialty with like a 190-220. Who's giving out interviews to these candidates?

I promise that I'm not being sarcastic, but I would honestly like to better understand the rationale of intentionally picking very low step 1 scores to interview when you're turning down so many amazing candidates who happen to have crazy high step 1 scores in addition to the full package?

The as treeebeard says there is more to life than a standardized test. Also the USMLE explicitly states the result must not be used to screen for residency. The poor result may have been from a bash day. I’d much rather take a subpar board score and otherwise stellar applicant than someone with a 260 and an app that basically shows no experience other than being really intense at school. This person must have some other things in their app that makes them very attractive.

To be sure most of the applicants are in 240s+ club, but if you automatically exclude someone with sheisty board scores you’ll be missing out on some really good residents.

 

[Donald Juan]

What? That seems like a terrible strategy for a program. What benefit could there be in intentionally interviewing candidates with near bottom quartile step 1 scores. What does a 214 bring to the table that you can't get from other applicants that's worth giving them an interview over the hundreds of other super qualified candidates?

Is it just a safety in case your program had to SOAP? As in, let's interview a 214 so that if worst comes to worst we will have a body here at this program if our rank list doesn't work out. It blows my mind because there's always 1-5 outliers who match each competitive specialty with like a 190-220. Who's giving out interviews to these candidates?

I promise that I'm not being sarcastic, but I would honestly like to better understand the rationale of intentionally picking very low step 1 scores to interview when you're turning down so many amazing candidates who happen to have crazy high step 1 scores in addition to the full package?

For one, step 1 score isn't everything. I'm sure the person with the 214 probably had an otherwise stellar application, and maybe having a bad day shouldn't be exclude them from being a dick doctor. I know you mention there are so many amazing candidates, but you also have to realize the dynamic of a specialty like urology where every applicant applies to almost 2/3 of the programs. Every program gets 200+ applications, and yes you will have like 50 people who are absolutely amazing on paper, have a 270+ on step 1 and 2 and have 12 first author publications in the gold journal, come from top tier med school and have letters of recommendation saying they walk on water, but those people get 40 interview invites and end up matching at hopkins or stanford and they only applied to the small state school in illinois because they are neurotic and applied to 40 back ups. For a smaller school in a less desirable location, it is wise to look for candidates in your ball park or people who have regional connections, and even though typically for GU that usually means people with 240+ even at "low tier" programs, it is very possible to find a diamond in the rough who gets overlooked by everyone else because of a step score cut off, and that individual can be a huge asset to your program when they actually start residency. Also realize that programs that are low to mid tier and only interview their top applicants are often the places that randomly go unmatched in a field where the match rate is only about 70%, and that typically signals future applicants that there is some problem at the program, so places try and avoid it.

 

[Dr. Doctor MD]

There is more to life than a standarized test taken in the second year of medical school.

Fantastic answer to my question, thanks for the detailed response. Glad you were able to boost your likes.

The as treeebeard says there is more to life than a standardized test. Also the USMLE explicitly states the result must not be used to screen for residency. The poor result may have been from a bash day. I’d much rather take a subpar board score and otherwise stellar applicant than someone with a 260 and an app that basically shows no experience other than being really intense at school. This person must have some other things in their app that makes them very attractive.

To be sure most of the applicants are in 240s+ club, but if you automatically exclude someone with sheisty board scores you’ll be missing out on some really good residents.

Fair enough point that there are some diamonds in the rough with super low board scores that might be passed up. My point was just that there are equal diamonds in the 240-270 range, so if all things are equal, why go with the ultra low step score?

For one, step 1 score isn't everything. I'm sure the person with the 214 probably had an otherwise stellar application, and maybe having a bad day shouldn't be exclude them from being a dick doctor. I know you mention there are so many amazing candidates, but you also have to realize the dynamic of a specialty like urology where every applicant applies to almost 2/3 of the programs. Every program gets 200+ applications, and yes you will have like 50 people who are absolutely amazing on paper, have a 270+ on step 1 and 2 and have 12 first author publications in the gold journal, come from top tier med school and have letters of recommendation saying they walk on water, but those people get 40 interview invites and end up matching at hopkins or stanford and they only applied to the small state school in illinois because they are neurotic and applied to 40 back ups. For a smaller school in a less desirable location, it is wise to look for candidates in your ball park or people who have regional connections, and even though typically for GU that usually means people with 240+ even at "low tier" programs, it is very possible to find a diamond in the rough who gets overlooked by everyone else because of a step score cut off, and that individual can be a huge asset to your program when they actually start residency. Also realize that programs that are low to mid tier and only interview their top applicants are often the places that randomly go unmatched in a field where the match rate is only about 70%, and that typically signals future applicants that there is some problem at the program, so places try and avoid it.

Very good response ^ and I appreciate you taking the time to write what you did. Much of what you said was similar to my theory that programs do it to guarantee that they don't go unfilled. And you are completely right that the top 20-25% of candidate probably soak up an absurd amount of interviews and if you interview the best of the best, you may have to SOAP a resident or go unfilled when all those candidates end up at top 10 programs.

 

[831929]

Fantastic answer to my question, thanks for the detailed response. Glad you were able to boost your likes.



Fair enough point that there are some diamonds in the rough with super low board scores that might be passed up. My point was just that there are equal diamonds in the 240-270 range, so if all things are equal, why go with the ultra low step score?



Very good response ^ and I appreciate you taking the time to write what you did. Much of what you said was similar to my theory that programs do it to guarantee that they don't go unfilled. And you are completely right that the top 20-25% of candidate probably soak up an absurd amount of interviews and if you interview the best of the best, you may have to SOAP a resident or go unfilled when all those candidates end up at top 10 programs.

Sometimes people with the highest scores have personalities that are hard to deal with. Programs want good doctors and people they can work well with and rely on. That does not always mean a high step score. I know plenty of hard-working people who are great clinically and have lower step scores but can hold a conversation and make the working environment a fun place to be.

It is true, step is not everything. Also, SD for average step score is like +/- 19 or more so really 224 is not some terrible score.

and as @Donald Juan said, top people usually rank top programs.

 

[Merely]

Fantastic answer to my question, thanks for the detailed response. Glad you were able to boost your likes.



Fair enough point that there are some diamonds in the rough with super low board scores that might be passed up. My point was just that there are equal diamonds in the 240-270 range, so if all things are equal, why go with the ultra low step score?



Very good response ^ and I appreciate you taking the time to write what you did. Much of what you said was similar to my theory that programs do it to guarantee that they don't go unfilled. And you are completely right that the top 20-25% of candidate probably soak up an absurd amount of interviews and if you interview the best of the best, you may have to SOAP a resident or go unfilled when all those candidates end up at top 10 programs.

The initial person said they interviewed 1 person with a 214. You then proceeded to freak out about why that person was given an interview claiming that everyone with a high test score has what that guy has plus a high score. The real answer is the one you belittled above, a test score is not everything. You’re obviously immature and have a lot to learn but hopefully with experience you’ll get there.

 

[CherryRedDracul]

The initial person said they interviewed 1 person with a 214. You then proceeded to freak out about why that person was given an interview claiming that everyone with a high test score has what that guy has plus a high score. The real answer is the one you belittled above, a test score is not everything. You’re obviously immature and have a lot to learn but hopefully with experience you’ll get there.

Hate to pile it on, but this.

Perhaps a lot of us grew up with the mentality that test scores are life, but at some point, I urge people to break their mind out of that box. And I hope more programs continue to do the same.

"I am not a number! I am a free man!"

 

[sella.turcica]

so many amazing candidates who happen to have crazy high step 1 scores in addition to the full package?

Your comment is based on the quite naive assumption that everybody with "crazy high step 1 scores" have "the full package". Not all people with high step scores come with excellent LoR's, pubs etc. Likewise, there is a tremendous amount of accomplished people who do not have "crazy high step 1 scores". People like you are the reason why so many good candidates are discouraged from going for their favorite specialty.

 

[Dr. Doctor MD]

Your comment is based on the quite naive assumption that everybody with "crazy high step 1 scores" have "the full package". Not all people with high step scores come with excellent LoR's, pubs etc. Likewise, there is a tremendous amount of accomplished people who do not have "crazy high step 1 scores". People like you are the reason why so many good candidates are discouraged from going for their favorite specialty.

Actually, I have plenty of experience with students applying competitive specialties and have talked with numerous program directors. The truth of the matter is that almost everyone is amazing who bothers to apply for competitive specialties. Terrible applicants don't just apply to be neurosurgeons and dermatologists. If they're submitting an app 9/10 times they have the experience to back it up to some degree or another. Sure there are a couple people with a high step one and a terrible CV or bad personalities, but these are rare and actually the exception rather than the rule.

People on SDN and in real life LOVE to perpetuate the rumor that a high proportion of people with high step scores are terrible people, with no other qualifications, who lack any type of social skills. This is just a defense mechanism to make you feel better about yourself. Sure some people with high step scores are robots or unfriendly, but guess what, I promise they aren't any more prevalent among 250+ people compared to 250- students. There's no magic to step 1, it doesn't make you a good or bad person. But it does generally speaking reflect on the work ethic of a person.

Why do you think people who destroy classes the first two years, go on to destroy step 1, then honor most of their classes, then get AOA, then graduate with a high class rank, and then match a great program?

Having a high step 1 doesn't make you a good doctor. Great medical students just happen to get high step scores because they're hard working and that spills over into every other aspect of their work.

I'll agree completely that there are phenomenal students who don't score as high as they wanted on Step 1 who probably are just as good as some people with 260s. And I'm also confident that most of the other 85% of students who don't get 250+ go on to be good doctors as well. So please don't mischaracterize my argument that you need a 250 to be a good doctor. That's absolutely not true and I never said or implied that.

Oh and if you're wondering where all the other 250+ people without a crazy CV, keep in mind that every specialty including FM and Psych match dozens of 250/260+ people every year. People don't just apply plastic surgery with a 250 and no research. because you're absolutely right, they'd probably have the same chance at matching a a 214 with 15 pubs, which would probably be low for both. You need a high step 1 and strong CV to match any competitive specialty and most people apply that for the ortho/plastic/derm type specialties know this.

But please continue to tell me all about how competitive specialties struggle to find killer applicants above a 250, or god forbid they dip down to a 240 (sarcasm)...

 

[DNC127]

Actually, I have plenty of experience with students applying competitive specialties and have talked with numerous program directors. The truth of the matter is that almost everyone is amazing who bothers to apply for competitive specialties. Terrible applicants don't just apply to be neurosurgeons and dermatologists. If they're submitting an app 9/10 times they have the experience to back it up to some degree or another. Sure there are a couple people with a high step one and a terrible CV or bad personalities, but these are rare and actually the exception rather than the rule.

People on SDN and in real life LOVE to perpetuate the rumor that a high proportion of people with high step scores are terrible people, with no other qualifications, who lack any type of social skills. This is just a defense mechanism to make you feel better about yourself. Sure some people with high step scores are robots or unfriendly, but guess what, I promise they aren't any more prevalent among 250+ people compared to 250- students. There's no magic to step 1, it doesn't make you a good or bad person. But it does generally speaking reflect on the work ethic of a person.

Why do you think people who destroy classes the first two years, go on to destroy step 1, then honor most of their classes, then get AOA, then graduate with a high class rank, and then match a great program?

Having a high step 1 doesn't make you a good doctor. Great medical students just happen to get high step scores because they're hard working and that spills over into every other aspect of their work.

I'll agree completely that there are phenomenal students who don't score as high as they wanted on Step 1 who probably are just as good. And I'm sure the other 85% of students who don't get 250s go on to be good doctors as well.

Oh and if you're wondering where all the other 250+ people without a crazy CV, keep in mind that every specialty including FM and Psych match dozens of 250/260+ people every year. People don't just apply plastic surgery with a 250 and no research. because you're absolutely right, they'd probably have the same chance at matching a a 214 with 15 pubs, which would probably be low for both. You need a high step 1 and strong CV to match any competitive specialty and most people apply that for the ortho/plastic/derm type specialties know this.

But please continue to tell me all about how programs struggle to find killer applicants above a 250

you are annoying.

After taking boards, if you don't realize how stupid they are then you are up in the night, or all you have on your app is that score and you are using this as a defense mechanism for how one dimensional you are.

And no I am not saying that to hide behind my scores. I am one of those dudes with good scores and probably more pubs than the rest of my class combined.

 

[Dr. Doctor MD]

you are annoying.

After taking boards, if you don't realize how stupid they are then you are up in the night, or all you have on your app is that score and you are using this as a defense mechanism for how one dimensional you are.

And no I am not saying that to hide behind my scores. I am one of those dudes with good scores and probably more pubs than the rest of my class combined.

Fine, call me annoying.

But at the end of the day the vast majority of programs in the vast majority of specialties place an enormous and disproportionate weight on Step 1 performance in deciding who to interview, and whether you like me or hate me, that's a fact. Whether it should be like that or not isn't up to me or you, that's just the way things have become in the last decade. As they say, don't hate the player hate the game.




... and yes after taking Step 1 I don't believe that small difference in scores should be interpreted as different, but boards are certainly not "stupid". There is unfortunately more chance than you'd think, and this is coming from someone with a good score just applying radiology. I had a a couple friends who were great students who had their dreams crushed by an unexpectedly low step score, so I can empathize.

 

[Dr G Oogle]

Actually, I have plenty of experience with students applying competitive specialties and have talked with numerous program directors. The truth of the matter is that almost everyone is amazing who bothers to apply for competitive specialties. Terrible applicants don't just apply to be neurosurgeons and dermatologists. If they're submitting an app 9/10 times they have the experience to back it up to some degree or another. Sure there are a couple people with a high step one and a terrible CV or bad personalities, but these are rare and actually the exception rather than the rule.

People on SDN and in real life LOVE to perpetuate the rumor that a high proportion of people with high step scores are terrible people, with no other qualifications, who lack any type of social skills. This is just a defense mechanism to make you feel better about yourself. Sure some people with high step scores are robots or unfriendly, but guess what, I promise they aren't any more prevalent among 250+ people compared to 250- students. There's no magic to step 1, it doesn't make you a good or bad person. But it does generally speaking reflect on the work ethic of a person.

Why do you think people who destroy classes the first two years, go on to destroy step 1, then honor most of their classes, then get AOA, then graduate with a high class rank, and then match a great program?

Having a high step 1 doesn't make you a good doctor. Great medical students just happen to get high step scores because they're hard working and that spills over into every other aspect of their work.

I'll agree completely that there are phenomenal students who don't score as high as they wanted on Step 1 who probably are just as good as some people with 260s. And I'm also confident that most of the other 85% of students who don't get 250+ go on to be good doctors as well. So please don't mischaracterize my argument that you need a 250 to be a good doctor. That's absolutely not true and I never said or implied that.

Oh and if you're wondering where all the other 250+ people without a crazy CV, keep in mind that every specialty including FM and Psych match dozens of 250/260+ people every year. People don't just apply plastic surgery with a 250 and no research. because you're absolutely right, they'd probably have the same chance at matching a a 214 with 15 pubs, which would probably be low for both. You need a high step 1 and strong CV to match any competitive specialty and most people apply that for the ortho/plastic/derm type specialties know this.

But please continue to tell me all about how competitive specialties struggle to find killer applicants above a 250, or god forbid they dip down to a 240 (sarcasm)...

You’re not wrong. The majority of people with great scores are also great in general. However, the stress the OP (and I’m sure lots of other students ) is experiencing is a direct result of an overrealiance on a single data point that by intention was not made to be used for the purpose it is being used for. I think it’s important to not immediately discount students from certain specialties because of one test taken on one day of their Med school and look at an entire application. Admittedly it’s hard to screen hundreds of apps for 3 or 4 spots, but perhaps the minds who’ve managed to score 250s and 260s could come up with a better system for identifying successful residents.

 

[AnatomyGrey12]

Actually, I have plenty of experience with students applying competitive specialties and have talked with numerous program directors. The truth of the matter is that almost everyone is amazing who bothers to apply for competitive specialties. Terrible applicants don't just apply to be neurosurgeons and dermatologists. If they're submitting an app 9/10 times they have the experience to back it up to some degree or another. Sure there are a couple people with a high step one and a terrible CV or bad personalities, but these are rare and actually the exception rather than the rule.

People on SDN and in real life LOVE to perpetuate the rumor that a high proportion of people with high step scores are terrible people, with no other qualifications, who lack any type of social skills. This is just a defense mechanism to make you feel better about yourself. Sure some people with high step scores are robots or unfriendly, but guess what, I promise they aren't any more prevalent among 250+ people compared to 250- students. There's no magic to step 1, it doesn't make you a good or bad person. But it does generally speaking reflect on the work ethic of a person.

Why do you think people who destroy classes the first two years, go on to destroy step 1, then honor most of their classes, then get AOA, then graduate with a high class rank, and then match a great program?

Having a high step 1 doesn't make you a good doctor. Great medical students just happen to get high step scores because they're hard working and that spills over into every other aspect of their work.

I'll agree completely that there are phenomenal students who don't score as high as they wanted on Step 1 who probably are just as good as some people with 260s. And I'm also confident that most of the other 85% of students who don't get 250+ go on to be good doctors as well. So please don't mischaracterize my argument that you need a 250 to be a good doctor. That's absolutely not true and I never said or implied that.

Oh and if you're wondering where all the other 250+ people without a crazy CV, keep in mind that every specialty including FM and Psych match dozens of 250/260+ people every year. People don't just apply plastic surgery with a 250 and no research. because you're absolutely right, they'd probably have the same chance at matching a a 214 with 15 pubs, which would probably be low for both. You need a high step 1 and strong CV to match any competitive specialty and most people apply that for the ortho/plastic/derm type specialties know this.

But please continue to tell me all about how competitive specialties struggle to find killer applicants above a 250, or god forbid they dip down to a 240 (sarcasm)...

You are correct in these statements, however the reason you are getting crap is because your original post came off incredibly douchey:

What? That seems like a terrible strategy for a program. What benefit could there be in intentionally interviewing candidates with near bottom quartile step 1 scores. What does a 214 bring to the table that you can't get from other applicants that's worth giving them an interview over the hundreds of other super qualified candidates?

Is it just a safety in case your program had to SOAP? As in, let's interview a 214 so that if worst comes to worst we will have a body here at this program if our rank list doesn't work out. It blows my mind because there's always 1-5 outliers who match each competitive specialty with like a 190-220. Who's giving out interviews to these candidates?

I promise that I'm not being sarcastic, but I would honestly like to better understand the rationale of intentionally picking very low step 1 scores to interview when you're turning down so many amazing candidates who happen to have crazy high step 1 scores in addition to the full package?

What do programs have to gain? Perhaps they saw a fantastic resident in the making whose only blemish was a 3 digit number. Just about everyone in medicine has the academic chops to do any field, and by only selecting for the high standardized test scorers you can miss on the other applicants who might be a great fit for your field and program. You have to remember that these surgical fields are 5 years long and usually smallish programs, meaning lots of interaction with everyone on a daily basis. They want to take the person who they would love to work with every single day for 5 years over the guy with great scores that they only see on the interview day. Most likely the low scorers that match these fields rotated with the program they matched at, and the program probably loved them and didn't care that their scores weren't the usual 250s they get from non-rotators.