I completely disagree. Step1 scores don't mean much at all when deciding how they will rank an applicant. Perhaps they help in the screening process, but not much after that.
If a program decides to interview you after looking at your step1/medschool/letters/research/etc AND your interviewers have positive things to say about you - I think it can help you a lot to let the program know that you will be ranking them first. It helps even more to have either your program director (or mentor/adivisor) call your program of interest and put in a good word for you. It stresses that you are serious about their program. Most programs like to boast that they didn't have to go down to far on their rank list to fill their spots. Knowing that someone is very interested in your program can definitely move them up so long as the other component of their file have not caused anyone on the admissions committee to have serious doubts about their ability to succeed.
Having said that, telling a program that you'll rank them 'high' is not really telling them anything. Does high mean your first choice? Your top 3? 5? I don't think those letters help all that much. Telling someone that you will rank them first or that their program was absolutely the best fit for you CAN help.
Our deans and program director told us that for IM the following are most important: 3rd year performance (especially IM), SubI, your medical school, letters of recommendation, AOA. They said Step1 was less important and that they couldn't remember making a decision for ranking based on Step1 scores. They gave us the impression that they are used to screen applicants and that the cut-off is no where near the cut-offs seen in more competitive specialties like derm, plastics, ortho, etc. Probably anything over a 220 is good enough. It is more about the whole package. And I think that a detailed letter, and perhaps a phone call on your behalf, can truly help and NEVER can hurt.
