Numbers are of prime importance. As an IMG try to score as high as possible on Step 1. Make sure there are no "red flags" in your record (i.e. behavior problems) and present yourself well on the interview. If there is a particular program you are interested in, do an elective and work really hard and try to fit in with the residents so that the residents really want you at the program. Many programs do consider what the residents have to say. If you are going to do an elective, pick a program you have a realistic shot at. Your personal background is interesting and may help a little but the bottom line is numbers!