Your step 1 scores will get you interviews. The rest will help the conversation along - you're fine.

I'm sure a 250 can open a number of doors. Heads up for the question of why your grades aren't in sync with your board scores. I think usually board scores of >250 are strongly associated with increasing class rank. I'm certainly no expert since I'm just in the application process right now, but if I were interviewing you, that's one of the things I might like to know about. I imagine good third year clerkship grades can cover for some M1-M2 sins so bust your A@# this year. Good luck

I wouldn't worry about your home program ranking you lower if you do away electives. They know that we all have to do aways in order to improve our chances at matching. Just do a good job at your home ortho rotation and be positive about their program if they ask. As for your application I wouldn't get discouraged by class rank, I think that a lot gets determined based on your performance in ortho electives anyway.

Top 10 selection factors according to JBJS Nov 2002 article: 1. Rotation at director's institution 2. USMLE part 1 score 3. Rank in medical school 4. Formality/ politeness at interview 5. Personal appearance of candidate 6. Performance on ethical questions at interviews 7. Letter of recommendation by orthopaedic surgeon 8. AOA 9. Medical school reputation 10. Dean's letter Keep in mind that this is averaged from surveys and that some programs will put more emphasis on other factors.

What Selection Criteria Do Orthopaedic Program Directors Value Most? (Taken from JBJS article Nov 2002) Academic Criteria Wagoner and Suriano found that, as a specialty becomes more competitive, its residency programs rely more heavily on academic credentials when screening applicant pools 1,5,6,9. Orthopaedics, which ranks among the most competitive surgical subspecialties, has been shown to place the highest value on objective criteria, such as United States Medical Licensing Examination (USMLE) scores, class rank, and membership in Alpha Omega Alpha, in screening applicants for residency programs 3,5,6,13. Orthopaedic program directors are particularly prone to emphasize the value of the applicant's cognitive knowledge. This is demonstrated by the Residency Review Committee's requirement that, to maintain accreditation, orthopaedic surgery residency programs must have a pass rate of 75% on the Part-I certification examination of the American Board of Orthopaedic Surgeons by residents who take it for the first time 12,15. Our study supports the notion that program directors highly value candidates' academic credentials, because USMLE scores, medical school class rank, and Alpha Omega Alpha membership were all among their top ten selection criteria 13 (Table I). Clark et al. reported that membership in Alpha Omega Alpha was one of the strongest predictors of a successful application to an orthopaedic residency program; however,