Orthogateboy,
Don't listen to some of these fools. I had 192 on Step I and got 242 on step 2, and matched at a top 20 program. You can't do any specific Step II prep until after 3rd year, but treat each of your clerkships as a way of "studying" for Step II. Read the appropriate Blueprint/BRS book several times during your rotation. Do additional "question" books at that time (A&L, Blueprints Q&A). You need to learn this stuff, not just know it for the test.
Get all A's in your clerkships, get good letters, use any connections you can think of, get a good advisor who knows people and is liked by people. Then, when your third year is over, give yourself 3-4 weeks to study for Step II. I used Kaplan Q-bank like it was my job. It tells you what areas you are weak in, and then you can go back and re-read those topics. Crush the boards is also a good book.
Assuming you do well on Step II, then do several AI's at attainable places, not just ones where they will grant you a courtesy interview. Being a likeable guy and a hard worker will get you farther than any 250. Finally apply to a ton of programs (I did over 55, and got 13 interviews - including places like Duke and Emory).
But for right now, all you can do is rock your clerkships and learn the material throughout the year. Just keep Step II in mind when your buddies are out drinking on a Friday and you are stuck at home reading Blueprints in OB/GYN. Good luck. Don't let others psyche you out. You know what you need to do, so go do it. It's possible. Good luck.
