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It's about the time of year for the requisite flurry of threads asking for application chances. Thought I would clear something up.
I have no idea how anyone answers this question.
As junior faculty, I have been involved in resident selection for 2 different institutions. Both could not be more different.
At one, each faculty and chief resident reading applications graded applicants on Transcript, Recommendations, Research, and Extracurriculars (read: were you an athlete, ex-military, or Rhodes Scholar? extra points) on a 1-4 scale. There was a Step 1 cutoff, so it didn't really matter what your Step scores were after you made the cut. The top X in terms of total scores were selected for interviews, with a few exceptions made by the PD in response to phone calls or other intangibles. Recommendations received the most weight and broke the most ties. Most of us literally skimmed the personal statement looking for personality disorders or inability to write in English. I don't think I ever looked at a Dean's Letter except to read the comments from attendings on Surgery rotations. In looking at the transcripts, those with all honors stood out, those with majority honors were middle of the pack, and those with few honors were on the lower end. Failing surgery was a red flag. Not honoring a NSGY Sub-I was a minor red flag. Failing a NSGY Sub-I was an automatic no.
At the other institution, transcripts were pored over. Failing anatomy meant your app was tossed. We looked at the distribution of grades for each rotation to put applicants in context. You can damn well bet the applicant with Step 1 of 260 was considered higher than the one with a 250. CVs were used to look for "interesting people" and we really did read into that one summer you spent building houses in Uganda. Recommendations mattered, but also WHO wrote them mattered - if it wasn't a personal friend of a faculty reviewer, it didn't really contribute much to your application. I always thought it was unfairly biased toward applicants from more "prestigious" backgrounds, but hey, what do I know. That program was certainly not all superstar residents.
The point is, stop wasting your time trying to read the mind of the application readers. And stop wasting even more time posting on here to get the input of other MS4s and PGY1s who have no clue what they're talking about. The only thing we all tend to agree on are the superstars and the red flags - everyone in between is subject to the individual institution's review process, and the vast majority of applicants are in this bucket. Your best bet is to do your research, find programs that fit what you want, and apply as widely as you can given your personal/financial situation.
We have had great residents come from everywhere, and shitty residents from the Harvards and UCSFs of the world. Any faculty member will tell you the same thing. Be realistic, but don't sell yourself short.
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