Chances at top programs

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I realize these are some of the most obnoxious posts, but it's amazing to see the qualifications of some of the people who post here, so here goes...

Top 5%+ at a top 10 school, step 1 score in the 250s, decent extracurriculars through years 1&2 and some undergrad research but no publications. What are my chances in the most competitive programs (e.g., top ranked neuro, ortho, etc.)? What can I do to craft the strongest application possible? I will almost certainly need to be in the northeast so I'm strongly interested in only a handful of programs, although my actual desired specialty is a little up in the air still. Thanks for your feedback.

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You should get some publications if you really want to maximize your application for top academic programs. Otherwise your application sounds solid, but you'll be competing for spots at top programs with applicants with numbers as good as yours, plus publications. So I'd say try to get into that and you should have the program of your choice.
 
Do you think publications are essentially required for top academic programs or are they just a feather in you cap? It seems like taking a year for research would be a little extreme but I can't think of another way to get some under my belt. Would, say, gunning for my med school's residency program or interviewing really well make up for it? Thanks again for your response.
 
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With numbers as solid as those, publications would essentially be icing on the cake. You do not absolutely need them to match at even the most competetive programs with stats like that. I've known people who have matched into gen surg, neurosurg, and ortho at places like Duke, Yale, MGH with no previous pubs if they have outstanding stats and letters.
 
No, I'm not saying to take a year off. Just try to get in on an ongoing project or even a case report in your spare time just to get your name on something.

I'm not saying it's necessary, but you asked "what can I do to craft the strongest application possible?", and, since everything else about you looks great, this is the only suggestion I could add to beef it up any more than it already is.
 
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