I am not the program director (thank God).
The way I see LORs are: if it's someone I know (and trust), then +++, otherwise neutral, but a negative LOR is -- (not ---, because sometimes negative LORs are no fault of the applicant, who may have been blindsided. I reserve some doubt if it's discordant with the rest of the application. Frankly, LORs are often so ridiculous than I can barely recognize the applicant, so I usually discount them.
To my mind all of these numbers and ranks are nothing but proxies. They have no value in themselves. A high step score does not mean you will offer value at a tumor board in ten years' time, nor does it ensure that one will maintain one's knowledge base or make ethical decisions. It won't predict that you become the go-to person in your group. These qualities are hard, if not impossible to predict, but they're what is really valuable (IMO). I think taking proxies too seriously is kind of a lazy way out. I understand their use as a screening tool because I don't want to review two hundred applications, but that's their only use for me.
What I want is someone with: 1) a good work ethic, 2) a good attitude, 3) a commitment to learning and knowledge (goes with humility), 4) a good team player and communicator, and 5) a professional.
Step scores are supposed to help with (1) and (3), but in my limited experience, their predictive value have failed on numerous occasions. As you point out, AOA and class rank are better proxies for (1) and (3). A consistent application is in line with 1, 3, and 5. Clinical honors is a weak indicator to my mind - too easily gamed and good future doctors can get blindsided by a poor clinical grade or two. A perfect set of honors in the clinical years smells like bs to me. Extracurriculars that show commitment and professionalism impress me (1, 2, 4, and 5), "constructed" CVs with numerous "leadership" positions in numerous interest clubs do not. Actual interest and commitment to research or dedication to an allied area (e.g. informatics) impresses me, a dozen publications in ten different disciplines do not.
Some of the best radiologists working today may not have been able to make it into radiology residency if they were to apply again. I always remember this. There's something else that sets these experts apart and it's not a test score. It's a commitment to learning and professionalism when there are no grades and there is no test coming up. It's a commitment to going the extra mile when it can't be marketed on a CV as an extracurricular. How do I find good proxies for that?
