As a graduate MD with USMLE scores of 246 on Step 1 and 248 on Step 2, and class standing in the top 5% in a highly esteemed medical school, I can tell you that high scores and ranks CAN mean very little and that low scores and ranks WON'T EXCLUDE you as long as you PASS!
I know bottom of the class MD's who barely passed both Step 1 and 2, who also took 5 or 6 years to finish a 4 year program, that have prestigious residencies (opthalmology, dermatology, surgery, orthopedics) because they were ultimate scutmasters with great personalities and attractive features. They did well only in 3rd year, because they played the game.
Conversely, the serious medical intellectual like myself and many others I've known may be held back without such scutmaster and personality skills. You won't know what happens until you try it, so my advice is to play the game, be likeable, just PASS your exams and boards, and work hard as hell while in the hospital. I'd trade my grades and scores anyday for the ability to be able to endure long hours and call while maintaining fast manual skills such as drawing blood, inserting NG tubes, spinal taps, intubations, and the like.
This is not to say that high grades and board scores are not good--it is to say that they won't carry you by themselves, and low ones won't exclude you if you have the other qualities. Of course, I can remember one of the residency directors interviewing me and telling me that his program had found that the only correlation between board scores and success as a resident was that lower board scores meant better resident performance and that higher board scores meant lower resident performance. I wish I had been tape recording his statement to expose him.
Good luck to you and by all means, remember that getting a residency is primarily a numbers game--apply to 15 programs and you're almost certainly guaranteed to get one of them. I thought my academic records would get me anything I wanted, and so applied for only 2 programs in 1 big city, and got screwed. I'll never make the mistake again of thinking that high grades and board scores guarantee anything, and in the future, I'll devote my time to learning practical manual skills and political games, and just pass the exams without even studying.
Dr. Morgus