Medical School: Low-tier Midwest USMD
Clerkship grades: P/HP/H - 3H, 3 HP (including IM), 1P (my first rotation :/)
M4 grades: Honors in IM sub-i
Class rank: 3rd quartile (because of the pass)
Step 1: Pass
Step 2: 258
AOA: no
GHHS: yes
Research: 1 first-author basic science manuscript submitted to a high impact journal but won't be published before ERAS is due, 1 second-author abstract in a high impact journal from the same project, 1 second-author case series in a low impact journal, 2 second-author abstracts, 4 posters, 1 oral presentation
Extracurriculars: Founded a club, 1 national leadership position in a lesser-known org, 1 leadership position in an IM subspecialty club, admissions committee, 2 tutoring/mentorship positions, significant free clinic volunteering
Awards: volunteering awards x2
LORs: Dept chair letter, 1 strong letter from IM sub-i, 1 strong letter from M3 IM attending, 2 solid letters from 2 different M4 IM subspecialty electives
Red flags: none
Career goals: not sure, gastroenterology, maybe heme-onc

Geographic preferences: new england, middle atlantic, east north central

Worried my list is too top heavy and not sure how much the pass + low class rank is holding me back in the context of the rest of my app. Any programs I should consider adding/removing? Any help is appreciated, thank you!!

edit: not sure why the last 4 schools listed under Reach are there, I feel like those would be targets?