As a student with a 4.0 GPA, Step 1 >265, Step 2 CK >270, Step 2 CS Pass, president of 2 interest clubs, founder of a community service organization, president of another community service organization, 10+ poster presentations, 3 first author publications (1 original article, 2 case reports), 3 other original articles submitted to journals and currently under review, that did not receive AOA I can tell you that every school has different criteria for AOA. At my school grades only get you eligible for AOA at which point you need to submit an application describing your extracurriculars and a general statement. Then a board of ~10 AOA med students, faculty and community physicians "rate" you based not on academics but on extracurricular activities. The sum of the ratings ends up determining whether you get in or not.

Long story short. It's basically a popularity contest riddled with conflicts of interest here at an MD US school. Students applying to the same specialty as me ultimately had the choice to influence my nomination for AOA which obviously wasn't in their best interest.

I hope programs can see through this when they look at my application.