Well, I now have had time to digest my USMLE step 1 score and I am pretty unhappy with it, 226/92. I really though I was going to much better since my qbank score (70%) and released item score (81% and shelf exam grade (average for all of them was 76)) were comparable to others who have scored in the 240 range. Now my question is with a score of 226/92 are my chances of matching in a NYC orthopaedic residency severely diminished and what can I now do to increase my chances. Any advice will be truly appreciated.