I would recommend not taking Step II early. Your Step 1 score will qualify you for any residency in the country.

Steps at our program are used in 2 ways. First to screen, and yours would be above any screen. Second, after all interviews are done and rank discussions begin, if applicants are equal on interview points (most important) then boards do come in to play, which is not that common. Given the very high scores we get, in that scenario you would be average or below.

I would certainly not rule out rotations because you think you aren't competitive enough. Rotate wherever you want to go, not where you think you are going to get in. Nothing beats impressing attendings and residents on a Sub-I (or interview), and given that you are very unlikely to be screened out anywhere based on your paper application it would be a waste to settle.

Did you mean OSU, i.e. Ohio State, or OU, as in University of Oklahoma?

Especially if you are going to be limited for family/personal reasons from a geographic standpoint, you should try and rotate at as many programs as you can and apply to all of them, no matter what your odds. That would mean the Mount Carmel Program in addition to OSU and in DC you could likely expand your application net to northern VA (Where you might end up living anyway even if you match toa DC program). Also, if you can swing applying to Baltimore programs (Union Hospital etc) that would also be to your advantage. Programs that you don't apply to are essentially already a "No" as far as the possibility of an interview goes. Having family/personal reasons to limit your geographic search for a residency can be a handicap for you, because the pool of potential programs is already being prematurely truncated. You can make up for this by doing elective rotations at as many places as possible in your potential pool so you will be a known quantity at those centers when it comes to invitations for interviews. There are pluses and minuses to all programs but in terms of training, I think that most in your geographic areas provide exceptional resident education.

n light of your application, I wouldn't say that the publications would be a "big boost" per se, but definitely good to have. In this case, it is unlikely that either of the papers would be in print by the time you go to interview (or possibly even by the time you match depending on where you submit the publications) but you can still add to the research section of your application as "works in progress or submitted for publication or under pee review depending on that status"

That being said, relative to my response above and in light of your situation, strongly consider doing "second look visits" if you can swing it at the places you would like to match at most once you complete your first round of interviews.

The most critical component however will be your away rotations and excelling at them to impress programs and get great letters of rec.

Why are you concerned? You have a 250, which is good. You may want to consider taking Step 2 right after you finish your rotations so things are fresh and you have a chance to improve your board score before your application is submitted which would look good to schools. Just rack up as many clerkship Honors as possible and you should be fine. Do aways at the schools you mentioned and apply broadly.

Dude. Calm down, take a deep breath. You are excessively worrying about things that aren't worth worrying about. I know its stressful and competitive but you are overthinking this in my opinion. It really doesn't matter when you rotate with your home program, you will be on a learning curve no matter where you are at but if you are competitive for ortho you should be able to pick it up no problem, you will just need to read more since you didn't have a 3rd year rotation in ortho. All of the things that apply to your surgery clerkship will apply to your ortho sub-Is.

As far as which service to rotate on... most people say trauma because it is where you see the most and get a good feel for what I consider to be the nuts and bolts of ortho since you see a little bit of everything. However, if this guy wants you on his service and wants to write you a letter you should go for it. You have no idea how far a good letter of recommendation goes is this field, especially if he is a fairly well known guy. It seems like on the interview trail all the hand guys know each other, all the trauma guys etc. The letter may be the most important thing you get out of your sub-I with the exception of knowledge and finding out if ortho is right for you. No one knows what services you rotated onwhen you interview unless they ask you and even then it won't matter which ones you were on. I've been on trauma, hand, joints, sports and tumor during my 3 aways. It doesn't matter which service and doesn't change your application one bit. A letter on the other hand does.