“So…what’s the deal…I know he wants a competitive residency…so if he doesnt get a top score, does that mean that goal is dashed?”
Although Step 1 is an important factor in considering whether to offer interview, it’s not the only one. All of his third year, perhaps early fourth year as well (e.g clinical performances, LORs (especially if from MDs in specialty), Step 2, MSPE, etc) also will play important roles in deciding whether S gets IIs to his desired specialty. The point is there is still much in S’s control which hopefully will go along with his soon to be learned strong Step 1 score.