I was recently accepted to do an away rotation at MGH. The problem is I already accepted a position at another institution because Harvard takes so long to get back to you. A realistic look at my application is that I am a solid mid tier urology applicant Step 1: 239, Step 2: 244 , AOA at a mostly unknown medical school. It's my understanding that many places similar to MGH have an extremely high Step 1 cutoff rate to be considered for an interview. If I were to accept the rotation and do well, would my Step 1 score hold me back from being considered for a spot? I would hate to waste an opportunity for a residency position at the other institution if I didn't have a chance at MGH. On the other hand, it would be an amazing experience no matter what the outcome. For you baseball fans, should I swing for fences or hit a solid double?
There's not an absolute correct answer here, but my advice is with the intense competitiveness of urology lately you should do what you can to maximize your chances of matching. To me, that means doing aways at places that are in your ballpark. Roughly half of matched applicants last year went to their home program or where they did an away, so you shouldn't squander an opportunity at a place you think you're not competitive.
I think what to do really depends on your situation. Do you have any other scheduled aways and what sort of program are those. Are you trying to stay in a particular region. To simply answer your question, I don't think your Step 1 score is going to hold you back if you do well on the rotation and genuinenly show interest in the program. It would be dramatically different if your step 1 was <225. If they have selected you to do an away, most places have some sort of selection criteria (some more than others). It more about making sure you would fit in with the program and show what you can do aside from what's listed on paper.Swing for the fences.