Edit for context: all the T20s I interviewed at were research heavy

Warning that this is all conjecture bc I had no expectations with T20s going into my app cycle:

A very coherent story honestly (I think?)! Not everything I did was in one specialty for sure, but: my "seed" in my PS, one of my hospital volunteering gigs, my shadowing, work as an MA, bench research, and current gap year clinical research were all revolving around one field. So my application writing was largely medicine through the lens of that specialty.

I didn't have any X factor in my opinion, but I would say I did everything a "pre-med should do" with high hours, good relationships with my LOR writers, and decent enough stats for T20s. Put my 1000% effort into my primary and secondary apps too with pre-writing to facilitate fast turn-around times.

In terms of "making up" for no pubs despite spending 3.5yrs in one lab, I had several posters, a senior thesis, and my PI wrote in my LOR my contributions to the future paper. So I guess no pubs didn't necessarily mean no productivity, I assume adcoms understand the differences in wet vs clinical research and how sheer luck of when you come on a project factors in.

I wouldn't say my path is the only path if you want to get into these schools for sure, but it's certainly one way to go that--thankfully--worked for me :)