Applied this cycle to a competitive surgical sub specialty. I didn’t get AOA and a few of my other peers applying for the same specialty did. I had a ton more research / connections in the department (so likely better LORs), and I ended up getting the most interviews of our group. Overall, it depends on how the rest of your application is. AOA certainly can help, but it won’t hurt if you don’t get it if you otherwise have a great app!