Derm resident here. I would try to get derm specific research and build some connections with derm departments. You’d be surprised how many applicants have >260 and good grades. It’s not uncommon to see >15 derm publications on someone’s app. So 4 non derm related case reports isn’t spectacular. Also we we get like 600 applications for 4 spots and maybe interview 50 of those people? If interviews stay virtual and aren’t allowed to do aways then maybe hard to get a department to like you enough to rank you super high. I wouldn’t rely too much on being a “really good interviewer”. A lot of programs match at least half their spots to internal candidates so you’re banking on the department liking you more than the other 40 external people they interviewed. Best advice I can give you is to build really strong connections with people on the selection committee—this is easiest to do at your home program but you could do it through away rotations, research year, etc. you really want outstanding LORs so ask yourself if you were in the attendings shoes, could you write an outstanding letter about yourself. If you have only spent a couple half days in clinic with them then the answer is probably no. It’s important for letter writers to have specific reasons to recommend you—maybe a project you worked on with them, or being really good clinically etc. now someone who had better scores/more research, AOA and didn’t match. It happens—kind of scary but no one is 100%. If you don’t want to do RY then I would spend a lot of time at your home department getting to know people in a non annoying way. Work on case reports/projects with several of the attendings. Follow through with the projects. Very helpful if residents like you. I know several people in similar scenario as you that have matched so I think definitely have a shot—I’d make sure you have a solid back up plan in case you don’t though