I will want every international medical graduate to understand that the process is extremely competitive
They are competing against he best in other parts of the world and they have a lot of factors against them (e.g. old Year of graduation, visa status, attending a medical school outside the USA etc).
The only factor they can change is the score they get.
To further buttress this point, I heard some programs receive as many as 5,500 applications for just 22 slots and more than 1,500 of the applicants score more than 240. This explains the need to get a very good score.