Advice needed. How can I as an incoming M1 at a rural Midwest school match EM at Mass General?

Esp now that STEP 1 is pass fail, I refuse to believe the battle is already lost based on pedigree. I want high level academic programs for 2 reasons 1. the fellowship I am interested in is only offered by the top hospitals in the country. 2. the upcoming state of EM means being a normal ER doc is out of the question. So how can I go from unranked to a top 3 hospital?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Residency Program Specific Discussions Source Type: forums