Most students try to get a clinical rotation in the USA. This helps them develop contacts and references required for USMLE. John Hopkins is a very expensive university and not everyone can afford education there. Many rich students faced issues getting into a residency program.
2 things determine your chances of getting a residency spot at John Hopkins
Having a good local personal reference is cherry on the top. Most of my acquaintances managed to get into residency without any rotation by just clearing the exam on the first attempt.