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You never know, the place you ranked lower but actually want might not have ranked you to match and you would have ended up at your first rank anyway.

Transfers to a different program in the same discipline, while theoretically possible, are exceedingly rare, as noted above. Your post implies you are going for IM, which has the advantage of usually big programs, whereas smaller specialties have so few spots at each school it's usually a non-starter. You can try, but realistically your chances are in the single digits, so definitely proceed and do the best you can wherever you end up.

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Don't have information on transfers, but if it helps at all, I know many who take the ROL you made 10/10 times. Always collegial/supportive >> prestige. Prestige is a made-up concept. You can do fellowship anywhere you want with good reference letters and electives. Don't freak out before you match. Everything will work out fine.

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