While AOA will help you (NO doubt about it.) Students often overlook the politics/connections that are required to get into a competitive specialty at a competitive program. This means: doing away rotations, getting to know the program director, it doesn't hurt if your program director knows theirs (and your's likes you of course). Think about it. You are a program director and you have 2 spots for derm. Would you rather take the unknown person with the 250 Step1, AOA, and risk that he/she may be an a-hole or worse psychotic OR would you rather have the 235 step1, non-AOA, who worked in your research lab, and came to your kids bat mitzvah (okay, I'm exaggerating, but you get the point.) CONNECTIONS MATTER from now until the end of your career. BE NICE TO EVERYONE...the lady that sits behind the desk in the office may be screwing the program director...now that you were rude to her...well your correspondence with the PD just got thrown in the trash!