My husband and I are both MS4s and are planning to couples match. While he was set on peds, he is now re-visiting the idea of derm in which case, we would definitely need to take at least 1 year off to bolster his app. Because we're new to the idea of derm, I had some scattered questions. My biggest concern like most people's is not matching even after taking 1 year off. This is particularly complicated since we'd be couples matching in peds and derm. Does anyone who's been down the derm + X couples matching have advice / lessons learned? Secondly, I know some people choose to complete a peds / med residency prior to derm residency which might end up being an alternative. Is this case, do people just do derm research during those residency years so they'll be competitive after residency? Also, does this route in actuality really handicap someone's changes at a reasonable derm program? Finally, if you're spending your peds residency, for example, trying to improve your app for applying to a derm residency afterwards, does that pretty much destroy your chances at other fellowships down the road if you still don't get into derm? Also, besides a place that has available derm research, are there other things to consider about a pediatrics residency program that would improve or hurt your chances at a derm program afterwards? Finally, considering the competitiveness of derm and number of people who go unmatched, what do people typically do for a backup plan? For example, is it pretty common to take a year off if you don't get in then re-apply to derm and a second program (e.g. med or peds)? Finally finally, I've heard at least a "240" is a safe-ish step I score. Is there a minimum number of honors in required clerkships that a reasonable applicant should really try reach to be "safe-ish?" Sorry for the long post, we went through all the algorithms in case he doesn't match next year and there doesn't seem to be anything that makes sense. Thanks in advance!