I think it depends on the programs that you apply to as what they want out of there residents. A lot of the DO Dermatology programs place more weight on personality and ability to work with others. COMLEX scores are important with Step 1 being superior to Step 2. I would say that if you are interested in DO Derm, make up for your score by doing volunteer and research hours. Publish a paper or two and do your best on rotations. If you want more info contact me.
An FM program is an option but not required. Some programs look down on these integrated residencies because they are entirely different in the way a dermatology patient is diagnosed and managed.
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