Unfortunately it's going to be very hard to match into IM or peds after a fail on Step 1, a low passing score, and also being a US IMG from the Caribbean. Those are a couple of red flags.
Peds is a smaller community and you have to show some real interest in kids from what I understand. So if you want it, you should start really showing interest now and also if you crush Step 2. Get some strong LOR's from pediatricians when you do your clinical rotations in the US.
IM you might have a chance at the lower tier programs if you crush Step 2 and also get strong LOR's from your clinical rotations in the US. The mean Step 2 for matched US IMG applicants is 234 (Charting Outcomes for IMG's 2016), you're going to have to be much higher than 234 on Step 2 as you have a much lower Step 1. I'd aim for 245 or even 250+. Show them you can really do well and leave no room for doubt. Research helps.
I'd also recommend applying to FM as a backup if you have an interest in FM.[/QUOTE
Thank you!!! awesome advice.