I guess I'm bored because I've just read this whole post, but I sometimes wonder when I see a OP similar to this if the person is a troll. I don't mean to be degrading but for those people who are really gunning for these ultra-competitive residencies and then follow that with "which should I choose DO or Carribean," are you kidding? If these are your two options it means that you probably didn't study hard enough, or you don't test very well, or maybe you're not quite as smart as some of your colleagues; but now all of a sudden you're going to come in a be the absolute cream of the crop of all US MDs, DOs and USFMDs. So, I find myself wondering what changed in your life that now you're going to excel in a way you have not shown you're capable of? Any way, good luck to all of us, it's going to be hard and hopefully fun.