Here's my experience with both. I am just a first-year studet, but I do have a little input.
Before I came to med school, I worked at the nation's busiest Level II trauma center (by what standards this was measured, I do not know, but it is a busy ED with a good amount of trauma, indigent care, etc.). Not a big teaching hospital, although we did have residents from the military spending a month at a time with us for trauma (from both San Antonio and Ft. Hood). We also had UTMB students doing an optional rotation track with us for, I think, a year.
What we lacked for Level I was full-time, in-house neurosurgery, and probably a few teaching programs. But the big thing was the neuro.
This place was a pretty good experience for the students. Lots of autonomy, no residents to crowd you, and I don't think I ever saw more than one student at a time on the EM service, in four years of volunteering and employment.
We got something like 80,000+ patient visits/year, and I think we had 6-7 trauma bays, with 3-4 of them being bigger than the others.
Now I am a first-year student at GA-PCOM, in a suburb of Atlanta. I spend one night a week volunteering at Grady Memorial Hospital, which is one of the nation's busiest Level I trauma centers. It is a core rotation site for Emory students, and I think Morehouse too. Additionally, there are about five undergrad schools within a stone's throw from this hospital, and there are a million pre-med volunteers from them, running all over the place. Most of them don't do anything, or are too nervous to get involved though.
At this place, there are residents and interns from every service you can imagine down there, at any given time. There are medical students doing core rotations, and visiting students doing electives. Probably half the attendings have an MPH or a PhD, and they are talking about something academic, or health-care related all the time. I sometimes try to stay within earshot of these conversations, because they can be pretty interesting.
Between the docs, interns, students, nurses, ancillary staff, volunteers, and shadowers, there are a million people in the department all the time. There are also some undergrads who wear blue coats and just seem to stand around. I don't have a ****ing clue what they are supposed to be doing, if anything. They aren't shadowing. I don't see them writing anything, or talking to the docs or nurses.
Grady is the epitome of the "broke, indigent care hospital." They have ****ty equipment, and I think 2 EKG machines that look like something off of the Flintstones. You hook up the 12-lead, and expect a bird to pop out, dip his beak in some ink, and start doing the tracing.
At my other hospital back home, the patient population was similar, and although it isn't a big money maker, there is plenty of very nice equipment, a shiny 64-slice CT scanner, less financial restrictions on medication, ordering tests, etc.
But at Grady, these guys LOVE to teach. They love students. They love what they do. I have no doubt that they are making a lot less money than they could make at any number of other places. Now that some of them know I'm a medical student, they will take time out to show me stuff. They are always asking if I have any questions. I couldn't ask for a better position as a volunteer.
Back at the ED back home, there wasn't much academic talk. If anyone asked me if I had any questions, it was usually a nurse or a resident. Some of the attendings are still my good friends (I'm 31, so I wasn't really some pre-med kid to them), and we'd go out drinking together or ride bikes together, but they weren't really big on the academic stuff.
At Grady, even before they knew I was a medical student, they'd be happy to answer any questions I'd have. I can't say enough good things about their faculty.
While my Level II that I worked at has some advantages, and in terms of patient volume, would squash a lot of Level I's, I think these Level I's are typically geared towards academics and education.
But the rumor is that my old hospital may be coming under the umbrella of UT-Southwestern soon, and they're planning on making the move to Level I, establishing more training, and maybe even a full medical school campus there. Austin definitely has the infrastructure to support it. There are several big hospitals very nearby each other. But the faculty at this place are far different from what I see at Grady.
Just my $0.02
