Haha I never imagined so many people would have the random problem with deciding between the exact same schools. There's already been a bit of discussion about this in
the corresponding thread in the school-specifics forum (this thread will probably be merged with that one soon).
I just wish San Antonio would give us a lot more detailed information about the new curriculum. What we've been told is pretty generalized and doesn't really tell us what things will be like. But the faculty are great, so even though there will undoubtedly be some road-bumps for the first class or two that goes through it, I'm sure it will be fine. I honestly think that my learning personality is better suited for Tech's block-style curriculum, though.
Over the past few months I've read and researched everything I can get my hands on about both schools. In order to help organize my own thoughts and feelings about this decision I have written a fairly detailed description of both schools and their respective locations. It is the result of months of perusing school websites, published statistics, forums, and speaking with people I know who may have some insight.
Remember that these thoughts apply to me and my family (I'm married with a kid) specifically, so you might have different considerations than I do. I wrote this for myself but also for my parents in San Antonio, since I felt that they deserved to be privy to our thought process since we are leaning towards Tech, which means taking their grandson 8 hours away. Fortunately distances aren't what they used to be. For example, Southwest often has flights between Lubbock and SA for under $100 round-trip. Even though I'm copy/pasting from my personal analysis, I think a lot of this information that I've collected may also be useful to you.
UTHSCSA
Curriculum
Traditionally San Antonio has used a very conservative curriculum that consisted of basically all-day lectures every day during the preclinical years (MS1/MS2). They have been successful with this approach for decades, although students sometimes complained of "overkill" in the basic sciences on stuff that isn't very high-yield for step 1 of the USMLE. For several years now they have been working on a new curriculum that is supposed to offer a more balanced approach. Mornings will still be lectures but the afternoons will be reserved for a variety of other learning tools, such as group-based learning, learning patient examination skills on both standardized and real patients, special topics seminars, web-based learning, and self-directed learning. The curriculum will be organized into organ systems modules. For example, during the respiratory module we will study the anatomy, physiology, histology, biochemistry, etc. of the respiratory system. This coordination should help students from feeling like their concurrent courses are "all over the place" with seemingly little continuity of theme. MS2 will end in mid-March, giving students a full 8 weeks, including spring break, to study and take step 1. MS3 clerkships begin in early June (about a month earlier than most schools). There is supposedly going to be some restructuring of MS3/MS4, but no specifics have been given by the Office of Curriculum as of yet. So while there will undoubtedly be a lot of advantages to the new curriculum, there will also naturally be several wrinkles to be ironed out with its inaugural class.
Facilities and student body
The South Texas Medical Center is currently undergoing several major (needed) expansions. There will be a lot of nice new wings and buildings to use during my clinical years (MS3/MS4). The medical school is not attached to an undergraduate university so student facilities (like a lounge, workout facilities, and recreation areas) are somewhat limited compared to Tech. The medical center is huge and offers a very wide range of pathology to learn from during clinical years. Except for Santa Rosas Childrens, which is downtown, just about everything is within walking distance of the medical school. UTHSCSA has one of the largest medical student bodies in the nation with close to 250 students in each class. The medical school also sponsors many large residency programs. These are great aspects that have a lot of advantages, but one of the disadvantages to any large medical school in a crowded medical center is that medical students are always at the bottom of the totem pole. Residents will end up doing many of the basic procedures and workups since their educational needs trump medical students' needs. It's not a really big deal in the end, but I've heard a few students say that they wish their clinical years were a little more hands-on. They are still hands-on enough, especially if you are proactive about getting experience, but they just wished it was a little easier to get their hands dirty. This is not unique to UTHSCSA. Virtually any medical school in a very large city faces the same challenge.
Cost
San Antonio's tuition this year is $15,813. The estimated total cost of attendance is $40,615. The reported average indebtedness of graduates is $132,007.
Reputation and research
UTHSCSA, like all the Texas schools, is very well regarded nation-wide. Its USMLE pass rates, residency match rates, and student satisfaction scores are all above 95%. Its most recent average step 1 score was 225 (185 was passing, 221 is national mean with standard deviation of 23). Resident match lists from recent years show a balance of students entering primary care fields as well as more competitive specialties (53% to primary care residencies). UTHSCSA has a robust research presence, comparable to UT-Houston or UT-Galveston. But UT-Southwestern is Texas' flagship campus for research and their NIH funding far exceeds all of these schools. San Antonio purposefully maintains a balanced mission of having a strong research presence but not so much that it overshadows their equal emphasis on the need for more primary care physicians. Still, San Antonio's research opportunities are more than sufficient for my needs and career goals.
Location and other intangibles
This is naturally the most subjective and difficult aspect to assess. San Antonio's obvious advantage is proximity to family and friends. This is a major consideration for us, especially since we have a child and are likely to have another within the next four years. There will always be helping hands when we need them. A social support system is already in place. San Antonio, compared to Lubbock, is quite large and travel times will be more significant. But we are familiar with the geography of SA, which would be one less learning curve for us to endure.
TTUHSC-Lubbock
Curriculum
Texas Tech implemented a new curriculum several years ago that has been highly successful. The faculty at Tech are notorious for being very enthusiastic about teaching and bending over backwards to help students get competitive summer internships, etc. Their 2009 average step 1 score was 231 and it has been increasing every year since then. The curriculum utilizes a block schedule where students only take one class at a time, allowing time to become deeply engaged with each course, mastering it, and moving on to another course. The order of courses is meaningful as they do build on each other, but I will never be juggling half-a-dozen classes at once and having to decide which to study more for and which to neglect when things get busy (Tech's Curriculum Overview). Tech is well-known for its world-class medical educators. Several of the textbooks used by medical students everywhere are authored or co-authored by active Tech faculty. Tech uses half-days of instruction and limits contact-hours to 22 per week. The afternoons are reserved for students to use at their discretion, with the exception of early clinical experience activities which take place during selected afternoons. For the most part I'd be in class from 8 AM to noon and then be free, allowing me to customize my study schedule according to my personal circumstances. 4th year only has six weeks of required rotations (four week neurology rotation and two week geriatrics rotation). Then there are a plethora of electives from which to choose. Many schools do not give you anywhere close to this much elective time. Elective time is great because it means I can tailor my education to my residency goals (which should be clear by then). If I choose something competitive like neurosurgery I could take a neurosurgery elective rotation and a surgical-ICU sub-internship and anything else that is not "standard" for most students but would go a long way in making me more competitive. Also Tech requires a web-based medical Spanish course, which will be tremendously useful for me, but I doubt I'd force myself to take it if it were only an elective. By the end of MS2 I have to be able to examine a patient and take a history in Spanish.
Facilities and student body
Tech's facilities are the best of any school I've interviewed at. They have a new academic classroom building with state-of-the art technology integrated into it. They have a large student lounge only for HSC students with workout area/lockers/shower, TV room, pool/foosball, and lots study areas and couches for napping. This is open 24/7 (badge access) and is often used by students on overnight call during clinical years since it is connected to the hospital but offers a quiet place to read or sleep when there is nothing else to do. Being connected to Texas Tech means I have access to their recreational facilities, which are extensive and impressive. The University Medical Center Hospital is the only trauma 1 center in all of west Texas and eastern New Mexico. It serves 108 counties (area larger than most states). So while Lubbock itself is only 1/10th the size of San Antonio (~300,000), the medical center is still very busy and offers plenty of pathology. All the major stuff gets flown into Lubbock. Tech has some very reputable residency programs, although they are not nearly as large as those in big cities. One of the big selling points that the students told us is that the clinical experience is unparalleled to anywhere else in Texas. One resident who did medical school at Tech made it a point to tell me that "The faculty are more willing to allow you to perform procedures at Tech if you ask than other institutions. It is very teaching oriented. You won't take a back-seat like at crowded medical centers." The student body at Tech is about half the size of San Antonio's (~140 students per class). After MS2 the class is divided into thirds and one group stays in Lubbock while the others go to either the Permian Basin or Odessa. You get to rank where you'd prefer to be assigned, and if you have a family/children/own a home you're almost guaranteed your top choice, although there are real perks to going to the non-Lubbock campuses if you choose to do so. The students are notorious for being very laid-back and friendly. The average age is a little older and a higher percentage of students are married or come from non-traditional backgrounds.
Cost
Tuition: $14,471; Total estimated cost: $41,358; Average indebtedness: $124,466.
Reputation and Research
Texas Tech has some great research opportunities for students. In the spring of MS1 you get bombarded with emails from faculty looking for students to do a summer research program with them. Since it is a somewhat smaller school compared to the big city schools it naturally has fewer NIH dollars, but fewer residents and smaller class sizes means anyone who is interested can find something really meaningful. A large number of students actually get papers published, which is a huge advantage when applying to highly competitive residencies. Their match lists are equally as impressive as San Antonio's. Like UTHSCSA, 50-55% of their graduates go into a primary care field (family medicine, internal Medicine, OBGYN, pediatrics, psychiatry). When it comes to national reputation and ability to land top residency spots you can't go wrong with any of the Texas schools. Given Texas' major problems with physician shortages, the state legislature and Board of Education try to ensure that all of their medical schools are top-notch.
Location and other intangibles
When I first began this process Texas Tech was one of those schools that I knew very little about. I assumed it would merely be a "last-resort" type of school where I'd be happy going but only if nobody else accepted me. My interview really opened my eyes to both Lubbock and the school, which was pretty surprising. Since then I've researched everything about it, and the more I learn the more I like it. It is a very family friendly city. Traffic does not exist, crime is very low, the public schools are good, housing is super cheap, and there are a large number of family-oriented things to do. The infrastructure is such that I can easily bike to school from wherever we live, something that's just not possible or safe in San Antonio. We could remain a one-car family in Lubbock, whereas we'd have to get a second vehicle at most other places. None of these factors alone is a really compelling reason to choose Lubbock over San Antonio, especially since San Antonio is where family is at. But when we look at the big picture we just feel inexplicably "drawn" to this school and location. We feel we'd be a better "fit" here and I enjoyed the environment here somewhat better. With making a decision this big you don't want to discount those feelings, since more often than not your gut-instinct will be right about such things.
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I tried to make these descriptions as fact-based as possible, but it's hard because so much of this stuff is anecdotal and subjective to begin with. I still think that overall this is a pretty decent big-picture assessment of both schools.