When you put it like that it sounds silly, but its the addition of the other things that I mentioned. Beyond that, having your name on a single publication or two publications is only a small fraction of the important elements to that early mentoring relationship. Its being taught the scientific method, how to write manuscripts, getting a couple middle authorships to fill out your CV and learn how the review process works. Anyone can say that this stuff is learnable on your own. And thats true. I had to learn a lot of it on my own. But if you can have someone who has been through it before guide you through it, then maybe this next generation can be better than we were at the same stage of our training. You could ask why its more likely to happen at a "prestigious" university. Well its because these programs end up having residents and fellows who went through those same processes (writing a bunch of papers, etc.) to get to that fellowship as opposed to less academic institutions.
Beyond that, it's developing the connection with residents and fellows in your field of interest who soon will be faculty in your field of interest who you can call upon when you're moving onto the next phase of training.
With respect to learning cutting edge techniques without understanding basic medicine. This is the school of thought that would suggest that every medical school is the same. An MD is an MD, and I agree that at most levels this is mostly true. There's no secret cure for cancer that is only taught at one school. The argument being that cutting edge stuff is not necessarily at the clinical level yet, so whether a person is trained in clinical medicine doesn't have a serious impact on their ability to be exposed to novel therapies that are still in their earliest phases of development. Moreover, its exceedingly hard to think of things that you've never even heard of before. I for one think that getting exposed to breadth of clinical scenarios and being at a center that is participating in trials (even as a student) is beneficial. When TAVR was new, i was a student at a participating center. And people were constantly talking about it around the medical center. Being part of that milieu was beneficial.
If your only concern is doing okay on step 1, passing your classes, and getting the degree, then I absolutely agree that the $200,000 is not worth it.
