One question I have is this (seeming, in my mind) contradiction:
1. It is said that the people in different schools really aren't that different, even when there is a big difference in rankings. Though I do not attend multiple schools, I have enough friends elsewhere to think that this seems right. There are very intelligent people spread out in the many medical schools. Thus, it seems to follow that people in one school do not do that much better on the boards or get better recommendations than students at another school.
Yet:
2. There is an unquestionable difference between the places that people match from different schools. While certainly the specialties people choose are based on what they want to do with their lives, and locations and programs of course are also due to preference in many cases, it is still unreasonable to compare the match list of Harvard to that of a much lower ranked school and say that they are equivalent in the competitiveness of their applicants. It cannot be that year after year, Harvard students disproportionately "prefer" to do their residencies at the programs that are hardest to get into. Again, people can match anywhere from anywhere, but the numbers that match at top programs are not evenly distributed. Looking at who gets their "first choice" is misleading as well because I have some friends who matched at one of their top 2 or 3 choices, but this was after they were denied interviews at their 10 top programs, so these choices were really much lower on the list.
So what I am saying (and I am sure someone will pick this apart, which is what I am hoping because I don't understand) is how can the people at different schools - let's say Harvard and low-ranked school X - be fairly comparable in terms of board scores, general fabulousness, etc. - yet the graduates of Harvard seem to be able to snag spots at some of the most competitive programs year after year to a higher degree than students from other schools. It seems like the school name must matter a great deal. And I get the idea that some programs are more malignant than others and thus the big name might not be as desirable as a layperson might think, but it does not follow that all these highly ranked programs in certain specialties (like places that are 1, 2, 3 in the US News hospital rankings for certain specialties) are disproportionately more malignant than those lesser known programs. One would imagine malignancy is fairly spread out, like anything else is, so you should be able to look at program prestige with a broad brush and know what is more competitive to get into.