I would say Columbia students have access to significant levels of hands on experience, even as a pre-clinical student (lots of chances to learn basic skills, even catch babies). One major advantage in our clinical year is that we are one of the few schools that rotates you through the surgical subspecialties. They aren't graded, but there are certain skills that you are expected to learn that are useful such as IV placement in anesthesia, catheter placement and rectal exams in urology, and the specific niche physical exams of optho, ent, neurosurg, and ortho. I think there is also a good range of independence as well. Some parts of a given rotation are heavily precepted by residents and attendings, where as at other points you are working with only minimal attending oversight unless you ask for it. Your comfort level, interest, and skill level also play a role in how much independence you have. The high volume of patients that we see tends to also help with gaining experience and doing procedures (residents get first dibs on procedures, but since we have so many patients there is room for students to learn complex things like lumbar punctures, paracentesis, etc).