You have to know yourself. I agree with the idea that "malignancy" is dependent on who's defining the term - especially when it comes to dealing with a bunch of pediatricians, who tend to be nice people overall.
The best advice is to make sure you apply to a wide variety of programs - from the highly prestigious to the understated gems, perhaps even including community programs.
Once you have this variety, listen to what the residents say. For example, when I was going through this process, I had one program where the residents talked over and over and over about how important it was to have a program where you had time to read. It was a smaller program that had a competing free standing children's hospital in town. They said things like "you're not going to see everything, so you need to have to time to read". Compare that to the program I ended up at. There, I had one resident who said "this is a program where you work, you see things because you're at the hospital" and another say, "if anything happens in the entire state, it comes here and shows up in our ER, so you just have to pay attention".
Those are extremes, but they demonstrate the point that depending on the type of learner you are, one program would be significantly better than the other. If you don't know yourself, you could certainly make a poor choice.
