I'm an R3 at a current "top 10" DR program (based on Doximity rankings, so take that with a big grain of salt). Having been on our selection committee the past 2 years I think I can give a little perspective. The short answer to your question is yes and no. Top 40 med school status gives an advantage in receiving an interview invitation, but ONLY if you're comparing applicants with identical Step 1 scores / applications. Once you've secured an interview spot the playing field is essentially equal. To clarify, let's say applicant A is from Harvard and applicant B is from a non top 40 med school; both applicant A and applicant B have 240+ Step 1 scores, and similar research/rec letters. When programs create their rank lists, ranking applicant A vs applicant B is entirely based on the interview itself and any in-person interactions you had with program faculty, staff, etc during the interview day. Nobody cares that you went to Harvard or Johns Hopkins if you suck as a person. To tell you the truth, a lot of "top tier" med school applicants end up burning themselves during the interview by incessantly mentioning they went to 'X' school.