**** med school "name" bias

[def1]

I hope this somehow doesn't find it way to come back and bite me in the ass but I need to vent because I am tired of the bull****. I have met with several program directors while on my aways and at my own home program who have told me that the name, or lack of a name, of my program will likely hurt me in the match. I scored ~>2 SD on both Step 1 and Step 2 putting me in the >90th percentile, I have received AOA after honoring every single rotation in medical school, I have great LORs and one from a highly regarded institution where I did an away, and yet every time I talk to a PD I can see their excitement over my application fade when it comes to talking about my home program.

What is the point of having standardized testing for Step 1 and Step 2 if you still rely heavily on the "name" of the program for who you pick to be part of your residency.

I am not whining here because I think I will go unmatched or anything. I think my app is pretty strong and I will likely match and match at a decent program. It just pisses me off that many programs will have already written off my application based on the name of my school alone.

I know this will probably never change and it doesn't do any good to worry about it. I can't change where I went to school but its just sad that residency programs still base decisions on something so unimportant. And for one thing, I am proud of my small unknown program. Honestly, after doing aways at two "top 10" programs, the level of teaching and education is pretty similar. I feel like I have been trained very well and it just sucks that most programs will not even give me the chance because they want to boast to each other who has the biggest dick based on how many ivy league students they got.

This was basically just a big long wall of text I needed to write because I feel like **** all today. Because busting my ass for 4 years doesn't mean as much because I wasn't lucky enough to go to a big name for medical school.

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[I'm No Superman]

Hey, at least its not as bad as Law school "name" bias.

 

[tvb]

You go to Ross or some **** dont you?

 

[tvb]

Oh nevermind you go to Texas tech - El Paso. That was hard to find though so I'm sure you'll never get found out.

 

[gregoryhouse]

Oh nevermind you go to Texas tech - El Paso. That was hard to find though so I'm sure you'll never get found out.

Except for the fact u now told everyone what school he is affiliated with lol.

 

[KinesiologyNerd]

I scored ~>2 SD on both Step 1 and Step 2 putting me in the >90th percentile, I have received AOA after honoring every single rotation in medical school, I have great LORs and one from a highly regarded institution where I did an away

If you listen closely you'll hear the sound of nobody crying for you.

Seriously. You've proved your mettle. You'll match somewhere nice. You'll become the kind of doctor you want to be. Worry about the things you can control like maybe applying to less stuffy programs or a more laid back specialty. Nobody knows where my med school is and nobody cares. It's wonderful!

 

[tvb]

 

[MilkIsGood]

welcome to life, where name brand and connections matter.

 

[piii]

This just in, life is unfair.

 

[eteshoe]

Hey, at least its not as bad as Law school "name" bias.

T14 or GTFO

 

[sliceofbread136]

Nobody cares...

 

[chipwhitley]

I hope this somehow doesn't find it way to come back and bite me in the ass but I need to vent because I am tired of the bull****. I have met with several program directors while on my aways and at my own home program who have told me that the name, or lack of a name, of my program will likely hurt me in the match. I scored ~>2 SD on both Step 1 and Step 2 putting me in the >90th percentile, I have received AOA after honoring every single rotation in medical school, I have great LORs and one from a highly regarded institution where I did an away, and yet every time I talk to a PD I can see their excitement over my application fade when it comes to talking about my home program.

What is the point of having standardized testing for Step 1 and Step 2 if you still rely heavily on the "name" of the program for who you pick to be part of your residency.

I am not whining here because I think I will go unmatched or anything. I think my app is pretty strong and I will likely match and match at a decent program. It just pisses me off that many programs will have already written off my application based on the name of my school alone.

I know this will probably never change and it doesn't do any good to worry about it. I can't change where I went to school but its just sad that residency programs still base decisions on something so unimportant. And for one thing, I am proud of my small unknown program. Honestly, after doing aways at two "top 10" programs, the level of teaching and education is pretty similar. I feel like I have been trained very well and it just sucks that most programs will not even give me the chance because they want to boast to each other who has the biggest dick based on how many ivy league students they got.

This was basically just a big long wall of text I needed to write because I feel like **** all today. Because busting my ass for 4 years doesn't mean as much because I wasn't lucky enough to go to a big name for medical school.

If you don't care about names, and you think the training is the same everywhere, why do you care about being at a top program for residency? You said you're confident you'll match somewhere so what's the big deal?

 

[Foot Fetish]

There are a few people in my program (mid-tier) who got into top 10 med schools but declined to go due to location and other factors. I personally declined an interview from a top 10 because it was too far from home. I was recently shocked to learn that the valedictorian of my high school, who had a perfect score on the SAT and went to Harvard undergrad, just matriculated at a mid-tier medical school. I have no doubt in my mind that this guy is equal to or smarter than anyone at Harvard Med right now, but he chose to go to a much lower ranked school for personal reasons. He will almost certainly be at the top of his class there. So, I think it's pretty unreasonable to judge a student based on which MD program they attended.

 

[SpacemanSpifff]

So, I think it's pretty unreasonable to judge a student based on which MD program they attended.

Not entirely. In general well-known programs have been around longer, have put out more graduates, and have established their quality as an institution. An "outstanding/top 10%/etc." endorsement on a dean's letter means more coming from a school that has graduated >5,000 students than a school that's only been around for five years. PD's are taking a calculated risk on each applicant, and having a larger sample size can mitigate that risk.

@chipwhitley is on point, OP. You've apparently become privy to the fact that even relatively unknown programs can provide good training, so why focus on the ivy's? Perhaps these PDs you've talked with are simply unfamiliar with your home program. It's clear you're a qualified applicant for whatever specialty you're applying in. Trust in your hard work, you'll be fine.

 

[tellmemore2020]

If the training there is equal, why are you so eager to go to those brand name programs? Oh right..

 

[Revolution9]

Reading SDN for a couple of years now I think I understand why a PD might be very interested in the "brand name" of the medical schools people are applying from... because we seem to be very interested in the "brand name" of the program. Go through posts talking about tiers of programs in different specialties and you'll see SDNers talking about the schools the residents went to in terms of number of DO's or IMGs or Ivy's or whatever. I think the PDs care, because they know we care. I think that if we collectively stopped caring, they would too. Just keep that in mind when judging a program because it has a large number of DO's or IMGs. I think we're part of the problem.

 

[solitarius]

I was recently shocked to learn that the valedictorian of my high school, who had a perfect score on the SAT and went to Harvard undergrad, just matriculated at a mid-tier medical school. I have no doubt in my mind that this guy is equal to or smarter than anyone at Harvard Med right now

Very unlikely.

Little fish swims in big nasty pond.

Just because Harvard swings near 1.000 in placing premeds, doesn't mean they all go to top schools.

 

[Foot Fetish]

Just because Harvard swings near 1.000 in placing premeds, doesn't mean they all go to top schools.

I don't follow your point; What's unlikely: that a Harvard alum would wind up in a mid to low ranked MD program or that my friend would be smarter than most people at Harvard Med? The guy I'm talking about is quite literally a genius (IQ>150). He scored in the 40's on his MCAT, had multiple publications in serious bench research, etc. There was nothing stopping him from attending Harvard Med or Hopkins. He CHOSE to go to a mid-ranked school. People like him aren't exactly rare. Try as they might, the top 10 medical schools don't have a monopoly on the brightest applicants.

 

[solitarius]

I don't follow your point; What's unlikely: that a Harvard alum would wind up in a mid to low ranked MD program or that my friend would be smarter than most people at Harvard Med? The guy I'm talking about is quite literally a genius (IQ>150). He scored in the 40's on his MCAT, had multiple publications in serious bench research, etc. There was nothing stopping him from attending Harvard Med or Hopkins. He CHOSE to go to a mid-ranked school. People like him aren't exactly rare. Try as they might, the top 10 medical schools don't have a monopoly on the brightest applicants.

It's quite likely that Harvard grads can end up at mid-tiers. It's often the case their numbers aren't competitive enough for top schools, yet it's possibly likely that some have personal or financial reasons for going mid-tier.

It's unlikely that your friend is smarter than other HMS students who likely have a similar or better app.

 

[Med Ed]

I hope this somehow doesn't find it way to come back and bite me in the ass but I need to vent because I am tired of the bull****. I have met with several program directors while on my aways and at my own home program who have told me that the name, or lack of a name, of my program will likely hurt me in the match. I scored ~>2 SD on both Step 1 and Step 2 putting me in the >90th percentile, I have received AOA after honoring every single rotation in medical school, I have great LORs and one from a highly regarded institution where I did an away, and yet every time I talk to a PD I can see their excitement over my application fade when it comes to talking about my home program.

Have you considered that you are reading too much into this? I'm fairly sensitive to giving people false hope when it comes to admissions.

I have randomly selected orthopedic surgery at UPenn as a program that is likely pretty damned hard to match into. Let's see where some of their current residents went to medical school:

PGY-1: Drexel x 2, NYMC
PGY-2: UConn, Missouri-Kansas, NYMC, UMass
PGY-3: UConn, Wisconsin
PGY-4: UCF, Drexel, SUNY Stony Brook, Rutgers
PGY-5: SLU, Rutgers

The place still has a lot of representation from top tier schools, but they clearly take high performers from a variety of institutions.

tl;dr Come back and complain about this after match day.

 

[solitarius]

^ To be fair though, some programs are notoriously nepotistic - eg Stanford Derm, MSK, MGH IM, etc.

 

[psychhopefull2016]

You know you can't win everything right. You go

^ To be fair though, some programs are notoriously nepotistic - eg Stanford Derm, MSK, MGH IM, etc.

nepotism isn't exactly the same as name recognition. I feel like with nepotism the program has worked with the applicant on rotations and they like to take their own. With pure name recognition it's "oh Jim went to Harvard, he must be good, accept him!"

 

[Foot Fetish]

Have you considered that you are reading too much into this? I'm fairly sensitive to giving people false hope when it comes to admissions.

I have randomly selected orthopedic surgery at UPenn as a program that is likely pretty damned hard to match into. Let's see where some of their current residents went to medical school:

PGY-1: Drexel x 2, NYMC
PGY-2: UConn, Missouri-Kansas, NYMC, UMass
PGY-3: UConn, Wisconsin
PGY-4: UCF, Drexel, SUNY Stony Brook, Rutgers
PGY-5: SLU, Rutgers

The place still has a lot of representation from top tier schools, but they clearly take high performers from a variety of institutions.

tl;dr Come back and complain about this after match day.

This is well and true, but the tragic disparity is probably in the unseen details...I bet those kids from Drexel had gigantic USMLE Step 1 scores, like certainly 260+...In contrast, someone from Harvard Med could have probably gotten in with 240's...maybe even 230's. What kind of message does this send? Work hard earlier in your career so you can slack off later. This is terrible imho because we should be valuing the later work proportionately more since it is forming the foundation of your medical knowledge.

 

[Med Ed]

...I bet those kids from Drexel had gigantic USMLE Step 1 scores, like certainly 260+...In contrast, someone from Harvard Med could have probably gotten in with 240's...maybe even 230's.

This is pure speculation. The only conclusion that can be reached from the information I shared is that individuals from "lower tier" schools are not shut out of UPenn ortho.

 

[Med Ed]

^ To be fair though, some programs are notoriously nepotistic - eg Stanford Derm, MSK, MGH IM, etc.

You may want to look up the word "nepotism."

 

[solitarius]

I would define name recognition == other institutions take prestigious medical school applicant consistently.

First degree Nepotism == taking an ordinate share of your own school's graduates year in, year out.

Second degree Nepotism == taking an ordinate share of another school's grads every year.

As for taking the lower stars kid from JHU, some see it as name recognition and others see it as nepotism.

 

[Mad Jack]

^ To be fair though, some programs are notoriously nepotistic - eg Stanford Derm, MSK, MGH IM, etc.

A small number of programs with a small number of slots are slightly discriminating against me, waaaaaah

 

[Med Ed]

I would define name recognition == other institutions take prestigious medical school applicant consistently.

First degree Nepotism == taking an ordinate share of your own school's graduates year in, year out.

Second degree Nepotism == taking an ordinate share of another school's grads every year.

As for taking the lower stars kid from JHU, some see it as name recognition and others see it as nepotism.

Nepotism: the unfair practice by a powerful person of giving jobs and other favors to relatives (emphasis added)

 

[solitarius]

A small number of programs with a small number of slots are slightly discriminating against me, waaaaaah

Being DO, you're sure to face discrimination beyond a few slot programs. Good to see you're taking it well ahead of next year's match.

 

[Mad Jack]

Being DO, you're sure to face discrimination beyond a few slot programs. Good to see you're taking it well ahead of next year's match.

I'm pretty whatever about it. I knew what I was dealing with going in, and I know which programs out there are diamonds in the rough that like DOs and have good match rate or in-house opportunities for the fellowships I am interested in. I went in knowing the weaknesses of the brand- to complain about them would be kind of ridiculous at this point. I'm not bitter or even upset about them, though it does kind of sick I might have to move again down the line due to limited opportunities in my area.

 

[WedgeDawg]

Have you considered that you are reading too much into this? I'm fairly sensitive to giving people false hope when it comes to admissions.

I have randomly selected orthopedic surgery at UPenn as a program that is likely pretty damned hard to match into. Let's see where some of their current residents went to medical school:

PGY-1: Drexel x 2, NYMC
PGY-2: UConn, Missouri-Kansas, NYMC, UMass
PGY-3: UConn, Wisconsin
PGY-4: UCF, Drexel, SUNY Stony Brook, Rutgers
PGY-5: SLU, Rutgers

The place still has a lot of representation from top tier schools, but they clearly take high performers from a variety of institutions.

tl;dr Come back and complain about this after match day.

I'm no expert on orthopedic surgery, but it's possible that Penn doesn't have a top (whatever that means) ortho program.

If we really want to go extreme and look at an example of a highly selective program within an already selective specialty i.e. "likely pretty damned hard to match into", let's look at UCSF neurosurgery, arguably the "best" neurosurgery residency in the country. Source: http://neurosurgery.ucsf.edu/index.php/about_us_residents.html

UCSF Neurosurgery medical schools represented:

WashU
UPenn
UCSF x6
Columbia
Yale
Michigan
OHSU (also has PhD)
UCLA x3
Emory x2 (1 also has PhD)
Rochester (also has PhD)
Harvard

Basically a laundry list of the top 10 and of the 4 residents who were not from top 10 schools, 3 had a PhD (I didn't list PhDs for people from top 10 schools, but there were quite a few).

 

[Mr Roboto]

I'm no expert on orthopedic surgery, but it's possible that Penn doesn't have a top (whatever that means) ortho program.

If we really want to go extreme and look at an example of a highly selective program within an already selective specialty i.e. "likely pretty damned hard to match into", let's look at UCSF neurosurgery, arguably the "best" neurosurgery residency in the country. Source: http://neurosurgery.ucsf.edu/index.php/about_us_residents.html

UCSF Neurosurgery medical schools represented:

WashU
UPenn
UCSF x6
Columbia
Yale
Michigan
OHSU (also has PhD)
UCLA x3
Emory x2 (1 also has PhD)
Rochester (also has PhD)
Harvard

Basically a laundry list of the top 10 and of the 4 residents who were not from top 10 schools, 3 had a PhD (I didn't list PhDs for people from top 10 schools, but there were quite a few).

Why do you assume the PhDs held by the T10s weren't relevant?

 

[mw18]

I think OP is looking at this from the wrong end. I don't think PDs take away theoretical "points" from your application for being from a smaller school. I think they assign points to people from top schools. And in the application process if you think you deserve something, then you're saying that someone else doesn't. In this case those others are graduates from highly ranked programs. The reasons top schools' graduates are given these points have been talked about but basically they are a more well-known commodity, but also their letter writers have a greater potential to be bigger in the field as well. So if an applicant from a top school has the same scores and same grades (same interview skills), then that top applicant will likely be ranked higher. Why wouldn't they be? All things are equal and they come from a known commodity and have letters with more clout. Can an applicant from a top school match with poorer scores and poorer grades? I'm sure it happens. But I think it just depends on the weight that each aspect of the application is given.

What has also already been discussed but bears repeating is that OP is complaining about the benefits afforded those from name-brand places while trying to go to a name-brand place. So say you match at MGH, and when you're finishing your residency you apply for jobs, particularly academic jobs. Should the fact that you went to MGH be completely disregarded and only use other standardized measures? Should the recommendations from those who interacted with you clinically at MGH not be held in higher regard than others? And when speaking on standardized measures, there are many of the established top schools that make no effort to teach board material because they know the school's brand will carry their students (and that their students are high-performing in general and will likely do well either way). Obviously there are many, many schools of every "ranking" that don't teach to the boards, but at top schools they almost make it a point not to.

 

[doggydog]

.

 

[WedgeDawg]

Why do you assume the PhDs held by the T10s weren't relevant?

Mostly laziness. If you want a ballpark, probably 50% of the top 10 residents had them, but you can check and get an exact number by going through that link.

I think you're right that it was wrong to not list them. UCSF is notorious for liking PhDs for their nsgy residents. If you want a non-PhD heavy comparison I would look at Barrow, Hopkins, or Columbia.

 

[WingedOx]

I'm just here to state my amusement that the thread title isn't bleeped out on the site's main page.

 

[Anicetus]

I might have missed this discussion, OP, but if name bran is so important to you why didn't you work harder in college to get to a better medical school? Like the rest of us.

Because less successful people are just lazier right? Just like how the poor people didn't try harder in high school and college and settled for less well paid jobs. Just like how kids with ADHD just didn't focus enough or sit still enough. The people at Harvard med must have never wasted time to party or ever had fun in their lives ever to have had been the top 0.1% of premeds in terms of "hard work". Wait, naturally bright? Gifted? Fantastic memory capabilities more than others? What? That **** is all fairy tales.

 

[Dr. Death]

.

 

[doggydog]

Because less successful people are just lazier right? Just like how the poor people didn't try harder in high school and college and settled for less well paid jobs. Just like how kids with ADHD just didn't focus enough or sit still enough. The people at Harvard med must have never wasted time to party or ever had fun in their lives ever to have had been the top 0.1% of premeds in terms of "hard work". Wait, naturally bright? Gifted? Fantastic memory capabilities more than others? What? That **** is all fairy tales.

OP is clearly capable of being in the top 90% of medical students with his steps. Why couldn't he do the same thing in college?

What are you even talking about?

 

[SpacemanSpifff]

I'm no expert on orthopedic surgery, but it's possible that Penn doesn't have a top (whatever that means) ortho program.

If we really want to go extreme and look at an example of a highly selective program within an already selective specialty i.e. "likely pretty damned hard to match into", let's look at UCSF neurosurgery, arguably the "best" neurosurgery residency in the country. Source: http://neurosurgery.ucsf.edu/index.php/about_us_residents.html

UCSF Neurosurgery medical schools represented:

WashU
UPenn
UCSF x6
Columbia
Yale
Michigan
OHSU (also has PhD)
UCLA x3
Emory x2 (1 also has PhD)
Rochester (also has PhD)
Harvard

Basically a laundry list of the top 10 and of the 4 residents who were not from top 10 schools, 3 had a PhD (I didn't list PhDs for people from top 10 schools, but there were quite a few).

What I take away from this post: several people from "mid-tier" institutions matched at "a highly selective program within an already selective specialty". You'll still be fine, OP.

 

[Anicetus]

OP is clearly capable of being in the top 90% of medical students with his steps. Why couldn't he do the same thing in college?

What are you even talking about?

Because scoring in the top 90% of college GPA and Mcat is not the same as scoring in the top 90% of medical school and step 1. By a lot.

Why do top tier med students do well in both? Maybe because there are way more confounding factors. For all we know, theoretical OP could've been 3.9 GPA with 39 Mcat and got shafted some other way out of top tier. We just going to tell them "it's because you didn't try hard enough."?

 

[OnePunchBiopsy]

I hope this somehow doesn't find it way to come back and bite me in the ass but I need to vent because I am tired of the bull****. I have met with several program directors while on my aways and at my own home program who have told me that the name, or lack of a name, of my program will likely hurt me in the match. I scored ~>2 SD on both Step 1 and Step 2 putting me in the >90th percentile, I have received AOA after honoring every single rotation in medical school, I have great LORs and one from a highly regarded institution where I did an away, and yet every time I talk to a PD I can see their excitement over my application fade when it comes to talking about my home program.

If all your numbers are legit, and I was in your shoes, if I spoke with that PD my interest in that program would "fade" as well.

Go to a program that wants you, not your school's name, and not one where you are made to feel inferior because of your school.

...and if you are making yourself feel interior, STOP IT.

 

[Goro]

MD schools can serve as feeder programs to residencies just as UG schools are feeders for med school. Their products are a known quantity. Students from newer schools might have it harder trying to match because they're well, unknowns.

 

[Mad Jack]

OP is clearly capable of being in the top 90% of medical students with his steps. Why couldn't he do the same thing in college?

What are you even talking about?

Getting into a top medical school starts with what college you get into out of high school. Not everyone reaches their full potential that early, for a wide variety of reasons. And even if he did do extremely well on a test, getting into a top school and a top program is about a while lot more than just grades and test scores., just as being a good doctor has very little to do with your Step results.

 

[def1]

If the training there is equal, why are you so eager to go to those brand name programs? Oh right..

Because fellowships have the same name-brand bias as residencies.

Really though I am fine going to almost any program in my chosen field and at this point I am more concerned with geography than name brand. A lot of the programs that I really like based on what Ive heard from current residents arent even in the top 20.

I am just saying its unfortunate and annoying to be discriminated against just because of the name of your medical school.

 

[def1]

I might have missed this discussion, OP, but if name bran is so important to you why didn't you work harder in college to get to a better medical school? Like the rest of us.

It had nothing to do with working harder. I'm pretty sure I worked harder than most people who went to Harvard and had their school paid for and didn't have to work a real job for a even a day.

Maybe if you came from a disadvantaged family in a disadvantaged area and didn't have guidance or mentors or anyone to show you how to be successful then you would understand why me and others in a similar situation don't have the privilege to end up at Harvard for college or medical school. As you said in a later post, I obviously have proved myself to be smart enough and successful in medical school to be in the top percentile and maybe if I grew up with the opportunities to have physicians as parents or teachers who actually cared to teach during high school I would have been at Harvard for med school. But thats not the way it worked out. I struggled to get into medical school because I was never taught how to be successful and every success I've had up to now I've learned how to do on my own. So if you want to make yourself feel superior because you were able to get into a top school when I wasn't maybe you should try and understand that not everyone has the same opportunities as you.

 

[Med Ed]

I'm no expert on orthopedic surgery, but it's possible that Penn doesn't have a top (whatever that means) ortho program.

If we really want to go extreme and look at an example of a highly selective program within an already selective specialty i.e. "likely pretty damned hard to match into", let's look at UCSF neurosurgery, arguably the "best" neurosurgery residency in the country. Source: http://neurosurgery.ucsf.edu/index.php/about_us_residents.html

UCSF Neurosurgery medical schools represented:

WashU
UPenn
UCSF x6
Columbia
Yale
Michigan
OHSU (also has PhD)
UCLA x3
Emory x2 (1 also has PhD)
Rochester (also has PhD)
Harvard

Basically a laundry list of the top 10 and of the 4 residents who were not from top 10 schools, 3 had a PhD (I didn't list PhDs for people from top 10 schools, but there were quite a few).

Oddly enough I knew someone (MD, PhD) who matched into UCSF neurosurgery from a mid-tier state school. I didn't keep up with him, but he probably graduated from there 3-5 years ago.

The top 10 research schools as defined by USNWR collectively graduate ~1,400 new physicians each year. It is entirely reasonable to expect that many of them will want to go into competitive fields (like neurosurgery), and many of that subset will be attracted to high power institutions (like UCSF) in highly desirable locations (like San Francisco). So yes, there will certainly be some select residency programs where it will be impossible to find a current resident from a sub-25 school.

But this observation does not really address the OP's concern, which seems to be that "name bias" is the sole factor that will keep a certain tier of programs forever out of his reach.

 

[doggydog]

.

 

[Foot Fetish]

But you're not the only person in the world that has had some adversity or who had to teach themselves how to think.

His issue wasn't that he didn't know how to think. He's obviously very intelligent. What you don't seem to understand is that privilege begets privilege in the sense that rich, highly-educated parents know all the tricks and unspoken rules for gaming the system, so their children have a massive advantage very early on. First-generation college students can be superior thinkers, but it won't matter if they don't know how to manipulate the extremely biased educational infrastructure, which tends to reward the children of doctors, lawyers, and businessmen who have connections and access to all the right supplemental educational resources. For example, a lot of 1st generation college students just show up and take the SAT without preparing. It's billed as an aptitude test, so they treat it as such, whereas people with college-educated parents know that it can be prepared for, so they buy expensive SAT prep courses that enable them to get into schools like Harvard...

A computer can have the most efficient algorithm in the world, but it won't arrive at the right answer if it only has access to ****ty data.

 

[mw18]

His issue wasn't that he didn't know how to think. He's obviously very intelligent. What you don't seem to understand is that privilege begets privilege in the sense that rich, highly-educated parents know all the tricks and unspoken rules for gaming the system, so their children have a massive advantage very early on. First-generation college students can be superior thinkers, but it won't matter if they don't know how to manipulate the extremely biased educational infrastructure, which tends to reward the children of doctors, lawyers, and businessmen who have connections and access to all the right supplemental educational resources. For example, a lot of 1st generation college students just show up and take the SAT without preparing. It's billed as an aptitude test, so they treat it as such, whereas people with college-educated parents know that it can be prepared for, so they buy expensive SAT prep courses that enable them to get into schools like Harvard...

A computer can have the most efficient algorithm in the world, but it won't arrive at the right answer if it only has access to ****ty data.

But you and OP make the assumption that students at top schools unilaterally come from these backgrounds. That is not the case. The majority of people at top schools come from privileged backgrounds, yes, but the majority of students at all med schools do. It may preclude one more, I don't know. But you don't really know either. You may know that top schools have more kids from the Ivy league undergrads (I don't know that this is true, but much like the residency from med school situation it does seem likely), but you don't actually know if they might just be more highly performing.