This was a toss up, and on closer inspection both programs appear equal in their strengths (solid midtiers, 3 hospital system w/VA, x+y). For me, I rotated at MUSC (although it was in a diff specialty) and loved the hospital, the residents/attendings from other specialties, and the general friendliness that is representative of the South. As someone interested in cards and pulm/cc, I believe they are the only heart/lung/liver/kidney transplant program in South Carolina. MUSC is one of the oldest medical institutions in the US, and benefits from a long history of private donors and NIH funding which gives residents the opportunity to pursue longitudinal clinical research. How that translates into fellowship matching is another story, since many residents tend to stay at MUSC or somewhere in the South (I did see one resident match in Colorado about 3-4 years ago). Moreover, the Chairman, PD and APDs have been around for many years and get the importance of resident input and how to weigh their demands with the vision + rigor of the program. Outside of MUSC, Charleston is one of my favorite cities in the country--one of the best restaurant scenes at reasonable prices, an up and coming coffee scene, and a good number of breweries to keep the stars in this kid's eyes. My wife will never forget the cheeky smile I had on my face when I saw how cheap iHop pancake specials were compared to where I currently live.
FWIW, loved Tulane as well. The PD is passionate about his program and has made residents the focal point. That said, I got the impression that you have to "drink the koolaid", to fit in. Nola is also its own little country that my wife can't tolerate, and I wasn't sure what kind of research opportunities existed there (not a big selling point). I'm also not sure how they do with fellowship match, and it looks like they haven't released their stats for this year's class. "Better the devil you know" is quasi applicable in this scenario.