as is true in the rest of life, how "prestigious" your background is, will help you. the "stronger" your medical school, the more helpful it will be to land the better residencies. however, i do believe that residency training is more important than medical school. first of all, you have to get out of your head the notion, that all ivy league residencies are good. this may be true for undergrad but not for residencies. you'll realize as you go through your medical career, that residencies really vary from field to field. in my opinion (being an EM resident), the stronger EM programs are in larger cities (secondary to volume) and at places where medicine and surgery are not as strong (otherwise you lose out on procedures and there is a lot of territorial fighting). Training at a strong IM program, for instance, will give you a better chance at landing a fellowship, while training in IM at a small community program makes it more difficult to get a fellowship. it really depends what your plans are and what you want to do. i don't think where you train makes a difference in terms of vacation, but it may make a difference in the job you land and the ease with which you do it. programs that are more prestigious nationwide (i.e have "a name" in the field) will allow you to find a job easier wherever you go. hope this helps. if you're still a med student, i would just strive for the best so that there will be no regrets later on when you decide you want to go, for instance, into derm (or whatever)