Mt Sinai has really made a lot of changes, (I'm one of the residents). I think people who have may have called it second tier haven't been there in a while. The program is 9 years old, and has made great changes every year. Now it's a 4 year program with residents working 32 hours/wk in the 4th year giving you time to develop your niche/mini fellowship, and clinically you are running the department in a Jr attending role. With the new changes people have been concentraing on sim medicine, US, admin, law, and public health during the 4th year. We've been getting jobs based on a lot of this 4th year work, bringing these disciplines to other programs. (Last year's Chief is setting up the sim lab at USC.) Next year we're starting a global health program for 3 residents per class, giving them an extra curriculum (2 weeks of classes), a 2 week preliminary visit to ther global health site in the 3rd year, and 2 months combined to visit their site in the 4th year with time left to publish the data/experience. Sites range from Haiti to Africa...
Conference is amazing, and we have 30 invited speakers this year thanks to all Jagoda's conncetions. This has to be one of the most in the country...
The blend of Elmhurst and Sinai is amazing, and Sinai is the premiere program now in the NY City, (but I'm a little biased). They've given a purpose to the 4th year, which will make you an attractive candidate in both academic and community environments when it's all said and done. I think we've changed tiers and then some...