I think its somewhere in between the two you mention.
I'll just say that there is no way walmart man wins out. He may have game, but ultimately, you have to have cards to play with. You can only get away with bull**** for only so long. And, as you mentioned, people who figure out medical school (like the many other challenges in life, i.e. successful businessman, musician, etc) have confidence. Confidence is the only true peacock feather.
However, too many people going to medical school think that simply having a slightly better card is better. I'd argue this is false. You have to both have the card and be able to play it. The way I see it, its a skill that can be acquired, however, through experience and failure, much like how one learns how to be confident--through experience and failure. Confidence in life begets confidence in women, which begets more confidence in life....