Sorry to hijack/change the topic, but on the heels of what you've mentioned, at what gap in programs would the quality of program matter, for example,
how about harbor-UCLA vs UTSW/UPMC/Emory
This is my rule of thumb. It is obvious that there are exceptions.
1- I put the so called Top 5-6 programs at first. My only exception is MIR because of its location. For example, I choose MGH over UTSW or UPMC. Now among these top 5, not a difference. I choose location.
2- Then any big or midsize university program is my second level. So UTSW, UPMC, UCLA, U Maryland, Emory, UW Seattle, .... Among these programs, I rank them based on the location I want to go. So if you want to live in Maryland in the future, I choose U of MD over Emory or I choose U of Chicago over UCLA if I want to stay in Chicago.
3- Then community programs (Cleveland clinic and Mayo-clinic Rochester are in the category 2 and not this category).
This is how I rank. Always 1>2>3. A Top category 2 can be ranked higher than some of category 1 programs. For example, totally fine to put UCLA or Stanford over MIR or UPenn. Especially some of Category 2 programs have some of the best fellowships. For example, MSK at UCSD is better than UCSF. So choosing UCSD over UPenn is fine.
Harbor-UCLA is a category 3 and even in Category 3 is mid to low in ranking. Definitely I will not choose it over Emory or UTSW or UPMC.
Disclaimer: This is my personal opinion. It may be wrong, may have biased or ... People may tell you to rank Harbor-UCLA over Emory if you want to stay in sunny South California. You may find some people who say that they did it and worked for them well.