begginandpleadin
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Vandy has quite a few superb neurosurgery applicants this year. Any top 40 NIH funded institution "feeds" into these residencies. Can't see a compelling reason to pass up the debt-free opportunity.
I assume you mean UCSF. It has a tough culture but the results are clear that their students match very well and frequently at West coast programs including UCSF itself. We have been very impressed with their applicants as a whole. Vandy applicants are great too but if your goal is an academic West coast practice I would take the 100k debt provided you were equally happy at both programs. If you liked Vandy more then 100 percent go to Vandy. The reality is you may change your mind and go into ent or something else where perhaps UCSF vs Vandy is more pertinent.
Is the prestige difference between UCSF and Vandy very significant when it comes time for PD to rank applicants in competitive surgical subspecialties like ENT, and more importantly when residency grads are applying to faculty positions? I definitely understand that UCSF has a leg up when it comes to research, etc. just trying to get a feel for how much pedigree is important among the already top-tier schools.