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Based on your pros and cons, it seems like Columbia might be a better fit because of its business school, incredibly diverse patient population, and emphasis on service. Another key difference between the schools is AOA membership. Columbia announces it at graduation so it does not affect your residency apps. The last 2 years at Vanderbilt you are ranked, and they assign AOA status before your residency apps. These are two phenomenal schools, and you cannot go wrong either way.
The existence of AOA or assigning it before apps are out is not a key difference between schools lol. AOA is a tiny part of medical school that is irrelevant for most of the class.
OP, if you're nervous about living in a big city, Nashville is going to be way more manageable than NYC. Personally I'd go with Columbia: cheaper and more prestigious school.
So having one school ranking you based on 2 years of clinical grades and having your AOA status reported to a residency program while the other doesn't isn't something worth considering in a decision? Interesting.