During my interviews, WashU in my opinion had everything that you see at MGH/Brigham, JHU, UCSF, and Columbia, but with a slightly lower reputation. Size matters, and the front-loaded aspect common to all of these programs is important for those who want to choose specific electives or research time. The program is by the way especially strong for those interested in interventional/neuroradiology for obvious reasons. A few of the current incoming residents apparently chose WashU despite having gauranteed rank spots at MGH and JHU (per the PD). Finally, the ability to combine your PGY-1 with the rest of your residency is a great perk allowing you to complete your psychiatry and ER requirement before you even start.
St. Louis is definitely nothing compared to New York or San Fran, or Boston. The area around the hospital is nice, and the city is really cheap--so not bad for a resident paying back loans. Also, the patients are extremely diverse given the huge encachement area that WashU serves.
If you have any questions regarding the WashU program, please feel free to PM me.