Both schools will prepare you for success on the boards and beyond. Go where you'll be happy. For me, that was Penn. I was in the same boat as the original poster: It was down to WashU and Penn because of $ issues. I ultimately chose the city that was better and the location that was closer to home. Having gone back to WashU for ophtho residency interviews, I am convinced I made the right decision for me. But everyone is different. I'm a real city person. The only downside is that Philly is more expensive than St. Louis. But there is also a lot more to do and the city is more fun and walkable.
I take issue with your statement that WashU's residencies are better than Penn's. Both are national leaders in numerous fields. In some cases, WashU has a better reputation. In others, Penn does. It depends on what specifically you're interested in.
I posted this on the pre-allo website regarding your question about studying for step 1:
1) According to our Dean, Penn's mean and median Step 1 scores have frequently been #1 in the country. (I am sure that Wash U's are similar, especially considering that the schools have relatively similar accepted applicant profiles.)
2) We actually have MORE experience before taking Step 1. Why? Because we don't take it until after the 1.5 yrs of preclinical + an additional year of clinical work. (We usually take it at the end of January or begining of February of our 3rd year). You have no other academic committments at that time and you can theoretically take as long as you want to study. Now I can hear some of you thinking, "won't you forget biochemistry after doing clinical work for a year"? Trust me when I tell you that you forget biochemistry the minute you hand in your exam. Everyone has to review it, Penn students no more than any others.
3) You will have the experience of taking multiple national shelf exams on clinical material prior to taking the boards. This is great for developing test-taking skills. Also, more and more questions on Step 1 are being presented in the form of clinical vignettes. You get really good at reading these and parsing out the key details when you take the shelf exams.
4) I can't underestimate just how much having some clinical experience helped me on Step 1. Even though in theory it is supposed to test preclinical subjects, the knowledge base that you develop and solidify while in the clinics really helps you out on the exam. You become much more comfortable with microbiology, side effects of drugs, physiology and pathophysiology, etc. when you actually are responsible for patient care. There were many instances where there were patient description and after a few sentences, I thought to myself something like, "oh, that's ascending cholangitis...duh." I never would have been that comfortable after just preclinical work.
I think that if you ask any Penn student, we are incredibly happy that we took Step 1 after our core rotations. And 1.5 yrs of preclinical is more than enough. And don't even get me started on the extra time we had for electives, away rotations, travel, etc.
But the take-home message is that both schools are great. I'm sure I would've been happy at WashU but I've been very happy at Penn.
I'd be happy to discuss how I made my decision (back in the day) over the phone if you PM me.
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