What does higher tiered residencies mean?

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24858

I was just curious, I hear a lot of talk about going to an upper tier residency such as MGH vs a lower tier residency. What in the scope of things is the difference?
If you want to do a fellowship, and there is a fellowship available at a non upper tier residency, wouldnt it be a wiser decision to do your residency at the lower tiered residency and let them get to know you, then do your fellowship at the same place?
 
anyone want to answer or is everyone too focused on the doomsday anesthesia threads?
 
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