I asked this before, but I'm not sure if I asked you specifically -- is the MCAT then not a great equalizer? If someone could have gone to a T20 school but did not, for whatever reason, are they now screwed unless they are one of the lucky few to be able to break through, even with a superlative GPA that is not taken as seriously as one from Yale, and a tippy top MCAT that should be valued the same coming from New Haven as Yale? (I.e., a 4.0/522 from New Haven will never be the same as 4.0/522 from Yale, but at the end of the day, there are only so many 522s (and 4.0s!), so does the person from New Haven still have little to no chance because a 3.8/518 from Yale is still more desirable at your school?)
Regardless of whether it’s right or wrong, the harsh truth is that attending a well-known top ranked school does offer advantages. Success begets more success. This is the whole reason why there is a gap between those who are advantaged vs not. That wider social discussion is outside the scope of SDN. The “prestigious” school benefit is the same and the effect is true outside of medicine as well. E.g. Top tech firms actively recruit fresh grads out of MIT, Stanford, cal tech, etc but not others.
There are both implicit and explicit reasons for this.
First, the elephant in the room. There is unconscious human bias. For no “good” reason other than a Harvard, Yale, Stanford, MIT etc sounds impressive. However, that is pretty superficial and matters little beyond initial impression. Plenty of premeds from these schools do not get into medical school.
This particular question is asked at all levels of training. Undergrad->med school->residency->fellowship->first real attending position. For the top schools/programs, the reality is that *a lot* (read: not all) circulate people back and forth between institutions of the same tier. Just look at match lists of residency programs at top places and see where their residents come from. Of course you will also hear the anecdote of the person from a lower ranked school/program really standing out. These are outliers. Most people will not be outliers.
Going back to the undergrad example. The real differences in the application can often be seen throughout the experiences that students have. Top schools tend to be where the leaders of academics, research, etc congregate. World class artificial intelligence research may be happening at MIT or Stanford, but likely not at the University of New Haven. Someone who did substantive work on machine learning on a health care problem under the mentorship of a reknowned expert would have a unique and compelling application as compared to someone who did only standard things. Apply that to any area, international experiences, health policy, research, etc etc. also apply that to endowments and industry partnerships. I remember that one of the freshman seminar classes on some jet propulsion topic at my undergrad included a “field trip” with an expenses paid charter flight to a jet engine test site in a neighboring state. There is also the benefit of the self-selected peer group of motivated individuals. Several dorm mates at a place like Stanford may be Olympic athletes (sounds crazy but true).
Ultimately though, there is a difference between having more opportunity and taking advantage of it. There is a marked difference in the experiences (and thus applications) of someone who coasted at a big name school vs someone who truly took advantage of their time there. These two types of students are pretty easy to spot.
Lastly, what is your goal? Different medical schools look for different types of applicants. Some are looking to train great physician scientists. Others may focus entirely on training pure clinicians. Experiences that matter may differ in importance depending on your goals and what the school looks for in their ideal student. The big name schools matter more if you’re looking for the academic career.
Despite what some people may tell you to sugarcoat, there is definitely an “escalator” that starts very very early. Doesn’t mean being on the escalator is a guarantee of success; can fall off at any time. However, those on the escalator who take advantage will have an easier time than those taking the stairs.
The advice in the end is the same though. There are things you can control and things you can’t. Make sure that you are taking full advantage of all opportunities and being as successful as you can be in the setting you’re in. That will reflect in your application.