<p>Anecdotally, many more African American med school aspirants get to the top med schools in the country via UMBC and Xavier than from elites, while "smarter" URMs who go to HYPSM, etc, join the detritus of dashed dreams at the elites. At the lower-tier schools, they receive the handholding and nurturing that they will never get at the elites. They take tests over to get better grades, develop confidence, and go on to earn MD/PhDs.</p>