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I think the issue of cut throat is somewhat of a myth. Now that the internet is the source of reading journal articles assigned nightly, there are not library stampedes to the Reference room for reserved readings that used to create ill feeling among students waiting their turns or unable to locate hard copies of required articles like in my era. Call me naive but in order to have the unblemished records, references and essays that most Vanderbilt students have upon admission..there is already personal discipline and self direction in place for most students. I am not saying no one at Vandy or peer institutions has character issues but I was really deeply impressed with the character of my sons' roommates at Vandy and at Duke..ditto hallmates etc. My sons at both institutions got roommates who were health nuts, had very clear goals, chose hard paths and knew how to put in study hours and appeared to be cheering their friends on daily. I really think this is a non issue in undergrad school. You really are in charge of your own destiny and standing in labs and classrooms. Teachers get a class at Vandy now where every single student was a high school standout. It is up to the student to discover how far their abilities will take them in math, sciences, foreign languages and writing skills. What was good enough for high school As however does not necessarily predict your new path. This is a hard lesson for many. An SAT high math score doesn't automatically mean you can make it to the next levels in math as successfully etc just as a good high school essay does not mean you can be a successful philosophy major.
If many of the students at Vandy are gifted, it is probably also true that the more advanced your education, the more unique each student becomes as they find their own talents..they do not resemble each other and are not alike in their pockets of giftedness.
This is actually a freeing discovery for undergrads I think. It isn't like high school where you are taught in a herd to take the same exams no matter how different you really are from each other.
We do have a friend who just started in Vandy Med and he tells me it is an amazingly positive atmosphere for first years.
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