I also think that completely focusing on the GPA/rigor of the school, is missing some of those other things that may not be seen as “making a difference” in med-school applications in the same way, but that, based on both observation and a bit of research, are part of most successful candidates’ profiles
For example, I was surprised to hear how difficult it is to get clinical and research experience starting early in the college process at some schools. Based on my daughter’s experience, I had assumed that finding a lab assistant position within a week of freshman orientation was the rule rather than the exception, but apparently, that’s not true everywhere. Even things like having those opportunities on campus may be a factor to consider. Access to key ECs and the opportunities they offer may also vary from school-to-school.
Finding a mentor and developing relationships with faculty is another relevant factor that may be easier at a smaller school or at a school where a student is at the top of the academic heap as well.
And, honestly, finding a school that “fits” and where the student feels they can “stretch comfortably” seems to encourage appropriate course selection and enables the student to take advantage of opportunities when they present themselves.
Med schools are looking for students with high GPAs and MCATs, but my guess is that students who are “on the bubble” in terms of academic preparation are better served by looking for a school where they can maximize their potential rather than one where they think they might be able to get an extra .05 out of the grading system.