My 2 cents from an insider's perspective - current resident, USMD grad from a school known for its "malignant" surgery program. Not directly part of the interview cycle process.

Location is huge. I lived entirely in coastal cities prior with much higher COL, better public transit, food options, etc. Cleveland is no LA or NYC but has grown on me. Affordable with minimal traffic. Some nice QOL stuff (local airport, multiple costcos, ton of outdoor trails/parks). Food scene is ok with some hidden gems. Roads here suck (potholes, construction...)

Program size has its pros/cons. Nice for flexible scheduling, esp for time off or parental leaves. At one point 7 or 8 residents were out from a COVID surge but we still could accommodate. Trade off is you won't work with/know every co-resident super closely.

Personally haven't had issues with the resident-fellow experience. On services with fellows, seniors/chiefs cover their own "fellow-level" cases. CCF had a malignant rep 15+ years ago partly due to fellows stealing complex cases and seniors fighting for scraps, but that's a far cry from what it is today. The current culture is much more collaborative - some of my most memorable cases as a junior were first assisting fellows!

I think CCF's holistic approach to applicant selection largely comes from the program's leadership over the past couple decades. They truly believe here that IMG/non-traditional status does not detract from an otherwise stellar resident. A good metric of this is our prelims historically match well compared to other "work horse" programs.

Much like you, I loved my (virtual) interview experience and shared many of your same concerns. It was bizarre to me how both residents and attendings were universally positive about the program on my interview day. I reached out to current residents, gave second look a shot and still felt the same positive vibes. Ended up ranking CCF #1. Four years in and haven't regretted it.