I don't understand the difference, but they both have bad connotations. I hate being called either, and apparently my classmates just love these terms.
There's a segment from one of my favorite TV shows that comes to mind...
...if you think that I'm going to miss even one opportunity to pick up half-a-mile boat speed, you're absolutely out of your mind. When it costs us nothing, when we give up nothing?! You're out of your mind.
Let me put this in context. The show is the West Wing, the speaker is Bruno Gianelli, campaign manager for the presidential re-election campaign, and he's telling the President about getting an edge in his old sail races, and by analogy, his current campaign. If you haven't seen the show, it's not for everyone, but those who stick with it, love it.
Honestly, as a first-year med student, the notion that I could be responsible for someone's life in the future is kind of terrifying. So,short of sabotaging anyone else (which I have never and would never do), I'll seize every opportunity to make myself a better doctor.
Where's the harm in that? It doesn't hurt me, it doesn't hurt anyone else in my class, and it sure as hell isn't going to hurt the patients if the med students are better at their jobs.
So if you're in med school and you're not pushing yourself to be better, you're absolutely out of your mind.