Flexner and the whole time system: The second flexner report and the wholetime system in American academic surgery

BACKGROUND: Reform in medical education started in the mid 19th century and continued through the early decades of the 20th century. Both Carnegie and Rockefeller foundation monies were applied to the process of attempting to improve medical education. The University of Cincinnati College of Medicin e, associated with a municipal hospital and a municipally owned university, offered a model for improvements in medical education in other municipal h ospitals. The attempt to institute the "whole-time" ("full-time" salaried, "University") system, and restructure the University of Cincinnati College of Medicine along radical lines hitherto unknown in much of the country and in particular to the city of Cincinnati, disturbed the relationship of the College of Medicine with the community and echoes to this day. The tension s between the "University-salaried" professors of clinical surgery and the practitioners attempting to practice at the institution have abated but rem ain unresolved. CONCLUSION: The history of the establishment of the full-time chairs, inclu ding the Christian R. Holmes Chair of Surgery, led to a rethinking of the r ole that the full-time system might play in American medical education. Am J Surg. 1999; 178:2-13. (C) 1999 by Excerpta Medica, Inc.