Flexner and the whole-time system: the second Flexner report and the whole-time system in American academic surgery

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 Medicine, associated with a municipal hospital and a municipally owned university, offered a model for improvements in medical education in other municipal hospitals. 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 tensions between the "University-salaried" professors of clinical surgery and the practitioners attempting to practice at the institution have abated but remain unresolved.

The history of the establishment of the full-time chairs, including the Christian R. Holmes Chair of Surgery, led to a rethinking of the role that the full-time system might play in American medical education.