Why is such a large internationally recognized orthopaedic department located in a rural state? The answer to this question begins with a series of events occurring in the first decade of the 20th century. At that time medical education in the United States lacked an overall organization and was not based on scientific principles. These observations led the Carnegie commission to fund a study of all of medical schools in Canada and the United States. They selected a remarkable educator, Abraham Flexner, to conduct this study. Starting in 1909 he visited every medical school in the United States and Canada. In his opinion, none of the four Iowa schools (the Osteopathic and Drake Medical Schools in Des Moines and the State University of Iowa Medical School and Homeopathic School in Iowa City) met the minimal standards.
Flexner noted that the Drake Medical School was well intentioned, but feeble and should withdraw from a competition to which it was unequal. When he visited Iowa City, he found that neither the Dean nor the Chief of Surgery lived in Iowa City. The only person he could interview was one of the sisters of Mercy who was in charge of the clinical operations of the University Hospital at that time. Flexner noted that the University of Iowa Medical School had a weak clinical faculty, poor scientific programs, a small patient base, and an out of the way location. He recommended that it close.