Orthopaedic Surgery Training in North Carolina: The Impact of The Flexner Report and The Sherman Antitrust Act.

The current medical schools and orthopaedic residency programs in the state of North Carolina have evolved based upon geopolitical, economic events, historical reports and regulations. The American Medical Association Committee on Medical Education, the Flexner Report and the Sherman Antitrust Act and their recommendations were codified by state regulatory agencies and state law. These important pressures created the programs as they are known today. The result was the forced closure of most early medical institutions in the state of North Carolina in the early 1900s. Industrial resource consolidation by monopolies was the motivation for the Sherman antitrust act. Enforced by Theodore Roosevelt, this legislation disbanded major monopolies and encouraged philanthropy. This manuscript details the evolution of modern medical education and highlights the impact of historical social, economic and political events on the development of Duke, Wake Forest, University of North Carolina and Charlotte/ Atrium Health orthopedic programs in North Carolina. (Journal of Surgical Orthopaedic Advances 31(3):139-143, 2022).