After founding and directing a college-preparatory school in his hometown of Louisville, Kentucky, Flexner published a critical assessment of the state of the American educational system in 1908 titled "The American College: A Criticism". His work attracted the Carnegie Foundation to commission an in-depth evaluation into 155 medical schools in the US and Canada. It was his resultant self-titled "Flexner Report", published in 1910, that sparked the reform of medical education in the United States and Canada. Flexner was also a founder of the Institute for Advanced Study in Princeton, which brought together some of the greatest minds in history to collaborate on intellectual discovery and research.