A survey of North American medical schools in 1990 led to a report two years later that assessed change in medical education and recommended a number of improvements. The explosion of medical knowledge combined with the need to foster self-directed learning has put in motion curriculum revision which involves new approaches to teaching, aided by computer applications.
The ACME-TRI Report on educating medical students states that "to practice medicine in the twenty-first century, medical students educated in the twentieth century must be given a strong grounding in the use of computer technology to manage information, support patient care decisions, select treatments, and develop their abilities as lifelong learners."
An expanded information base in medicine has led to a reliance on self-directed study, incorporation of case-based learning sessions and a focus on computer literacy in medical education. In addition, the shift toward managed care, away from inpatient service has impacted on the educational setting, requiring new training programs for allied health professionals like nurses and physician assistants. This in turn affects libraries, who must strengthen collections to include materials for these students. More affiliated programs with local colleges, and an increase in students accepted for the allied health degree programs such as the Physician Assistant program have widened the scope of the traditional medical library, adding demands to the available budget, computer facilities, and study space.
Another factor affecting change in medical education is the importance of outcome measures. Medical schools now need to assess clinical competencies of students, to provide outcome analysis since it is required for the accreditation process. Some managed care organizations also require establishment of outcome performance criteria, which is leading to more "management by outcome" for clinical practices. Finally, increased state and federal attention and funding for public health and preventive medicine will necessitate a focus toward training in these areas.
All of these changes impact on library administration and especially on collection management. Curricula which emphasize computer resources and problem-based methods of learning, coupled with radical changes in technology of information retrieval and storage, pose great challenges for the medical librarian. Library collections and the use of materials are rapidly being transformed, and the librarian's role is destined to change accordingly.
In the January 1994 issue of the Bulletin of the Medical Library Association, the editor stated that "progressive medical libraries were confronting philosophical and economic issues associated with preserving emphasis on collection development while adapting new operational procedures related to electronic publications and printing on demand."
In discussing the changing library, Naomi Broering declares that the concept of ownership of a large library collection and a facility that must be open a minimum of sixteen hours a day may no longer be realistic.
The Media Library where I am director is currently open 15 hours a day during the week and eight hours a day on weekends when classes are in session. We have a permanent staff of three full-time employees with some additional hourly student help. Although some items in our collection are used year after year, others are sitting idle on shelves due to the phenomenon known as "interactive multimedia."
History of the Media Center
Today's modern "Media Center" is a far cry from the early audiovisual library: a shelf of 16 millimeter motion picture canisters and plastic containers of filmstrips which gradually moved aside for film loops and super8 reels, only to be supplanted by microfiche products and teaching packages comprised of two inch by two inch slides in carrousels and audio tapes accompanied by a …