Computer-based technologies provide unprecedented opportunities to integrate biomedical information for teaching. Images, still and moving, as well as sounds can be linked to descriptive text, creating an interactive teaching document. A large collection of these objects can be integrated into dynamic documents through cross-referencing by hypertext links. Long-text documents, adjusted for web-based presentations, can be searched either using keywords or through a full-text search.

The Tufts University Health Sciences Library led the IAIMS planning (Integrated Advanced Information Management Plan funded by the National Library of Medicine) which would frame the future of technology development on the Health Sciences campus. This strategic plan called for an integrated and seamless university-wide network and virtual campus-wide databases. Emanating from this plan, THSL staff designed, planned and implemented the Health Sciences Database (HSDB). The database is a tool to efficiently and effectively manage curricular information important today as medical education undergoes intense change affected by both the growing body of knowledge required to practice medicine and by reforms in the health care system. Specifically the database project was designed to address several challenges:

1. Access to local information: At Tufts computers are used most frequently to enhance communication and less frequently to enhance our effectiveness as students, teachers, clinicians, and researchers. As at many universities, it is easier to access national databases for gene sequencing or clinical guidelines than it is to access information produced at Tufts. Documents and slides exist separately as parts of faculty, departmental, or library collections with no means or ability to integrate or even consistently update them.

2. Curriculum Changes: The THSL, academic deans and curriculum committees are addressing problems common to academic health centers including curriculum revision, faculty development, and relationships to affiliated clinical teaching sites. Specifically, Tufts' reassessment of its curricula has focused on the following major problems and progress towards solutions:
   1. The improved integration of preclinical basic sciences with clinical education: The curricular structure, i.e., organization mainly by basic science departments for the first two years and by clinical rotation in the last two years, is one of the barriers to cross-discipline dialogue. There is insufficient or limited linkage between basic science concept and their clinical significance. The Curriculum Committee and Dean's office are presently leading faculty in a major integration effort across the four years. The HSDB, is an important tool in this process.

   2. The need to formalize the development of a core curriculum and learning objectives for each phase of medical school, especially in areas such as primary care: The learning objectives and core curricula must be specific, address competency issues, be agreed upon and made accessible regardless of the students' and faculty's location. Such core curricula and learning objectives arepresently being developed for the first three years of the curriculum. Dissemination, revisions, and evaluations are expected to take place with the help of the database.

   3. The complex problems regarding availability and access to slide and text collections, particularly course reserves: Barriers include library hours, limited copies, and limited viewing rooms. Faculty slide collections are currently shown only during lectures. Some are reproduced in black and white for the syllabus, but students never again see the originals. The wealth of clinical diagnostic images, many already digitized and available from affiliated hospitals, are not available for research and teaching.

3. Managed care is the growing trend in health care delivery. The primary care physician is at the center of this system. Medical educators and physicians are seeking ways to keep up with biomedical knowledge and needed changes in clinical practice and to improve the management of their practices. While the demand for information is great, the time to access it is limited. Attendance at Continuing Education CE seminars takes time away from clinical practice. The transfer of important information may fail to occur. The use of technology in practice management and clinical support is currently growing exponentially with no sign of slowing down.

1. The creation of networked relational document databases, which integrate text with multimedia and create dynamic links to information within and without the database, are indexed, and are full-text searchable. These educational databases will be accessible via an Intranet.

2. The creation of tools which address changing needs in medical education and clinical care.

3. Electronic access to curricular materials so they can be used in the development of educational materials to improve teaching and learning for students, faculty and practicing clinicians.