This has major implications for the educational delivery system. Until now this system has been driven almost exclusively by the traditional 19th century lecture-room format in which a faculty member of an educational institution talks for about an hour in front of a captive audience of students. A series of such talks usually constitutes a "course" in the lecturer's field of study. One or more times during the lecture course the faculty member will demand that the students answer a series of written questions or solve a series of problems using data and methods derived from the lectures and from one or more textbooks the students are required to purchase. These written tests constitute a feed-back mechanism that enables the faculty member to determine how many and which students have retained some specified fraction of the material covered in the lectures.

Nowhere has this 19th century anachronistic pedantry survived in so well-preserved a form as in the modern medical school. As the 20th century draws to a close we still see professors holding forth in the large classroom-amphitheaters like latter-day Koches or Oslers. But, as the pace of life and learning picks up, the personal lecture format is becoming as difficult to administer as it is to justify. Like a painted Egyptian sarcophagus in a bustling subway station, the traditional verbal lecture is starting to look out of place, or even in the way.

Consider the possibilities of a computerized curriculum. Every student would have two computers: a desktop machine in the dorm room and a laptop (or "notebook") to carry around school. The student could spend all of his or her time in the library, laboratory or clinic and simply plug the laptop into a digital wall outlet that allowed access to an in-house local area network (LAN). Subject matter formerly presented as lecture material could be called up on the screen as needed to supplement the lab procedure or library information. An entire textbook in multimedia format with sound and color pictures keyed to the text could be accessed by the student while he or she was examining a specimen in the lab or a patient in the clinic. This could enable a profound change in the traditional structure of the first-year medical school curriculum which, up to now, has been centered on an artificial and inefficient dichotomy between lecture and laboratory.

Let's look at a specific case: the first-year class in a medical school has arrived at the study of the accessory glands of the digestive tube. Today's organ is the liver. Students sit around lab tables, some of which contain prosected cadavers with the liver exposed in situ while other tables contain whole livers or livers still connected to the small intestine. Each student plugs their laptop computer into the wall receptacles.

Once in the LAN, the student can call up a multimedia textbook of gross anatomy, a video disk of 30,000 color histology photomicrographs, a series of abdominal radiograms, electron micrographs of liver tissue, a videotape of a patient with liver disease, the patient's laboratory test results, a video disk of pathological photomicrographs, EMs or X-rays and taped comments by various physicians and professors on liver topics. All of this while examining real livers in the laboratory.