Headquarters Medford\/Somerville, Mass.Core Business EducationStudent enrollment 8,500Faculty 4,000URL www.tufts.eduEthel Bullitt had a severe case of medical student amnesia. After two years of cramming her brain with thousands of new biomedical terms, images of cells, symptoms of diseases and drug interactions, her memory had turned to mush. In a few days, the 25-year-old Tufts University medical student would have to report to her first clinical rotation in surgery. Her worst fear: forgetting everything she\u2019d ever learned.Bullitt began second-guessing herself: What is the proper way to listen to a patient\u2019s heart and lungs? What are the proper steps in examining the knee? So before she ever stepped into a teaching hospital, Bullitt went to her school\u2019s website and logged on to the Health Sciences Database\u2014a virtual medical student\u2019s brain containing lectures, lab slides, anatomy illustrations and her own notes\u2014and reviewed physical diagnosis procedures. "It\u2019s great to be able to have this kind of backup when you\u2019re feeling a little shaky, because surgery rotation is a grueling experience," she says. "You have to determine how the patient is doing, and you need to be sure you are right. The surgeons are basing some of their decisions on what you tell them."Bullitt\u2019s experience is one example of how the Health Sciences Database is transforming the way Tufts trains physicians, dentists and veterinarians. No other medical school in the country\u2014and Tufts University School of Medicine in Boston is among the top-ranked\u2014has created this kind of KM system for students and faculty. Tufts credits the system with helping students to master course material more easily, keeping the curriculum up-to-date and increasing organizational efficiency. The system is becoming a national model for medical education. Not only did Tufts put together a model system, it did so at a time when medical schools and teaching hospitals face tremendous pressures. The demands of managed care have squeezed faculty time. Declining insurance reimbursements for patient care services have cut into revenue. And federal and state funding for treatment and research has diminished. Yet the system evolved in a culture of innovation and creativity at Tufts that stayed focused on continually improving education. "The challenge now is for IT to provide the tools to develop a potentially more effective model for educating medical students," says Bruce Metz, vice president of information technology at Tufts.CIO awarded Tufts a 2001 Enterprise Value Award because its contribution to medicine far exceeds mere financial return on investment. "Educational institutions need role models, and Tufts is one," says John Glaser, vice president and CIO at Partners HealthCare System in Boston, one of this year\u2019s judges. "In training physicians and health-care professionals in a complex, volatile industry that is less amenable to time restraints, managing and keeping course material current and integrated is crucial. Tufts has taken on a very messy educational challenge, done an extraordinary job of sizing up that challenge and is doing some pioneering work."Down from the Ivory TowerCall Elizabeth Eaton a pioneer, but she prides herself on being a pragmatist. The director of Tufts\u2019 health sciences library learned in the late 1980s of a new project by the American Association of Medical Colleges (AAMC) in Washington, D.C., and the U.S. National Library of Medicine (NLM) in Bethesda, Md., to explore the use of technology in library information management at medical schools. Her mission: to get Tufts\u2019 foot in the door. The project meant obtaining the backing of two of the nation\u2019s most powerful medical organizations. It also meant money\u2014big money. Eaton wanted Tufts to stake its claim to the hundreds of thousands of dollars in NLM grants.Eaton got what she was after. Tufts received its first $241,000 grant in 1990. The medical school also chipped in startup funds. To decide how to use the money, she convened a planning team, including members from the health sciences library, the educational dean\u2019s office, IS and administration. The team held a marathon of more than three dozen focus-group sessions with faculty and students to find out how technology could help them teach and learn. From the long wish list, one item leapt out: a library of digital images of laboratory slides that faculty use to teach students how to identify cells, tissues and microorganisms.Each semester, demand for these slides created chaos, especially just before exams, when hundreds of students would descend on the library to view the only two slide carousels that the university could afford to create. Faculty members were also distraught because over the years many slides\u2014some of them rare and more than a century old\u2014had been destroyed, misfiled or had disappeared from the library altogether. The decision was unanimous: They would build a digital image library. The team chose to use database technology to build the system\u2014a decision that would prove to be prescient. "One of the most important things that we did was think database in terms of organizing the information," Eaton says. "Of course, librarians have been thinking that way for a hundred years, so it\u2019s not hard to understand how we got to that point. But a lot of schools didn\u2019t do that."Choosing the right technology wasn\u2019t Tufts\u2019 biggest challenge. The greatest hurdle was changing organizational culture. When asked for her opinion about the database, Mary Y. Lee, a physician and the medical school\u2019s dean of educational affairs, told Eaton, "The students will not use the system unless it\u2019s connected to the curriculum." Eaton now had doctor\u2019s orders: create content, content, content. And there was plenty of content to be had. In Lee\u2019s office suite towers a 6-foot-high by 4-foot-wide bookshelf, crammed end to end with three-ring binders stuffed with course materials for the first two years of medical school. The keepers of this information trove? The faculty. Handing over their slides to be digitized was one thing, but turning over their course materials was another. "Initially we had a lot of faculty\u2014screaming is too strong a word, but close to screaming at me\u2014saying that I was going to replace them," Lee says. "I was ruining medical education by replacing them with machines." Winning faculty buy-in took a tag-team effort. Lee reassured faculty the system was not intended to replace traditional medical education methods. Metz explained how IT could help alleviate larger economic pressures facing Tufts by reducing costs and increasing efficiency. But Metz closed the deal by telling them the system could improve their effectiveness in the classroom. "In higher education, people have been teaching the same way for centuries," he says. "The truth is that they\u2019ve been doing it very well. But to point out that a new model of education can work with a higher level of quality\u2014that gets people\u2019s attention." The team found instructors who had been using the Internet since its early days and were eager to put their material online. Then, other faculty wanted to try the system too. Soon instructors began collaborating to create and integrate course content. "Initially, we had some very strong opponents who became extremely strong proponents after they started using it," Lee says.When the site made its debut in September 1997, students raved to their instructors about having around-the-clock access to course material on the Web. "The great thing was being able to look at the slides at home," says Bullitt, who lives 20 miles from the downtown Boston campus. Using the website as a personal knowledge management system, she organized her course materials into her own folders and made frequent electronic notes. "It\u2019s like having an annotated textbook that I could use anywhere, anytime," she says.In a sort of collective "aha!" faculty and students realized that the system could do much more than digitally duplicate textbooks and lab slides. Ideas for new applications and features snowballed. Eaton\u2019s development team worked nonstop to keep up with requests to put content online, including post-course evaluations by students and class schedules. Despite the momentum\u2014and more grants\u2014the development team recognized that the system could not survive indefinitely on grants alone. So in 1999, the team began drumming up support from Tufts\u2019 veterinary and dental schools, adding some of their course materials to the database as a trial and proposing a budget in which all three schools would support the system.Today, the system contains approximately 70 percent of the medical school curriculum and a smaller percentage of veterinary and dental school courses. It has evolved from a simple digital image library to a knowledge management system that integrates complex layers and levels of medical information across many disciplines. "It\u2019s more than just throwing a bunch of images into a file," says Richard Jakowski, a professor at Tufts\u2019 veterinary school. "You have to integrate them with text, put them in the right spot and make them mean something. Otherwise, you\u2019re getting a pop when you can make an atomic bomb." A Big Bang for EducationTalk about a KM explosion at Tufts. Although there is little quantitative evidence so far that the system is directly improving students\u2019 comprehension or increasing exam scores, anecdotal evidence abounds that the project is creating value. Lee says students report they\u2019re learning material faster and more easily. Faculty say that lectures have become more interactive. The system also seems to be transforming traditional, didactic medical education at Tufts into a model of self-directed study more common in other graduate school programs. "That\u2019s what\u2019s so exciting about this," says Anthony Schwartz, associate dean for academic and outreach programs at the veterinary school. "Students learn best when you provide them with this kind of structure\u2014with links to where you would like them to go\u2014and then turn them loose. They\u2019re not only going to learn what they need to get through school, but they\u2019re going to explore areas they couldn\u2019t otherwise."Tufts is the only health sciences school in the country that has integrated its curricula so that students can transcend course-, discipline- and profession-specific boundaries. "The interdisciplinary implications of this system are very powerful," Schwartz says. For example, medical students studying salmonella in humans can link to veterinary school material to learn about the source of the bacteria, its effect on chickens and cattle, ways it is transmitted to humans, prevention and treatment. "These kinds of concepts can be taught not by new courses, but by cross-disciplinary linkages so that students have a direct understanding," he adds.More than 100,000 connections between courses and atoms of content within the system help students understand. Because the data is entered in Lego-block-like chunks, changing or updating course material is much easier than manually re-creating entire courses on paper. "If you\u2019re teaching Shakespeare, you don\u2019t have to worry about Shakespeare becoming obsolete," Metz says. "But medical and science [information] could have a short half-life, so that when it\u2019s time to update course material, it makes sense to do so in a modular, digital form." The beauty of the database is its flexibility, says Lee. "The model allows you to take chunks of information, manipulate it, reuse it and put it together in a way that suits your own unique needs. I think that\u2019s what\u2019s going to be so attractive to other schools."Dozens of universities from as far away as South Africa have visited Tufts to see demonstrations of the system and its potential applications for medical education. The AAMC is exploring the idea of creating a national database of health sciences information, which would be available to all U.S. medical schools, based on Tufts\u2019 system. "It doesn\u2019t make any sense to have every medical school in the country replicate this," says Dr. Michael E. Whitcomb, senior vice president of the division of medical education, AAMC. "If we could develop something that all medical schools could use, it would be a tremendous advantage." Eaton, Lee and Metz are thrilled that what began as a grassroots effort may benefit not only Tufts, but also the greater scientific community. "Part of our mission is to go beyond what we do on our campus and to make a contribution to the world," says Metz. "So we\u2019re very committed to the beginnings of a movement to use the system as a national model. It\u2019s part of what our mission is about."Bullitt, who is in the middle of a clinical rotation in adult internal medicine this semester, continues to rely on the Health Sciences Database website for long-distance learning\u2014and to cure any future spells of medical student amnesia. Even after she graduates in 2002, she and other Tufts graduates can continue to use the system if they are staff members at any of Tufts\u2019 affiliated institutions. One of the most important lessons she has learned at Tufts, she says, is how to use technology as a tool to continue her education\u2014a lifelong task for medical professionals. "That\u2019s the world we live in," she says. "You take what you\u2019ve learned from your education and constantly add to it, and it\u2019s nice to build that habit now. This system isn\u2019t going to be a textbook I\u2019m going to throw out in a couple of years because it\u2019s no longer accurate. It\u2019s always evolving."