1. The M.D. Thesis at Yale A tradition dating from 1839 1839 graduates presented dissertations on such subjects as dysentery, chlorosis, the color of the skin, and epilepsy, and one future psychiatrist wrote on ”Hope as a Remedial Agent."

2. 1840-1920 The 19 th century history of the Yale Medical thesis was characterized as a well- intentioned strategy to keep students away from non-academic distractions, an academic formality without methodological requirements. It was customary at the turn of the century for medical students to pose with the body they were dissecting. This photograph was taken in March 1899 by William Blackwood, the janitor. See full exhibit Medicine at Yale 1701-1901 at http://info.med.yale.edu/library/exhibits/yalemed1/

3. Sink or Swim? See full exhibit Medicine at Yale 1901-1951 at http://info.med.yale.edu/library/exhibits/yalemed2/

4. The Yale System (1925-) Milton C. Winternitz, Dean 1920-1935 Medical students were to be treated like graduate students, given freedom and responsibility to succeed in their education. Required course examinations and comparative grading were eliminated. Course requirements were made flexible and space was carved out in the curriculum to carry out original thesis research and to take electives.

5. The M.D. Thesis Requirement All students at Yale University School of Medicine engage in research during medical school. Students may choose laboratory, clinical, epidemiology, or history of medicine topics. Publications in the literature may serve as the source of data for research. There must be a specific hypothesis that can be supported or rejected by new data that are generated by the student. Each student works closely with a faculty research mentor.

6. Theses in the Yale Medical Library Traditionally, the medical library has received one printed, bound copy of each student thesis. Each thesis is then cataloged and shelved within locked stacks in the library. The library stopped doing subject analysis on each thesis. All theses written between 1900 and 1974 are shelved in a facility about one mile from the medical library.

7. Y2K: The Era of Obsolescence? Print theses were hidden, inaccessible, and overlooked. As widespread electronic journal access has reduced the perceived need to visit the library, locked shelving and skeletal cataloging was rapidly relegating usage to an unprecedented level of insignificance.

8. Improving Subject Access to Print Theses: THESISweb Harvest thesis bibliographic records from the online catalog, using Endnote  Digitize abstracts from print theses, using OCR software Add abstract to Endote record Provide access to enhanced endnote files, using Reference Web Poster  http://thesis.med.yale.edu/

9. THESISweb: Benefits Access to more subject and study design data Endnote records can be exported into user libraries (such as the Director of Student Research) “Natural Sunset”: Thesis abstracts can be copied back into OPAC records at any point- a natural retirement point for THESISweb.

10. ETD: Electronic Theses and Dissertations Fate provided an opportunity to attend ETD2000. I began to view the THESISweb project as not an end in itself but a prefatory step in an eventual proposal for moving the full text of theses into the ETD era. http://www.ndltd.org/

11. Spring 2002: A Modest Proposal Initiated a dialogue with the Director of Office of Student Research, Dr. John Forrest Jr., in order to share my prediction of print thesis obsolescence. Agreement that a student thesis is part of an increasingly interconnected world of scientific knowledge, a potential source of inspiration, methodology, and insight for future researchers and students. http://www.med.yale.edu/facres/

12. Concern: “ Ingelfinger thinking” In the late 1960’s, under the editorship of Franz Ingelfinger, the New England Journal of Medicine(NEJM) adopted an editorial policy of declining to review or publish research that had been previously published elsewhere, in theory seeking to protect the health of the public from non-peer reviewed research news prematurely distributed to the popular press. (Not to mention self- interest of maintaining a competitive publication advantage) Other biomedical journals followed the lead of the NEJM Why would any medical student or advisor intending to submit their research to a prestigious journal risk a rejection because of a prior ETD edition?

13. Think Different A thesis is not a research paper. Open archiving initiatives such as the NIH PubMed Central archive. ETD software can suppress access to the electronic thesis for a specified time period or limit access to the institutional campus. Some journals grant alternative access immediately on publication (e.g. Science : “We allow posting of manuscript copies of papers at not-for-profit publicly funded World Wide Web archives immediately upon publication.” ) http://www.sciencemag.org/feature/contribinfo/faq/prioronline_faq.shtml)

14. Proposal Succeeds! With assurance that reasonable publishing delays and controls could be implemented, Dr. Forrest approved an immediate request for student voluntary participation in the Yale Medicine Thesis Digital Library (YMTDL) project in March 2002, less than two months before the spring thesis submission deadline. The Director of Student Research and the Head Reference Librarian would co-direct the project in its pilot implementation stage.

15. First Steps (Spring 2002) Given the ingrained thesis submission routine for students, faculty mentors, and the Office of Student Research, there was no consideration of altering the actual submission and review process at the last minute. The “shock of the new” ETD format would be considerable at a Medical School with much reverence for both history and paper. Yet it would be necessary to collect some true examples of theses for digital conversion at this moment or expect to wait at least a year for the next thesis submission season.

16. Immediate Action Twelve students, or about 15% of the graduating class responded by filling out and submitting a participation form Manuscripts in word processing format were eventually received from 8 students. The participation form was modeled on the ETD project at Virginia Polytechnic Institute and State University (Virginia Tech). The low percentage of response was nevertheless considered significant, in that the status of the project at the moment of submission was primitive, consisting mainly of good intentions, version one of a participation form, and an FAQ on the web.

17. Post-graduation Action 2002 Official certification of the participation form by the Office of the Yale General Counsel for the University. Received permission from the Yale Library AUL for Technical Services to join NDLTD International collaboration at a time when Yale was eager to expand its international profile. Membership provided use of the ETD software from Virginia Tech. Yale Library membership would avoid delay. Medical student theses are unique enough to receive consideration independent of other dissertation treatment on campus.

18. YMTDL Server/Web Implementation In late October 2002, Information Technology Services-Medicine (ITS-Med) system administrator Arthur Belanger installed the Virginia Tech ETD software on a secure server. I proceeded to convert student word processing manuscripts into PDF format and upload records. The Medical Library webmaster, Gillian Goldsmith Mayman, proceeded to create a prototype public interface that possessed visual synergy with a recent comprehensive web redesign.

19. Public Debut The public announcement of YMTDL was issued in late February, 2003. Completing the work necessary for the public debut in time for the School of Medicine graduating class of 2003 participation was an important step in “making it real.” http://ymtdl.med.yale.edu/

20. Improving Student Participation in YMTDL Publicity was simplified and made more attractive. During library education activities with 4 th year medical students, the YMTDL project was mentioned. Posters were also conspicuously placed in student mailboxes, campus bulletin boards, and near Medical Library computer labs where students normally work on the final version of their thesis.

21. Wanted: Class of 2003 MD Theses Starting with the School of Medicine graduating class of 2002, the Medical Library and Office of Student Research began a collaboration to publish electronically the full text of student theses on the Internet as a valuable byproduct of student research efforts. http://ymtdl.med.yale.edu/ Why is this important? Print research is increasingly ignored. Your thesis should be part of the internet- connected world of scientific knowledge, a potential source of inspiration, methodology, and insight for future researchers and students. At Yale, or anywhere.  You keep your copyright. We seek your non- exclusive permission to host an electronic copy at Yale.  This should not interfere with your journal publication efforts. YMTDL offers students up to a three-year delay in the electronic release of the copy of your thesis; or access can be permanently restricted to the Yale campus.  Your thesis has a permanent internet home (URL). Add the link to your CV, publications, or send it to your parents.  Your participation can be updated in the future, either by you or a designated "proxy." Please Note: OK, I want to participate. What do I do?  Fill out the attached permission form, and have your mentor or thesis department chair sign the form. The form is also available on the YMTDL web site in the FAQ section.  Turn in the form, accompanied by a disk or CD with your final thesis word processing document. Other files are welcomed as well. The Office of Student Research or Charlie Greenberg  in the Medical Library can receive the form and materials.  If you have questions, check out the full FAQ document on the YMTDL web site. You can also speak to Mr. Greenberg , who is in charge of mounting your thesis on the YMTDL web site.