As medical school curriculums shift emphasis in teaching from lecture formats to the use of computer-based resources to promote self-directed learning, medical librarians must cope with dramatic changes in the types of materials students require and in the use of the collections. They also need to reevaluate their role as information managers in light of the differences in the way new material is being accessed by users, This paper describes the integration of multimedia courseware into a traditional medical audiovisual library collection and how these changes ore affecting our collection polities and our relationships with users. Since many formats we consider ''traditional'' are now being replaced by integrated networked products, the consequences for libraries are far-reaching, for example, electronic textbooks and videodiscs which reside on computer workstations eliminate the need for the library to lend this material. Students who purchase their own programs or who own computers have less need to visit libraries when they tan access collection information via a modem or use material that they own, librarians need to discover new ways to deal with these dramatic shifts in the use of collections, and need to ask hard questions about the future of the audiovisual center, The paper concludes by offering glimpses into media renters of the 21st century and job descriptions of future information specialists.