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This report is the proceedings of a 2003 symposium on "Electronic Scientific, Technical, and Medical Journal Publishing and Its Implications," which brought together experts in STM publishing, both producers and users of these publications, to: (1) identify the recent technical changes in publishing, and other factors, that influence the decisions of journal publishers to produce journals electronically; (2) identify the needs of the scientific, engineering, and medical community as users of journals, whether electronic or printed; (3) discuss the responses of not-for-profit and commercial STM publishers and of other stakeholders in the STM community to the opportunities and challenges posed by the shift to electronic publishing; and (4) examine the spectrum of proposals that has been put forth to respond to the needs of users as the publishing industry shifts to electronic information production and dissemination.